Vascular phenotyping in diabetes research in sub-saharan Africa: A neglected priority with high translational value

The burden of diabetes in sub-Saharan Africa (SSA) is rising faster than in any other region of the world, with affected individuals at a substantially higher risk of developing microvascular and macrovascular complications. Existing evidence indicates that sub-Saharan Africans with diabetes living in SSA experience higher rates of vascular complications compared with their counterparts in high-income settings; studies exploring the biological basis of this remain very limited, as the majority of diabetes research in SSA is limited to descriptive epidemiology. There is minimal incorporation of recommended vascular phenotyping tools, including assessments of arterial stiffness, arterial occlusion, endothelial function, and microvascular function. This limits mechanistic understanding, undermines vascular risk stratification, and constrains translation into effective patient management strategies. This viewpoint advocates for the prioritization of vascular phenotyping within sub-Saharan African diabetes research. Sequentially, the article outlines the differential burden of diabetes-related vascular complications in sub-Saharan Africans living on the continent, current epidemiological gaps, the potential role of vascular phenotyping in improving clinical outcomes and health systems and proposes pragmatic steps in integrating vascular phenotyping into existing research in SSA. Many tools for vascular phenotyping are increasingly becoming affordable, portable, and automated. Given its feasibility, integrating vascular phenotyping into diabetes research in SSA should therefore be treated as an urgent priority rather than a future aspiration, given its clear benefits, including deeper insight into disease mechanisms, more precise targeting of care, and findings with global relevance. What is required now is a deliberate shift in priorities.