Dynamics impact, and feasibility of self-monitoring of blood glucose in the rural resource-constrained setting of Western Kenya

Abstract

here has been considerable concern regarding the rapidly growing prevalence of diabetes, particularly in resource-rich settings as a result of the shift toward more sedentary lifestyles that occurs with calorie-rich diets (1). Although much of the global attention to diabetes has focused on resource-rich settings and emerging markets, the diabetes ep- idemic has also been expanding in resource-constrained settings such as sub-Saharan Africa (2). Estimates from the International Diabetes Federation suggest that the preva- lence of diabetes is expected to in- crease by 98% in sub-Saharan Africa by 2030, in contrast to an expected 54% increase in the rest of the world (3). Furthermore, there is an alarm- ingly high mortality rate attributable to diabetes in sub-Saharan Africa compared with all other parts of the world, with 76.4% of diabetes-related deaths occurring in people <60 years of age (4). Despite these disturbing trends, there has been little effort to address this growing burden. Currently, most funding for international health care development focuses on communi- cable diseases, especially HIV and tuberculosis (5). However, the infra- structure that has been established to manage chronic infectious dis- eases such as HIV can be adapted to address many other chronic diseases, including diabetes (6–8).