BACKGROUND Previous studies of diabetes in Eastern Mediterranean Region (EMRO) did not assess the prevalence of either unknown diabetes or prediabetes. We conducted a systematic review and meta-analysis to estimate the prevalence of undiagnosed type 2 diabetes and prediabetes as well as variations by region in EMRO, using the relevant publications since 2000. METHODS We carried out a comprehensive electronic search on electronic databases from January 1, 2000 to March 1, 2018. We selected cross-sectional and cohort studies reporting the prevalence of undiagnosed type 2 diabetes, prediabetes, or both. Two independent reviewers initially screened the eligible articles; then, synthesized the target data from full papers. Random- or fixed-effect models, subgroup analysis on Human Development Index (HDI), and publication year and sensitivity analysis to minimize the plausible effect of outliers were used. RESULTS Amongst 849 identified citations, 55 articles were entered into meta-analysis, involving 567,025 individuals. The forest plots estimated 5.46% (confidence intervals [CI]: 4.77-6.14) undiagnosed diabetic and 12.19% (CI: 10.13-14.24) prediabetics in EMRO. Low HDI countries and high HDI countries had the highest (7.25%; CI: 4.59-9.92) and the lowest (3.98%; CI: 3.11-4.85) undiagnosed diabetes prevalence, respectively. Very high HDI countries and low HDI countries had the highest (13.50%; CI: 8.43-18.57) and the lowest (7.45%; 1.20-13.71) prediabetes prevalence, respectively. In addition, meta-regression analysis showed a statistically significant association between publication year and prevalence of prediabetes (Reg Coef = 0.059, P = 0.014). But such finding was not observed for undiagnosed diabetes and publication year (Reg Coef = 0.034, P = 0.124), prediabetes and HDI (Reg Coef = 0.128, P = 0.31) and undiagnosed diabetes and HDI (Reg Coef = - 0.04, P = 0.96). CONCLUSION The prevalence of undiagnosed diabetes and prediabetes was high and increasing. The notion of universal health coverage is a priority; that is the integration of the primary, secondary and tertiary health levels, as well as employing the available action plans. Therefore, future studies, using identical screening tool and diagnostic criteria, are warranted to make an accurate picture of diabetes in EMRO.

中文翻译：

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地中海东部地区（EMRO）未诊断的2型糖尿病和前驱糖尿病的患病率：系统评价和荟萃分析。

背景技术先前在东地中海地区（EMRO）进行的糖尿病研究并未评估未知糖尿病或糖尿病前期的患病率。自2000年以来，我们使用相关出版物进行了系统的回顾和荟萃分析，以评估未诊断的2型糖尿病和前驱糖尿病的发生率以及EMRO中各地区的差异。方法我们从1月1日开始对电子数据库进行全面的电子搜索。 ，从2000年至2018年3月1日。我们选择了横断面研究和队列研究，这些研究报告了未被诊断的2型糖尿病和/或糖尿病前期的患病率。最初有两名独立的审阅者筛选了符合条件的文章；然后，从全文中合成目标数据。随机或固定效应模型，人类发展指数（HDI）的亚组分析，使用了出版年和敏感性分析，以最大程度地减少离群值的可能影响。结果在849个被识别的引文中，有55篇文章被纳入荟萃分析，涉及567,025个人。在EMRO中，森林地块估计有5.46％（置信区间[CI]：4.77-6.14）未诊断出的糖尿病患者和12.19％（CI：10.13-14.24）。低HDI国家和高HDI国家的未诊断糖尿病患病率分别最高（7.25％; CI：4.59-9.92）和最低（3.98％; CI：3.11-4.85）。高HDI国家和低HDI国家分别具有最高（13.50％; CI：8.43-18.57）和最低（7.45％; 1.20-13.71）的糖尿病前期患病率。此外，荟萃回归分析显示出版年份与前驱糖尿病患病率之间存在统计学上的显着相关性（Reg Coef = 0.059，P = 0。014）。但是对于未诊断的糖尿病和发表年份（Reg Coef = 0.034，P = 0.124），糖尿病前期和HDI（Reg Coef = 0.128，P = 0.31）以及未诊断的糖尿病和HDI（Reg Coef =-0.04，P = 0.96）。结论未被诊断的糖尿病和糖尿病前期的患病率很高并且还在增加。全民健康覆盖的概念是一个优先事项；这就是初级，二级和三级健康水平的整合，以及采用现有的行动计划。因此，有必要使用相同的筛选工具和诊断标准进行进一步的研究，以准确了解EMRO中的糖尿病情况。04，P ＝ 0.96）。结论未被诊断的糖尿病和糖尿病前期的患病率很高并且还在增加。全民健康覆盖的概念是一个优先事项；这就是初级，二级和三级健康水平的整合，以及采用现有的行动计划。因此，有必要使用相同的筛查工具和诊断标准进行进一步的研究，以准确了解EMRO中的糖尿病。04，P ＝ 0.96）。结论未被诊断的糖尿病和糖尿病前期的患病率很高并且还在增加。全民健康覆盖的概念是一个优先事项；这就是初级，二级和三级健康水平的整合，以及采用现有的行动计划。因此，有必要使用相同的筛选工具和诊断标准进行进一步的研究，以准确了解EMRO中的糖尿病情况。