The burden of prediabetes in low- and middle-income countries: a systematic review and meta-analysis

The global burden of diabetes is rising sharply, with a significant proportion of cases emerging in low- and middle-income countries (LMICs). Prediabetes, a condition characterized by elevated blood glucose levels that do not yet meet the threshold for diabetes, serves as a crucial stage for intervention and prevention. Despite its importance, comprehensive data on prediabetes prevalence in LMICs are sparse. Thus, we conducted a systematic review and meta-analysis to ascertain the prevalence of prediabetes in LMICs. We systematically reviewed studies on prediabetes in Low- and Middle-Income Countries (LMICs) from 1^st January 2003 and 31^st July 2024 using PubMed, Scopus, and Web of Science databases. The NIH study quality assessment tool assessed bias, and pooled prevalence was determined via a random-effects model. We examined publication bias through funnel plot analysis and Begg's and Egger's tests. The prevalence of prediabetes estimated from 164 studies conducted in LMICs was 13.1% (95% CI: 11.7%, 14.5%) based on the World Health Organization (WHO) criteria, and 27.0% (95% CI: 24.5%, 29.5%) based on the American Diabetes Association (ADA) criteria. The pooled prevalence did not significantly differ between males and females for both diagnostic criterias and by study design. The analysis indicated a noteworthy degree of heterogeneity in the pooled estimates (I2 > 70%; p < 0.05). The findings from this study indicated a higher burden of prediabetes within LMICs with regional variations.