Dessie Getenet, Mulugeta Henok, Amare Desalegne, Negesse Ayenew, Wagnew Fasil, Getaneh Temsgen, Endalamew Akililu, Adamu Yibeltal Wubale, Tadesse Gizachew, Workineh Aster, Lebu Sarah
Department of Nursing, School of Health Science, College of Medicine and Health Science, Bahr Dar University, Bahr Dar, Ethiopia.
Department of Nursing, College of Health Science, Debre Markos University, Debre Markos, Ethiopia.
J Diabetes Metab Disord. 2020 Sep 22;19(2):1931-1941. doi: 10.1007/s40200-020-00635-9. eCollection 2020 Dec.
Despite the high prevalence of diabetes in Africa, the extent of undiagnosed diabetes in the region is still poorly understood. This systematic review and meta-analysis was designed to determine the pooled prevalence of undiagnosed diabetes mellitus among adults in Africa.
We conducted a systematic desk review and electronic web-based search of PubMed, Google Scholar, EMBASE, and the World Health Organization's Hinari portal (which includes the SCOPUS, African Index Medicus, and African Journals Online databases), identifying peer-reviewed research studies on the prevalence of undiagnosed diabetes among adult individuals using pre-defined quality and inclusion criteria. We ran our search from June 1, 2018 to Jun 14, 2020. We extracted relevant data and presented descriptive summaries of the studies in tabular form. The I test was used to assess heterogeneity across studies. A random effects model was used to estimate the pooled prevalence of undiagnosed diabetes mellitus at a 95% confidence interval (CI). Funnel plot asymmetry and Egger's tests were used to check for publication bias. The final effect size was determined by applying a trim and fill analysis in a random-effects model.
Our search identified 1442 studies amongst which 23 articles were eligible for inclusion in the final meta-analysis. The average pooled prevalence of undiagnosed diabetes mellitus among adults was 3.85 (95% CI: 3.10-4.60). The pooled prevalence of undiagnosed diabetes mellitus based on geographic location was 4.43 (95% CI: 3.12-5.74) in Eastern Africa; 4.72 (95% CI: 2.64-6.80) in Western Africa; 4.27 (95% CI: 1.77-6.76) in Northern Africa and 1.46 (95%CI: 0.57-2.34) in southern Africa respectively.
Our findings indicate a high prevalence of undiagnosed diabetes in Africa and suggest that it may be more prevalent in Western Africa than the rest of the regions. Given the high levels of undiagnosed diabetes in the Africa region, more attention should be paid to incorporating diabetes screening and treatment services into existing diabetes related programs to reduce the prevalence of undiagnosed cases.
尽管非洲糖尿病患病率很高，但该地区未确诊糖尿病的程度仍知之甚少。本系统评价和荟萃分析旨在确定非洲成年人中未确诊糖尿病的合并患病率。
我们对PubMed、谷歌学术、EMBASE和世界卫生组织的Hinari门户（包括SCOPUS、非洲医学索引和非洲在线期刊数据库）进行了系统的案头审查和基于网络的电子搜索，使用预先定义的质量和纳入标准，确定关于成年个体未确诊糖尿病患病率的同行评审研究。我们的搜索时间为2018年6月1日至2020年6月14日。我们提取了相关数据，并以表格形式呈现了研究的描述性摘要。I检验用于评估各研究之间的异质性。采用随机效应模型估计未确诊糖尿病的合并患病率，置信区间为95%（CI）。漏斗图不对称性和Egger检验用于检查发表偏倚。最终效应大小通过在随机效应模型中应用修剪和填充分析来确定。
我们的搜索共识别出1442项研究，其中23篇文章符合纳入最终荟萃分析的条件。成年人中未确诊糖尿病的平均合并患病率为3.85（95%CI：3.10-4.60）。根据地理位置，东非未确诊糖尿病的合并患病率为4.43（95%CI：3.12-5.74）；西非为4.72（95%CI：2.64-6.80）；北非为4.27（95%CI：1.77-6.76）；南部非洲为1.46（95%CI：0.57-2.34）。
我们的研究结果表明，非洲未确诊糖尿病的患病率很高，并且表明在西非可能比其他地区更为普遍。鉴于非洲地区未确诊糖尿病的水平很高，应更加重视将糖尿病筛查和治疗服务纳入现有的糖尿病相关项目，以降低未确诊病例的患病率。
