Meta-Analysis
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World J Diabetes. Aug 15, 2025; 16(8): 109352
Published online Aug 15, 2025. doi: 10.4239/wjd.v16.i8.109352
Prevalence of diabetes distress among people with type 2 diabetes in South Asia: A systematic review and meta-analysis
Abul Bashar Mohammad Kamrul-Hasan, Joseph M Pappachan, Lakshmi Nagendra, Dimuthu Muthukuda, Deep Dutta, Saptarshi Bhattacharya, Dina Shrestha, Guru Prasad Dhakal, Manilka Sumanatilleke, Syed Abbas Raza, Sanjay Kalra
Abul Bashar Mohammad Kamrul-Hasan, Department of Endocrinology, Mymensingh Medical College, Mymensingh 2200, Bangladesh
Joseph M Pappachan, Faculty of Science, Manchester Metropolitan University, Manchester M15 6BH, Greater Manchester, United Kingdom
Joseph M Pappachan, Department of Endocrinology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal 576104, India
Lakshmi Nagendra, Department of Endocrinology, JSS Medical College, JSS Academy of Higher Education and Research, Mysore, 570004, India
Dimuthu Muthukuda, Department of Endocrinology, Diabetes and Endocrinology Center, Sri Jayewardenepura General Hospital, Colombo 10250, Sri Lanka
Deep Dutta, Department of Endocrinology, CEDAR Superspeciality Healthcare, New Delhi 110075, India
Saptarshi Bhattacharya, Department of Endocrinology, Indraprastha Apollo Hospitals, New Delhi 110076, India
Dina Shrestha, Department of Endocrinology, Norvic International Hospital, Kathmandu 44617, Nepal
Guru Prasad Dhakal, Department of Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu 11001, Bhutan
Manilka Sumanatilleke, Department of Endocrinology, National Hospital Sri Lanka, Colombo 00700, Sri Lanka
Syed Abbas Raza, Department of Endocrinology, Shaukat Khanum Cancer Memorial Hospital and Research Center, Lahore 54000, Pakistan
Syed Abbas Raza, Department of Endocrinology, National Defense Hospital, DHA Lahore, Lahore 54000, Pakistan
Sanjay Kalra, Department of Endocrinology, Bharti Hospital, Karnal 132001, India
Author contributions: Kamrul-Hasan ABM and Kalra S conceptualized the study; Kamrul-Hasan ABM, Dutta D, Bhattacharya S, Shrestha D, and Raza SA formulated the methodology; Pappachan JM, Muthukuda D, Sumanatilleke M, and Dhakal GP were involved in the literature search, study selection, and data extraction; Kamrul-Hasan ABM and Nagendra L performed statistical analysis; Kamrul-Hasan ABM, Pappachan JM, Muthukuda D, and Bhattacharya S drafted the manuscript; Nagendra L, Shrestha D, Dutta D, Dhakal GP, Sumanatilleke M, Raza SA, and Kalra S critically analyzed and revised the manuscript; All authors read and approved the final manuscript.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Joseph M Pappachan, MD, FRCP, Professor, Faculty of Science, Manchester Metropolitan University, Oxford Road, Manchester M15 6BH, Greater Manchester, United Kingdom. drpappachan@yahoo.co.in
Received: May 8, 2025
Revised: May 24, 2025
Accepted: July 15, 2025
Published online: August 15, 2025
Processing time: 98 Days and 15.5 Hours
Abstract
BACKGROUND

Diabetes distress (DD), an emotional problem arising from the challenges of living with diabetes and the relentless burden of daily self-management, is common among patients with type 2 diabetes (T2D). South Asia has a high T2D burden, and many studies have reported varying prevalence rates of DD in this area.

AIM

To estimate the pooled prevalence of DD among patients with T2D in South Asia, as it is crucial for developing effective therapeutic strategies.

METHODS

This systematic review and meta-analysis included cross-sectional studies conducted in South Asian countries involving adults with T2D and reported the prevalence of DD. The studies were identified by searching multiple electronic databases and registries from the inception of each database to January 30, 2025, using prespecified search terms. Four authors screened and extracted data independently. Meta-analyses were conducted using RStudio software with a random-effects model. The primary outcome was the pooled prevalence of DD.

RESULTS

Thirty-seven cross-sectional studies (28 from India, five from Bangladesh, and two each from Pakistan and Sri Lanka) with mostly high methodological quality involving 11500 subjects were included. The pooled prevalence of DD was 44% (95% confidence interval: 35-53, I2 = 97.4%). The prevalence of DD was highest in Pakistan (85%), followed by India and Bangladesh (42% each), and Sri Lanka (25%). Emotional burden was the most prevalent form of DD (60%), followed by treatment regimen-related distress (51%), interpersonal distress (31%), and physician-related distress (17%). Meta-regression analysis revealed no significant associations between the prevalence of DD and publication year, sample size, proportion of females, age, duration of diabetes, insulin usage, glycated hemoglobin levels, or diabetic complications.

CONCLUSION

South Asians with T2D seem to experience a relatively high burden of DD, and the emotional burden is the most common form of DD in this area. Larger studies utilizing unique tools and involving a broader participant base from the region would provide better epidemiological data for effectively planning high-quality diabetes care in South Asian countries.

Keywords: Type 2 diabetes; Diabetes distress; South Asia; Prevalence; Systematic reviews

Core Tip: Diabetes distress (DD), an emotional problem arising from the challenges of living with diabetes and the relentless burden of daily self-management, is common among patients with type 2 diabetes. This systematic review and meta-analysis encompassed 37 cross-sectional studies, involving a total of 11500 participants from South Asian countries. Of these, 28 studies were conducted in India, five in Bangladesh, and two each in Pakistan and Sri Lanka. The pooled prevalence of DD was 44%, with the highest in Pakistan at 85% and the lowest in Sri Lanka at 25%. Emotional burden was the most common form of DD (60%), followed by treatment regimen-related distress (51%), interpersonal distress (31%), and physician-related distress (17%).