Diabetes in Pakistan: A systematic review and meta-analysis.

OBJECTIVE: The purpose of this study was assess the time trend of the prevalence of prediabetes and diabetes and risk factors associated with diabetes in Pakistan by using a systematic review and meta-analysis. METHODS: A systematic literature search of Embase, PubMed, and the Cochrane library was carried out between January 1, 1995 and August 30, 2018. Diabetes and prediabetes prevalence estimates were combined by the random-effects model. The existence of publication bias was tested by Egger regression. This systematic review was reported following the PRISMA guidelines. RESULTS: The search conceded a total of 635 studies, only 14 studies were considered for meta-analysis. The prevalence of diabetes in Pakistan was revealed 14.62% (10.651%-19.094%; 14 studies) based on 49,418 people using the inverse-variance random-effects model. The prevalence of prediabetes was 11.43% (8.26%-15.03%; 10 studies) based on a total sample of 26,999 people. The risk factors associated with diabetes were mean age (ß = 0.48%, 95% CI: 0.21-0.78, p<0.001), the proportion of participants with a family history of diabetes (ß = 0. 45%, 95% CI: 0.08-0.82, p =0.018, p<0.001), hypertension (ß = 0.40%, 95% CI: 0.06-0.75, p = 0.022), weight (BMI) (ß = 0.21%, 95% CI: 0.02-0.4, p=0.030). CONCLUSIONS: There has been a continuous increase in the prevalence of prediabetes and diabetes in Pakistan. All parts of the country have been affected, with the highest in Sindh and lowest in Khyber Pakhtunkhwa. The main factors include growing age, family history, hypertension and obesity. A nationwide diabetes care survey on risk factors and prevention policy is highly recommended.

Prevalence of type 2 diabetes and pre-diabetes in Sri Lanka: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this research was to determine the prevalence of diabetes and pre-diabetes in Sri Lanka. DESIGN: Systematic review and meta-analysis. DATA SOURCES: MEDLINE (via PubMed), Web of Science, Sri Lankan Journals online and Google Scholar were searched for relevant articles published between January 1990 and June 2022 investigating the prevalence of pre-diabetes and diabetes in Sri Lanka. METHODS: Random effect meta-analyses were conducted to derive the pooled prevalence of pre-diabetes and diabetes and their 95% CIs. Heterogeneity was explored by subgroup and meta-regression analyses. Sensitivity analyses were used to evaluate the impact of any single study on the pooled estimates. Two authors screened articles, extracted data and evaluated the quality of selected studies. RESULTS: A total of 479 articles were reviewed, and 15 studies (n=30 137 participants) were selected in the final analysis. The overall pooled prevalence of diabetes was 12.07% (95% CI, 8.71% to 15.89%; prediction interval: 1.28-31.35). The pooled pre-diabetes prevalence was 15.57% (95% CI, 9.45% to 22.88%; prediction interval: 0.02-49.87). The pooled type 2 diabetes prevalence was the highest in the latest period of 2011-2021 (17.25%) than in the period of 2000s (11.84%) and 1990s (5.62%). CONCLUSIONS: The growing trend of diabetes and pre-diabetes over the last 30 years is alarming in Sri Lanka. The government of Sri Lanka needs to take steps to improve diabetes education, screening, diagnosis and treatment. PROSPERO REGISTRATION NUMBER: CRD42021288591.

Structural Analysis and Epitope Prediction of S2 Domain of SARS-CoV-2, Conservation Analysis Among Major Variants.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. There are four structural proteins of the virus: spike, envelope, membrane, and nucleocapsid proteins. Various vaccines were designed and are effectively being used against the spike protein of the virus. However, several vaccine-related complications have been reported worldwide. Assuming that the structural integrity of the whole protein might be contributing to these complications, this study was performed to design epitopes using the S2 domain of the spike protein, which could trigger a strong immune response. We have also predicted antigenic and allergenic properties of the selected epitopes. A total of 49 B cell epitopes passing antigenicity and other assessment filters were found using three methods. Among them, RDLICAQ had the highest antigenicity score (1.1443). However, only one cytotoxic T lymphocyte epitope, RSFIEDLLF, passed the essential filters with an antigenicity score of 0.5782 to show an appropriate immune response for T cells, while among 21 helper T cell lymphocyte epitopes that were filtered, FAMQMAYRFNGIGVT showed the highest (1.3688) antigenicity score. Conservation analysis revealed that the S2 domain is significantly conserved, thus making it an ideal candidate for vaccine development. We have also designed a vaccine construct based on the best suiting components found during the whole study. This construct and S2 domain solely can be future subjects of interest or might be included in a subunit cocktail formulation for attaining unabridged immunogenicity.

Prevalence of type-2 diabetes and prediabetes in Malaysia: A systematic review and meta-analysis.

OBJECTIVE: The main purpose of this study was to investigate the pooled prevalence of prediabetes and type-2 diabetes in the general population of Malaysia. METHOD: We systematically searched Medline (PubMed), Embase, Web of Science, Google Scholar and Malaysian Journals Online to identify relevant studies published between January 1, 1995, and November 30, 2021, on the prevalence of type-2 diabetes in Malaysia. Random-effects meta-analyses were used to obtain the pooled prevalence of diabetes and prediabetes. Subgroup analyses also used to analyze to the potential sources of heterogeneity. Meta- regression was carried to assess associations between study characteristics and diabetes prevalence. Three independent authors selected studies and conducted the quality assessment. The quality of the final evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. RESULTS: Of 2689 potentially relevant studies, 786 titles and abstract were screened. Fifteen studies with 103063 individuals were eligible to be included in the meta-analyses. The pooled prevalence of diabetes was 14.39% (95% CI, 12.51%-16.38%; I2 = 98.4%, 103063 participants from 15 studies). The pooled prevalence of prediabetes was 11.62% (95% CI, 7.17%-16.97%; I2 = 99.8, 88702 participants from 9 studies). The subgroup analysis showed statistically significant differences in diabetes prevalence by the ethical sub-populations with highest in Indians (25.10%; 95% CI, 20.19%-30.35%), followed by Malays (15.25%; 95% CI, 11.59%-19.29%), Chinese (12.87%; 95% CI, 9.73%-16.37%), Bumiputeras (8.62%; 95% CI, 5.41%-12.47%) and others (6.91%; 95% CI, 5.71%-8.19%). There was no evidence of publication bias, although heterogeneity was high (I2 ranged from 0.00% to 99·8%). The quality of evidence based on GRADE was low. CONCLUSIONS: Results of this study suggest that a high prevalence of prediabetes and diabetes in Malaysia. The diabetes prevalence is associated with time period and increasing age. The Malaysian government should develop a comprehensive approach and strategy to enhance diabetes awareness, control, prevention, and treatment. TRIAL REGISTRATION: Trial registration no. PROSPERO CRD42021255894; https://clinicaltrials.gov/.

Prevalence of foot ulcers in diabetic patients in Punjab, Pakistan.

Diabetes-related foot ulceration is prevalent and disabling, usually resulting in the amputation of the limb. The mortality rate is significant, and healed ulcers frequently reoccur. The main purpose of this study was to explore the prevalence of foot ulcers and their associated factors among diabetic patients in Punjab, Pakistan. Multistage cluster random sampling procedure was applied to perform a cross-sectional analysis in the state of Punjab, Pakistan. A sample of 1,503 people with diabetes, including 504 men and 999 women, were selected from different clusters. Data were collected from December 18, 2018, to June 30, 2019. Individuals of 18 years or above were selected. A binary multiple logistic regression analysis was utilized to find the factors associated with a diabetic foot ulcer. The overall prevalence of diabetic foot ulcers was 16.83% (95% CI: 14.9-18.7%). The prevalence among the female was 17.52% (95% CI: 15.2-19.9%), and the male was 15.48% (95% CI: 12.3-18.6%). In rural areas, prevalence was 13.91% (95% CI: 10.6-17.2%) compared to the prevalence of 17.96% (95% CI: 15.7-20.2%) in the urban area. Individuals 75 years and above had the highest prevalence of 66.67% (95% CI: 51.9-81.5%). According to the income status, subjects with monthly income above Rs. 61,000 had a prevalence of 24.24% (95% CI: 15.8-32.7%), and among overweight subjects was 25.49% (95% CI: 21.3-29.7%). This study found a relatively high prevalence of foot ulcers in Punjab, Pakistan. The results indicate that diabetic foot ulcers have become a major health problem in diabetic patients, and better strategies and preventive measures should be opted to deal with the epidemic.

The prevalence of hepatitis C virus in hemodialysis patients in Pakistan: A systematic review and meta-analysis.

BACKGROUND: Hepatitis C virus (HCV) infection is one of the most common bloodborne viral infections reported in Pakistan. Frequent dialysis treatment of hemodialysis patients exposes them to a high risk of HCV infection. The main purpose of this paper is to quantify the prevalence of HCV in hemodialysis patients through a systematic review and meta-analysis. METHODS: We systematically searched PubMed, Medline, EMBASE, Pakistani Journals Online and Web of Science to identify studies published between 1 January 1995 and 30 October 2019, reporting on the prevalence of HCV infection in hemodialysis patients. Meta-analysis was performed using a random-effects model to obtain pooled estimates. A funnel plot was used in conjunction with Egger's regression test for asymmetry and to assess publication bias. Meta-regression and subgroup analyses were used to identify potential sources of heterogeneity among the included studies. This review was registered on PROSPERO (registration number CRD42019159345). RESULTS: Out of 248 potential studies, 19 studies involving 3446 hemodialysis patients were included in the meta-analysis. The pooled prevalence of HCV in hemodialysis patients in Pakistan was 32.33% (95% CI: 25.73-39.30; I2 = 94.3%, p < 0.01). The subgroup analysis showed that the prevalence of HCV among hemodialysis patients in Punjab was significantly higher (37.52%; 95% CI: 26.66-49.03; I2 = 94.5, p < 0.01) than 34.42% (95% CI: 14.95-57.05; I2 = 91.3%, p < 0.01) in Baluchistan, 27.11% (95% CI: 15.81-40.12; I2 = 94.5, p < 0.01) in Sindh and 22.61% (95% CI: 17.45-28.2; I2 = 78.6, p < 0.0117) in Khyber Pukhtoonkhuwa. CONCLUSIONS: In this study, we found a high prevalence (32.33%) of HCV infection in hemodialysis patients in Pakistan. Clinically, hemodialysis patients require more attention and resources than the general population. Preventive interventions are urgently needed to decrease the high risk of HCV infection in hemodialysis patients in Pakistan.

Prevalence of diabetes and pre-diabetes in Bangladesh: a systematic review and meta-analysis.

OBJECTIVE: The purpose of this paper is to perform a systematic review and meta-analysis in order to summarise the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. DESIGN: Systematic review and meta-analysis. PARTICIPANTS: General population of Bangladesh. DATA SOURCES: PubMed, Medline, Embase, Bangladesh Journals Online, Science Direct, Scopus, Cochrane Library and Web of Science were used to search for studies, published between 1st of January 1995 and 31st of August 2019, on the prevalence of diabetes and pre-diabetes and their associated risk factors in Bangladesh. Only articles published in the English language articles were considered. Two authors independently selected studies. The quality of the articles was also assessed. RESULTS: Out of 996 potentially relevant studies, 26 population-based studies, which together involved a total of 80 775 individuals, were included in the meta-analysis. The pooled prevalence of diabetes in the general population was 7.8% (95% CI: 6.4-9.3). In a sample of 56 452 individuals, the pooled prevalence of pre-diabetes was 10.1% (95% CI: 6.7-14.0; 17 studies). The univariable meta-regression analyses showed that the prevalence of diabetes is associated with the factors: the year of study, age of patients and presence of hypertension. The prevalence of diabetes was significantly higher in urban areas compared with rural areas, while there was no significant gender difference. CONCLUSIONS: This meta-analysis suggests a relatively high prevalence of pre-diabetes and diabetes in Bangladesh, with a significant difference between rural and urban areas. The main factors of diabetes include urbanisation, increasing age, hypertension and time period. Further research is needed to identify strategies for early detecting, prevention and treatment of people with diabetes in the population. PROSPERO REGISTRATION NUMBER: CRD42019148205.