Global prevalence of advanced fibrosis in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

Abstract

Background and Aim: Patients with type 2 diabetes mellitus (T2DM) face a heightened susceptibility to advanced fibrosis, a condition linked to adverse clinical outcomes. However, reported data on liver fibrosis severity among individuals with T2DM vary significantly across studies with diverse characteristics. This meta-analysis aimed to estimate the global prevalence of advanced fibrosis among T2DM patients. Methods: A comprehensive systematic search of the EMBASE and MEDLINE databases from inception to November 2022 was conducted to identify studies assessing advanced fibrosis in individuals with T2DM. Random-effects models were utilized to calculate point estimates of prevalence, accompanied by 95% confidence interval (CI). Meta-regression with subgroup analysis was employed to address heterogeneity. Results: We identified 113 eligible studies involving 244,858 individuals from 29 countries. Globally, the prevalence of advanced fibrosis among T2DM patients was 19.5% (95% CI 16.8–22.4%). Regionally, the prevalence rates were as follows: 60.5% in West Asia (95% CI 50.3–70.4%), 24.4% in South Asia (95% CI 16.2–33.7%), 20.1% in East Asia (95% CI 14.7–26.1%), 20.0% in Europe (95% CI 15.8–24.6%), 15.8% in North America (95% CI 11.0–21.3%), and 11.3% in South America (95% CI 6.2–17.5%). The prevalence of advanced fibrosis varied notably based on the study setting and diagnostic methodology employed. Meta-regression models highlighted that 45.13% of the observed heterogeneity could be attributed to combined diagnostic modality and study setting. Conclusions: Globally, approximately one fifth of the T2DM population presents advanced fibrosis, with prevalence differing across geographical regions. Our findings underscore the need for effective strategies to alleviate its global burden.