Burden of Diabetes and Prediabetes in Nepal: A Systematic Review and Meta-Analysis

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Burden of Diabetes and Prediabetes in Nepal: A Systematic Review and Meta-Analysis Nipun Shrestha . Shiva Raj Mishra

. Saruna Ghimire .

Bishal Gyawali . Suresh Mehata

Received: April 29, 2020 Ó The Author(s) 2020

ABSTRACT Background: Unhealthy behaviors, such as energy-dense food choices and a sedentary lifestyle, both of which are established risk factors for diabetes, are common and increasing among Nepalese adults. Previous studies have reported a wide variation in the prevalence of prediabetes and diabetes in Nepal, and thus a more reliable Digital Features To view digital features for this article go to https://doi.org/10.6084/m9.figshare.12573050. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s13300020-00884-0) contains supplementary material, which is available to authorized users. N. Shrestha Institute for Health and Sport (IHeS), Victoria University, Melbourne, Australia S. R. Mishra (&) Nepal Development Society, Chitwan, Nepal e-mail: [email protected] S. Ghimire Department of Sociology and Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA B. Gyawali Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark S. Mehata Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal

pooled estimate is needed. Furthermore, Nepal underwent federalization in 2015, and the province-specific prevalence, which is necessary for the de novo provincial government to formulate local health policies, is lacking. This study aims to provide a comprehensive summary of the current literature on various aspects of diabetes in Nepal, i.e., the prevalence of prediabetes and diabetes as well as of the awareness, treatment, and control of diabetes in Nepal. Methods: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched three electronic databases— PubMed, Scopus, and Web of Science—using a comprehensive search strategy to identify eligible studies published up to April 2, 2020. Data on prevalence estimates of prediabetes and diabetes were extracted and pooled in a metaanalysis using a random effect model. Subgroup analyses and meta-regression were conducted to assess heterogeneity across the studies. The quality of included studies was assessed using the New Castle-Ottawa scale. Results: We included 14 eligible studies that comprised a total of 44,129 participants and 3517 diabetes cases. Half of the included studies had good quality. Overall, the prevalence of prediabetes and diabetes was 9.2% (95% CI 6.6–12.6%) and 8.5% (95% CI 6.9–10.4%), respectively. Among the participants with diabetes, only 52.7% (95% CI 41.7–63.4%) were aware of their diabetes status, and 45.3% (95%

Diabetes Ther

CI 31.6–59.8%) were taking antidiabetic medications. Nearly one-third of those under antidiabetic treatment (36.7%; 95% CI 21.3–53.3%) had their blood glucose under control. The prevalence of prediabetes and