title: Rural diabetes prevalence quintuples over twenty-five years in low- and middle-income countries: a systematic review and meta-analysis.
abstract: OBJECTIVE
  To verify the assertions that diabetes pandemic may be spreading across rural parts of low- and middle-income countries (LMICs), we performed a systematic review of published studies reporting diabetes prevalence in rural parts of LMICs.
  
  
  METHODS
  Electronic databases (EMBASE and MEDLINE) were searched for papers published from 1990 to 2011. Two independent reviewers screened the articles using structured criteria for inclusion and performed full-text reviews. Pooled prevalence of diabetes was estimated using meta-analysis. Potential factors influencing the estimates were identified by meta-regression and used for sensitivity analyses.
  
  
  RESULTS
  Rural prevalence of diabetes of LMICs was 5.6% (95% CI=4.6-6.6), and similar between men and women. This estimate remained robust in separate sensitivity analyses accounting for study quality, level of heterogeneity, age, and sex. In a multivariate meta-regression analysis, pooled prevalence varied by study year and region. Diabetes prevalence increased over time, from 1.8% (1.0-2.6) in 1985-1989, 5.0% (3.8-6.3) in 1990-1994, 5.2% (4.1-6.2) in 1995-1999, 6.4% (5.1-7.7) in 2000-2004, and to 8.6% (6.4-10.7) for 2005-2010 (p=0.001 for secular trend).
  
  
  CONCLUSIONS
  Prevalence of diabetes in rural parts of LMICs has risen dramatically. As 55% of LMIC populations live in rural areas, this trend has enormous implications for the global burden of diabetes.
authors.affiliation: Department of Ophthalmology, Emory University, Atlanta, GA, USA.
authors.forename: Christopher K
authors.initials: CK
authors.lastname: Hwang
authors.forename: Pauline V
authors.initials: PV
authors.lastname: Han
authors.forename: Azadeh
authors.initials: A
authors.lastname: Zabetian
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Ali
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D003906:Developing Countries / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D018570:Risk Assessment; D012424:Rural Population / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012959:Socioeconomic Factors