Prevalence and predictors of microvascular and macrovascular diabetes complications in adult Ugandans: a systematic review and meta-analysis

Abstract

Introduction There is a growing prevalence of diabetes and related chronic complications in Uganda. We conducted a systematic review and meta-analysis to document the prevalence and predictors of five microvascular and macrovascular diabetes complications in adult Ugandans with diabetes. Materials and Methods We searched Medline, EMBASE, CINAHL, Cochrane Library, and Africa Journal Online databases. We included studies on the prevalence and predictors of any chronic microvascular or macrovascular diabetes complications of interest. We conducted a random effect meta-analysis to determine the pooled prevalence of each diabetes complication. A narrative review was used to describe the significant predictors. Results A total of 20 studies involving 11,400 participants were included. The pooled mean (standard deviation) age of the participants was 54.8 (3.6) years, with the majority being female (pooled proportion of 61.1%, 95% confidence interval [CI] 57.1-65.2). For the microvascular diabetes complications, the pooled prevalence of diabetic neuropathy, retinopathy, and nephropathy was 56.8% (95% CI 44.9-68.7, I2 = 98.56%, p<0.001), 19.5% (95% CI 3.9-35.2, I2 = 99.60%, p<0.001), and 17.7% (95% CI 7.3-28.0, I2 = 99.36%, p<0.001), respectively. For the macrovascular diabetes complications, the pooled prevalence of peripheral arterial disease and diabetic foot disease was 32.2% (95% CI 15.8-48.7, I2 = 97.67%, p<0.001) and 5.5% (95% CI 1.7-9.2, I2= 90.22%, p<0.001), respectively. Hypertension comorbidity, physical inactivity, family history of diabetes, body mass index ≤30 kg/m2, and pregnancy were predictors of diabetic nephropathy in three studies. In two studies, a history of a foot ulcer and age >60 years were predictors of diabetic neuropathy while female sex, hypertension comorbidity, and use of glibenclamide were predictors of peripheral arterial disease. Discussion Chronic diabetes complications are very common in adult Ugandans with diabetes, especially diabetic neuropathy and peripheral arterial disease. Regular screening and optimal management of diabetes and its complications should be emphasised in Uganda.