{"title":"Strengthening diabetes care in sub-Saharan Africa: health systems, digital innovations, lifestyle interventions, and socioeconomic dimensions","authors":"Shabana Cassambai, Pamela Godia, Silver Bahendeka, Damilola Omodara, Deborah Ikhile, Samuel Seidu, Kamlesh Khunti","doi":"10.1016/s2213-8587(26)00035-5","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00035-5","url":null,"abstract":"The prevalence of diabetes, particularly type 2, in sub-Saharan Africa is rising at an alarming rate. This surge has exposed deep structural challenges, including an over-reliance on hospital-based services and strong cultural and faith-based influences that shape health-seeking behaviours. These factors, combined with socioeconomic inequalities and urbanisation, contribute to poor glycaemic control. Several strategies have been proposed to tackle this problem, including task shifting, integrated models that make use of HIV care infrastructure, digital health tools such as SMS reminders, culturally adapted lifestyle and nutrition programmes, community-based and faith-based interventions, and public–private partnerships. Despite these promising approaches, evidence of long-term sustainability, scalability, cost-effectiveness, and the impact of these interventions remains scarce. Additionally, stigma, gender-related barriers, and patient-reported outcomes are insufficiently studied in sub-Saharan Africa. Large-scale, longitudinal research is urgently needed to assess health system strengthening and culturally grounded models. Achieving effective diabetes care will require resilient, inclusive systems that integrate clinical, community, and digital innovations within the sociocultural and economic realities of the region.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"22 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deborah Ikhile, Samuel Seidu, Damilola Omodara, Jean Claude Katte, Kaushik Ramaiya, Kamlesh Khunti
{"title":"Diabetes-related complications and multiple long-term conditions in sub-Saharan Africa: determinants and management strategies","authors":"Deborah Ikhile, Samuel Seidu, Damilola Omodara, Jean Claude Katte, Kaushik Ramaiya, Kamlesh Khunti","doi":"10.1016/s2213-8587(26)00036-7","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00036-7","url":null,"abstract":"Saharan Africa is experiencing a rapid increase in the burden of diabetes, accompanied by increasing rates of microvascular, macrovascular, and pregnancy-related complications. This Series paper synthesises current evidence on diabetes-related complications in sub-Saharan Africa and examines shared cardiometabolic risks, mental health comorbidities, and interactions with communicable diseases through a multiple long-term conditions lens. Widespread late diagnosis and inadequate control of key cardiometabolic risk factors (eg, hypertension, dyslipidaemia, obesity, and hyperglycaemia) drive high complication rates—whereas mental health disorders and infectious disease comorbidities further exacerbate susceptibility. Although risk factor reduction is central to preventing diabetes complications in sub-Saharan Africa, progress is impeded by multilevel barriers spanning individual, interpersonal, health system, societal, and policy domains. To address this growing complexity, we identify priorities for research and implementation, including the development of context-specific guidelines, scalable integrated care models, strengthened surveillance systems, and long-term cohorts co-designed with communities, health-care providers, and policy makers.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"11 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147751559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammed K Ali, Rodrigo M Carillo-Larco, Troels Krarup Hansen, Nikhil Tandon, Martin Ridderstråle
{"title":"A conceptual framework for modernising and right-sizing global diabetes care","authors":"Mohammed K Ali, Rodrigo M Carillo-Larco, Troels Krarup Hansen, Nikhil Tandon, Martin Ridderstråle","doi":"10.1016/s2213-8587(26)00070-7","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00070-7","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"9 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147725921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"What REDEFINE 5 signals for obesity trials in Asia and beyond","authors":"Yu Mi Kang, Vanita R Aroda","doi":"10.1016/s2213-8587(26)00012-4","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00012-4","url":null,"abstract":"No Abstract","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"7 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147708650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Efficacy and safety of co-administered cagrilintide and semaglutide versus semaglutide alone in adults with overweight or obesity with or without type 2 diabetes in Japan and Taiwan (REDEFINE 5): a multicentre, randomised, active-controlled, phase 3a trial","authors":"Toshimasa Yamauchi, Niels-Peter Becker, Christoffer Andersen Hagemann, Kuo-Chin Huang, Arihiro Kiyosue, Soo Lim, Yukiko Onishi, Ananda Kosuvaripalli, Tomoko Takano, Yasushi Ishigaki","doi":"10.1016/s2213-8587(25)00402-4","DOIUrl":"https://doi.org/10.1016/s2213-8587(25)00402-4","url":null,"abstract":"<h3>Background</h3>The combination of cagrilintide and semaglutide has been shown in global studies to induce reductions in bodyweight. We assessed the efficacy and safety of a fixed-dose combination of cagrilintide 2·4 mg and semaglutide 2·4 mg versus semaglutide 2·4 mg for weight management in an east Asian population.<h3>Methods</h3>This double-blind, parallel-group, phase 3a trial (REDEFINE 5) was conducted across 21 sites (community, hospital) in Japan and one site in Taiwan. We included participants aged at least 18 years with a BMI of at least 27 kg/m<sup>2</sup> and at least two obesity-related complications, or with a BMI of at least 35 kg/m<sup>2</sup> and at least one obesity-related complication (per the Japan Society for the Study of Obesity guidelines), with or without type 2 diabetes. Participants were randomly assigned (1:1) to once-weekly subcutaneous injections of cagrilintide–semaglutide or semaglutide (both escalated to 2·4 mg), plus lifestyle intervention, for 68 weeks. Randomisation was done centrally using an interactive web response system and stratified according to planned CT scan, BMI of at least 35 kg/m<sup>2</sup>, and type 2 diabetes status. Participants, site staff, investigators, and study funder were all masked to active study treatments. The primary endpoint was relative change in bodyweight from baseline to week 68. Efficacy analyses were done in all participants who underwent randomisation, using the trial product estimand (ie, assuming the treatment was taken as intended, regardless of dose) as the primary estimand. Missing data at week 68 were imputed. Safety analyses were done in all participants who underwent randomisation and received at least one dose of trial product. This trial is registered with <span><span>ClinicalTrials.gov</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span> (<span><span>NCT05813925</span><svg aria-label=\"Opens in new window\" focusable=\"false\" height=\"20\" viewbox=\"0 0 8 8\"><path d=\"M1.12949 2.1072V1H7V6.85795H5.89111V2.90281L0.784057 8L0 7.21635L5.11902 2.1072H1.12949Z\"></path></svg></span>) and is complete.<h3>Findings</h3>Between April 3, 2023, and Sept 15, 2023, we screened 355 individuals; 331 were randomly assigned to cagrilintide–semaglutide (n=164) or semaglutide (n=167). 226 (68%) participants were male and 105 (32%) were female; 80 (24%) had type 2 diabetes. 17 (10%) participants discontinued cagrilintide–semaglutide and ten (6%) discontinued semaglutide. The estimated mean change in bodyweight from baseline to week 68 was −18·4% (SE 0·7) in the cagrilintide–semaglutide group versus −11·9% (0·7) in the semaglutide group (estimated treatment difference [ETD] −6·5 percentage points [95% CI −8·4 to −4·6]; p<0·0001). Adverse events were reported by 143 (87%) of 164 participants in the cagrilintide–semaglutide group and","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"224 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147708651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicholas Ken-Yoong Hee MBBS, Quan-Hziung Lim MBBS, Prof Kamlesh Khunti FMedSci, Ying-Guat Ooi MBBS, I-Weng Yen MD, Marniza Saad MD, Prof Elif I Ekinci PhD, Prof Hung-Yuan Li PhD, Prof Shireene R Vethakkan MD, Prof Juliana C N Chan MD, Prof Lee-Ling Lim PhD
{"title":"Secondary causes of diabetes: a crossroad of endocrinology and oncology","authors":"Nicholas Ken-Yoong Hee MBBS, Quan-Hziung Lim MBBS, Prof Kamlesh Khunti FMedSci, Ying-Guat Ooi MBBS, I-Weng Yen MD, Marniza Saad MD, Prof Elif I Ekinci PhD, Prof Hung-Yuan Li PhD, Prof Shireene R Vethakkan MD, Prof Juliana C N Chan MD, Prof Lee-Ling Lim PhD","doi":"10.1016/s2213-8587(26)00027-6","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00027-6","url":null,"abstract":"Cancer and diabetes share a bidirectional relationship, with cancer increasingly recognised as an associated factor of diabetes, both from the disease itself and its treatments. In this Review, we aim to: (1) summarise the distinct mechanisms of dysglycaemia arising from cancer and neuroendocrine tumour treatments, including targeted therapies such as PI3K–AKT–mTOR inhibitors, antibody–drug conjugates, immune checkpoint inhibitors, corticosteroids, and somatostatin receptor ligands; (2) examine the often overlooked aspect of the secondary cause of diabetes as an early manifestation of cancer; and (3) highlight research gaps and encourage a collaborative care approach to manage the rising rate of dysglycaemia as a result of cancer and its evolving treatments. To address the first two objectives, we incorporate relevant case vignettes to contextualise the discussions.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"130 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147681085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Low visceral fat and kidney disease risk in men with diabetes","authors":"Carmine Zoccali, Francesca Mallamaci","doi":"10.1016/s2213-8587(26)00045-8","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00045-8","url":null,"abstract":"","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"24 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147681082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juan Shi MD, Prof Dong Zhao MD, Jing Wang MD, Prof Yufan Wang MD, Qijuan Dong MD, Jiahang Hu MD, Prof Yubo Sha MD, Ying Peng MD, Yuancheng Dai MD, Qidong Zheng MD, Fengmei Xu MD, Haiyun Lan MD, Bangqun Ji MD, Prof Li Li MD, Prof Hongmei Qiu MD, Ranhua Jiang MD, Rong Tang MD, Prof Shen Qu MD, Liu Yang MD, Tingyu Ke MD, Sheli Li MD, Zhiyun Zhao MD, Prof Yifei Zhang MD, Prof Weiqing Wang MD, MMC and ChinaMAP Collaborative Group
{"title":"Sex-specific and BMI-specific associations between visceral fat and diabetic kidney disease in patients with diabetes: a large-scale multicentre prospective cohort study","authors":"Juan Shi MD, Prof Dong Zhao MD, Jing Wang MD, Prof Yufan Wang MD, Qijuan Dong MD, Jiahang Hu MD, Prof Yubo Sha MD, Ying Peng MD, Yuancheng Dai MD, Qidong Zheng MD, Fengmei Xu MD, Haiyun Lan MD, Bangqun Ji MD, Prof Li Li MD, Prof Hongmei Qiu MD, Ranhua Jiang MD, Rong Tang MD, Prof Shen Qu MD, Liu Yang MD, Tingyu Ke MD, Sheli Li MD, Zhiyun Zhao MD, Prof Yifei Zhang MD, Prof Weiqing Wang MD, MMC and ChinaMAP Collaborative Group","doi":"10.1016/s2213-8587(26)00001-x","DOIUrl":"https://doi.org/10.1016/s2213-8587(26)00001-x","url":null,"abstract":"There are few large-scale prospective studies on directly measured visceral fat area (VFA) and diabetic kidney disease, with inconsistent findings across sex and BMI. We aimed to investigate the association between VFA and incident diabetic kidney disease risk and to examine how this association differs by sex and BMI.","PeriodicalId":48790,"journal":{"name":"The Lancet Diabetes & Endocrinology","volume":"316 1","pages":""},"PeriodicalIF":44.5,"publicationDate":"2026-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147681084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}