Dr Chris Watson and Master Chisale reviewing MTIMA results in Mzuzu

It is currently estimated that 347 million people worldwide suffer from diabetes with more than 80% living in low and middle-income countries (LMIC). Sub-Saharan Africa will see a rise in incidence of diabetes from 12.1 million in 2010 to 23.9 million in 2030. Overall Africa will suffer an approximate relative increase of 81%, the largest in the world. Just like the developed world, 90% of diabetes patients in Sub-Saharan Africa have Type 2 diabetes (T2D)

The most common cause of death in people with T2D is cardiovascular disease. Cardiovascular disease is on the rise and it is estimated that the number of people with hypertension in Africa will increase by 68% from 75 million in 2008 to 126 million in 2025 . Numerous epidemiological studies are concordant over the fact that the risk of experiencing a Cardiovascular Disease (CVD) event in people with diabetes is two to four times greater than that among those without diabetes. A recent review demonstrated that in sub Saharan Africa coronary heart disease may affect 5% to 8% of type 2 diabetic patients and cardiomyopathy, up to 50% of all patients which is very different to patterns in Western countries.

The African continent is at a tipping point, where public health action must take place now in order to address the startling rise of diabetes and cardiovascular disease. Current efforts to diagnose and treat diabetic patients in Malawi are in a primal state. The HIV and TB pandemic have soaked up much of the resources and commitment of government and aid agencies over the past two decades. With that in mind, education and resources for diabetic prevention and treatment need to be developed and strengthened in order to prevent and treat T2D and its associated complications.

Managing Type 2 Diabetes in Malawi and Africa (MTIMA) will involve implementing a holistic approach to prevention and treatment of diabetes. It is based on Wagners Chronic Care Model and WHO Implementing Chronic Care model. The project will conduct low cost, culturally adapted diabetes prevention education interventions for community groups, self-management education for T2D patients, and clinical education for healthcare workers in particular enabling community health workers (CHW) to deliver basic effective diabetes care. It will deliver an electronic clinical decision support system to assist community and clinic health workers based on International Diabetic Federation (IDF) and Malawian Ministry of Health guidelines. This will be combined with standardised medication protocol to more effectively treat diabetes and its attendant cardiovascular risk.

MTIMA is a community based approach allowing decentralisation and deprofessionalisation of diabetes care. This will build on existing international guidelines and models for care of chronic illness and emerging evidence from high income countries to ensure greater access to prevention and treatment strategies for diabetes care in low and middle income countries.