Prevalence of microvascular and macrovascular complications of diabetes in newly diagnosed type 2 diabetes in low-and-middle-income countries: A systematic review and meta-analysis

Abstract

There is an excessive burden of diabetes complications in low-resource settings. We conducted a systematic review to determine the nature and frequency of diabetes complications in newly diagnosed with type 2 diabetes. A systematic search was performed using Medline, CINAHL and Global Health online databases from inception to July 2020. Articles reporting prevalence of microvascular or macrovascular complications within six months of type 2 diabetes diagnosis and published in English or French from low- and middle-income countries (LMICs) were eligible for analysis. Data were extracted using a standardized data extraction tool. Descriptive statistics were used to describe the prevalence of micro and macrovascular complications in newly diagnosed type 2 diabetes. Assessment of heterogeneity was conducted using the inconsistency index (I2) and Cochran-Q chi2 statistical tests. Publication bias was assessed by the Funnel plot and Egger test. A total of 3 292 records underwent title or abstract screening and 95 articles underwent full text review. Thirty-three studies describing 13 283 participants (aged 20 years and older) met the inclusion criteria. The eligible studies were from Asia (n = 24), Africa (n = 4), Oceania (n = 2), South America (n = 2) and the Caribbean (n = 1). For microvascular complications, the median prevalence (interquartile range) of retinopathy, nephropathy and neuropathy were 12% (6%-15%), 15% (7%-35%) and 16% (10%25%) respectively. For macrovascular complications, the median prevalence (interquartile range) was 10% (7%-17%) for ischaemic heart disease, 6% (1%-20%) for peripheral arterial disease and 2% (1%-4%) for stroke. There was evidence of substantial heterogeneity between studies for all outcomes (I2 > 90%. We found a high prevalence of complications in newly diagnosed type 2 diabetes in LMICs. Findings suggest that many people live with diabetes and are only diagnosed when they present with complications in LMICs. Research is needed to guide timely and effective identification of people living with diabetes in these settings.

The role of ncRNAs‐mediated pyroptosis in diabetes and its vascular complications

“…Long-term hyperglycemia can damage the cardiovascular system, resulting in vascular complications of diabetes (VCD) (i.e., microvascular complications and macrovascular complications). 3 Microvascular complications mainly include diabetic nephropathy (DN) and diabetic retinopathy (DR), 6,7 whereas macrovascular complications mainly include diabetic cardiomyopathy (DCM). A cross-sectional study reported that 12% of diabetic patients suffered from DR, 15% suffered from DN, and the median prevalence of macrovascular complications was lower than that of microvascular complications (about 10%).…”

“…However, the disability rate and case fatality rate of macrovascular complications were higher. 7 The potential molecular mechanisms of VDC include inflammation, inappropriate activation of oxidative stress, mitochondrial dysfunction, dyslipidemia, and thrombosis, which together promote metabolic disorder and further promote VCD. 8 Recent evidence has revealed that the abnormal release of extracellular vesicles and their carried noncoding RNAs (ncRNAs) also contribute to the development of VCD.…”

“…A cross‐sectional study reported that 12% of diabetic patients suffered from DR, 15% suffered from DN, and the median prevalence of macrovascular complications was lower than that of microvascular complications (about 10%). However, the disability rate and case fatality rate of macrovascular complications were higher 7 . The potential molecular mechanisms of VDC include inflammation, inappropriate activation of oxidative stress, mitochondrial dysfunction, dyslipidemia, and thrombosis, which together promote metabolic disorder and further promote VCD 8 .…”

Mechanism of action of Huangbaichen Sanwei formulation in treating T2DM based on network pharmacology and molecular docking

“…The burden caused by the multiple complications of DM on families and society has become increasingly serious. [1] Notably, the prevalence of T2DM in China is particularly high. A study has projected that by the year 2050, the age-standardized prevalence of DM worldwide would increase by > 2%.…”

Partial Synthetic PPARƳ Derivative Ameliorates Aorta Injury in Experimental Diabetic Rats Mediated by Activation of miR-126-5p Pi3k/AKT/PDK 1/mTOR Expression

“…Type 2 diabetes (T2D) is a worldwide concern that establishes a significant influence on patient mortality and morbidity [ 1 ], affecting about 463 million adult people aged 20–79 years [ 2 ], which is expected to increase by 51% to 700 million by 2045 [ 2 , 3 ]. T2D is characterized by peripheral insulin resistance [ 4 , 5 ], which diminishes glucose reuptake in skeletal muscle and adipose tissue, leads to defective hepatic glucose output, and impairs insulin production from pancreatic B-cells [ 6 , 7 ].…”