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Purpose <p>Although South Asia exhibits a considerable burden of type 2 diabetes mellitus (T2DM), the numbers of undiagnosed T2DM remains inadequately characterized at the regional level. This systematic review and meta-analysis aimed to approximate the pooled prevalence of undiagnosed T2DM among the general adult population and to assess country-specific variations in South Asian countries.</p> Methods <p>A comprehensive literature search was directed in PubMed, Scopus, Cochrane Library, ScienceDirect, and Web of Science for studies published between 1994 and 2022. Observational studies reporting the prevalence of undiagnosed T2DM among adults aged 20–79 years in South Asia were included. By using logit transformation, Random-effects meta-analysis was conducted to assess pooled prevalence. While using Cochran’s Q and I² statistics Heterogeneity was calculated, publication bias was assessed using funnel plots and Egger’s test, and subgroup analyses were performed by country.</p> Results <p>In this review, a total of 28 studies containing 104,019 participants and 5719 undiagnosed T2DM cases were included. The observed pooled prevalence of undiagnosed T2DM was 6.67% (95% CI: 4.99–8.58%) with considerable uncertainty as indicated by a very wide prediction interval (0.33%–19.75%) and extreme heterogeneity (I² = 98.5%, <i>p</i> &lt; 0.001). At country-level substantial variation was seen, with the highest prevalence in Sri Lanka (30.54%; 95% CI: 17.90–44.82%), followed by Nepal (7.02%; 95% CI: 4.24–10.44%), Pakistan (5.97%; 95% CI: 3.97–8.33%), Bangladesh (5.84%; 95% CI: 5.28–6.42%) and India (5.26%; 95% CI: 3.66–7.14%). The results of Egger’s test (t = 1.84, <i>p</i> = 0.0773) suggested no statistical significance evidence of publication bias.</p> Conclusion <p>These findings should be interpreted with attentiveness because of extensive heterogeneity and variability across studies. However, the high number of undiagnosed T2DM in general population of South Asia reflects a great burden and indicates inter-country differences. Therefore, this conclusion highlights the need for advanced surveillance systems, valid diabetes screening, and approach to health care facilities, especially in deprived and high-risk population in the region.</p>

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Prevalence of undiagnosed type 2 diabetes in South Asia: A systematic review and meta-analysis

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  • 发表日期：

    2026年8月1日

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  • Faiza Afzal,
  • Imtiaz Ahmad,
  • Kainat Khalid,
  • Ikram Bashir,
  • Sohail Akhtar

摘要

Purpose

Although South Asia exhibits a considerable burden of type 2 diabetes mellitus (T2DM), the numbers of undiagnosed T2DM remains inadequately characterized at the regional level. This systematic review and meta-analysis aimed to approximate the pooled prevalence of undiagnosed T2DM among the general adult population and to assess country-specific variations in South Asian countries.

Methods

A comprehensive literature search was directed in PubMed, Scopus, Cochrane Library, ScienceDirect, and Web of Science for studies published between 1994 and 2022. Observational studies reporting the prevalence of undiagnosed T2DM among adults aged 20–79 years in South Asia were included. By using logit transformation, Random-effects meta-analysis was conducted to assess pooled prevalence. While using Cochran’s Q and I² statistics Heterogeneity was calculated, publication bias was assessed using funnel plots and Egger’s test, and subgroup analyses were performed by country.

Results

In this review, a total of 28 studies containing 104,019 participants and 5719 undiagnosed T2DM cases were included. The observed pooled prevalence of undiagnosed T2DM was 6.67% (95% CI: 4.99–8.58%) with considerable uncertainty as indicated by a very wide prediction interval (0.33%–19.75%) and extreme heterogeneity (I² = 98.5%, p < 0.001). At country-level substantial variation was seen, with the highest prevalence in Sri Lanka (30.54%; 95% CI: 17.90–44.82%), followed by Nepal (7.02%; 95% CI: 4.24–10.44%), Pakistan (5.97%; 95% CI: 3.97–8.33%), Bangladesh (5.84%; 95% CI: 5.28–6.42%) and India (5.26%; 95% CI: 3.66–7.14%). The results of Egger’s test (t = 1.84, p = 0.0773) suggested no statistical significance evidence of publication bias.

Conclusion

These findings should be interpreted with attentiveness because of extensive heterogeneity and variability across studies. However, the high number of undiagnosed T2DM in general population of South Asia reflects a great burden and indicates inter-country differences. Therefore, this conclusion highlights the need for advanced surveillance systems, valid diabetes screening, and approach to health care facilities, especially in deprived and high-risk population in the region.