Prevalence of diabetes distress among people with type 2 diabetes in South Asia: A systematic review and meta-analysis.

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. To estimate the pooled prevalence of DD among patients with T2D in South Asia, as it is crucial for developing effective therapeutic strategies. 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. 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, I 2 = 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. 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.