In SSA, adult diabetes is now a major problem in some countries and in the next decade is anticipated to become one of the most challenging public health conditions throughout the region. Compared to other parts of the world, SSA currently has a low proportion of adults living with diabetes. However, this proportion is growing more quickly than in other regions due to population ageing including as a result of effective HIV treatment, as well as changes in diets and lifestyles13. Meanwhile, SSA has the highest mortality rate due to diabetes and the highest percentage of undiagnosed cases compared to other regions.
The colliding epidemics of communicable and non-communicable diseases in SSA mean that many adults are living with more than one diagnosis, often HIV, and managing co-morbidities. Diabetes is an example of the scenario where promotion of self-care and self-empowerment can be experienced by patients as treatment burden, and this burden potentially reduces their capacity to collaborate in their care14. Shippee et al’s (2012) cumulative complexity model suggests that increasing multimorbidity will have negative impacts on healthcare by creating an imbalance between the patient’s workload (care demands) and their capacity to address these demands.