Prevalence of untreated prediabetes and glucose metabolism disturbances in Mexico: An analysis of nationally representative surveys spanning 2016-2021

Abstract

OBJECTIVE: Characterizing prediabetes phenotypes may be useful in guiding diabetes prevention efforts; however, heterogeneous criteria to define prediabetes have led to inconsistent prevalence estimates, particularly in low- and middle-income countries. We estimated trends in untreated prediabetes prevalence in Mexico across different definitions and its association with prevalent cardiometabolic conditions. METHODS: We conducted a serial cross-sectional analysis of National Health and Nutrition Surveys in Mexico (2016-2021), totaling 21,442 Mexican adults, excluding individuals with diagnosed or undiagnosed diabetes. Prediabetes was defined using ADA (impaired fasting glucose [IFG] 100-125 mg/dL and/or HbA1c 5.7-6.4%), WHO (IFG 110-125 mg/dL), and IEC criteria (HbA1c 6.0-6.4%). Prevalence trends of prediabetes over time were evaluated using Poisson regression and its association with prevalent cardiometabolic conditions with logistic regression. RESULTS: Prevalence of prediabetes in Mexico in 2021 was 27.3%. Despite an overall downward trend in prediabetes (RR 0.960, 95%CI 0.940-0.979), this decrease was primarily driven by decreases in prediabetes by ADA-IFG (RR 0.883, 95%CI 0.861-0.907) and WHO-IFG criteria (RR 0.878, 95%CI 0.838-0.921), while prediabetes by ADA-HbA1c (RR 1.049, 95%CI 1.022-1.077) and IEC-HbA1C criteria (RR 1.064, 95%CI 1.014-1.115) increased over time. Prediabetes prevalence increased over time in adults >40 years, individuals with central obesity, self-identified as indigenous or living in urban areas. Regardless of the definition, prediabetes was associated with increased risk of cardiometabolic conditions. CONCLUSIONS: Prediabetes rates in Mexico from 2016-2021 varied based on defining criteria but consistently increased for HbA1c-based definitions and high-risk subgroups. Regardless of the definition, prediabetes clusters subjects with high cardiometabolic risk.