Populations of African descent are at the forefront of the worldwide epidemic of type 2 diabetes mellitus (T2DM). The burden of T2DM is amplified by diagnosis after preventable complications of the disease have occurred. Earlier detection would result in a reduction in undiagnosed T2DM, more accurate statistics, more informed resource allocation and better health. An underappreciated factor contributing to undiagnosed T2DM in populations of African descent is that screening tests for hyperglycaemia, specifically, fasting plasma glucose and HbA_1c, perform sub-optimally in these populations. To offset this problem, combining tests or adding glycated albumin (a nonfasting marker of glycaemia), might be the way forward. However, differences in diet, exercise, BMI, environment, gene–environment interactions and the prevalence of sickle cell trait mean that neither diagnostic tests nor interventions will be uniformly effective in individuals of African, Caribbean or African-American descent. Among these three populations of African descent, intensive lifestyle interventions have been reported in only the African-American population, in which they have been found to provide effective primary prevention of T2DM but not secondary prevention. Owing to a lack of health literacy and poor glycaemic control in Africa and the Caribbean, customized lifestyle interventions might achieve both secondary and primary prevention. Overall, diagnosis and prevention of T2DM requires innovative strategies that are sensitive to the diversity that exists within populations of African descent.

非洲人后裔在全球2型糖尿病（T2DM）流行中处于最前沿。在发生可预防的疾病并发症后，通过诊断可以扩大T2DM的负担。尽早发现将减少未诊断的T2DM，更准确的统计信息，更明智的资源分配以及更好的健康状况。导致非洲裔后裔T2DM未被诊断的一个未得到充分认识的因素是高血糖症的筛查测试，特别是空腹血糖和HbA _1c，在这些总体中的效果不理想。为了解决这个问题，结合测试或添加糖化白蛋白（一种非空腹血糖指标）可能是解决问题的方法。然而，饮食，运动，BMI，环境，基因-环境相互作用以及镰状细胞性状的普遍性存在差异，这意味着诊断测试或干预措施对非洲，加勒比海裔或非裔美国人的个体均不能一律有效。在这三个非洲人后裔人群中，仅对非裔美国人人群进行过密集的生活方式干预的报道，已发现它们可提供有效的一级预防T2DM而不是二级预防。由于非洲和加勒比地区缺乏健康素养和血糖控制不佳，量身定制的生活方式干预措施可能同时实现二级和一级预防。总体而言，T2DM的诊断和预防需要创新的策略，这些策略必须对非洲人后裔中存在的多样性敏感。