In Africa, where healthcare resources are often limited, managing the dual challenges of diabetes and HIV is crucial to improving population health and well-being. People living with HIV are at a higher risk of developing diabetes, often due to the long-term use of antiretroviral therapy (ART), which, while lifesaving, can have side-effects that increase susceptibility to other health conditions. As World Diabetes Day highlights the importance of comprehensive diabetes care that supports well-being, the META Trial is shedding light on an innovative approach to diabetes prevention in this high-risk population. This groundbreaking study, the largest trial of metformin conducted in Africa, aims to identify a low-cost intervention that can prevent or delay diabetes in people living with HIV and pre-diabetes who are on ART.
With this year’s World Diabetes Day theme emphasising that everyone with diabetes deserves the chance to live well, the META Trial suggests a new paradigm for African healthcare. By focusing on prevention rather than only treatment, this trial represents a proactive approach to addressing the rising diabetes burden in Africa and aligns with the broader goal of making comprehensive diabetes care accessible to all.
Why HIV and diabetes care are interconnected
As ART has extended life expectancy for people living with HIV, many are now living long enough to face additional health challenges, including diabetes. ART, while highly effective at controlling HIV, can lead to insulin resistance and weight gain, both of which increase the risk of developing diabetes. In countries like Tanzania—ranked among the top five countries in Africa for the number of people living with diabetes between the ages of 20 and 79—this is a significant public health issue. The META Trial is designed to address this by focusing on the prevention of diabetes in a vulnerable group that is currently underserved in diabetes care.
The trial aims to determine if metformin, a widely used and affordable diabetes medication, can delay or prevent the onset of diabetes in people with HIV, who are already at high risk. Metformin has been shown to delay progression to diabetes in studies conducted in North America, China and India. The effects of metformin on glycaemia in pre-diabetes in African persons, including those who are living with HIV, have not been quantified. Should this intervention prove effective, it could offer a scalable, low-cost solution that would be a game-changer for diabetes prevention across the continent.
Prevention as a path to well-being
One of the core messages of World Diabetes Day is that people with diabetes should be able to live well. This means that beyond medical treatment, there should be a focus on supporting well-being in all its dimensions. Currently, diabetes care often lacks sufficient support for mental, emotional, and social well-being. For individuals in Africa, where diabetes-related health expenditure is among the lowest in the world, the cost of care can be prohibitive, leaving many without the resources to manage their condition effectively.
“According to the World Health Organization Integrated African Health Observatory, Africa (=International Diabetes Federation African region) had the second lowest diabetes-related expenditure (US $13 billion), accounting for 1% of global diabetes-related expenditure.”
The META Trial’s preventative approach offers a unique contribution to well-being. By focusing on stopping the disease before it starts, the trial supports a better quality of life for those at risk. Preventing diabetes also reduces the healthcare burden on individuals and families, who would otherwise face long-term expenses for diabetes treatment, monitoring, and complications. In this way, prevention directly enhances well-being by allowing people to avoid the physical, financial, and emotional toll of a chronic disease.
The Potential Global Impact of the META Trial
The insights gained from the META Trial could have far-reaching implications for diabetes care worldwide, especially in low-resource settings. If successful, this trial will provide globally relevant evidence that metformin can be used to prevent diabetes in a high-risk population. This would reinforce the importance of prevention as a component of comprehensive care.
In addition to examining metformin’s effectiveness, the META Trial will compare diagnostic methods, and study complications related to HIV and diabetes. These ancillary studies will provide valuable data for improving diabetes screening and diagnosis, not just for individuals living with HIV and pre-diabetes, but for the broader population as well.
Lighting the Path Forward
The META Trial’s slogan, “Lighting the path forward,” reflects its commitment to uncovering new knowledge that can transform care, particularly for vulnerable populations living with pre-diabetes. As World Diabetes Day reminds us, supporting the well-being of people at risk for or living with diabetes requires comprehensive, accessible health systems. By focusing on prevention, the META Trial is helping pave a way forward that could lead to better health outcomes and a better quality of life for many in Tanzania and beyond.