Prevalence and predictors of micro-vascular diabetic complications among patients with diabetes mellitus in Ethiopia: a systematic review and meta-analysis

Background The global incidence of diabetes mellitus (DM) complications contributes significantly to morbidity and mortality. However, reports on the prevalence and contributing factors of micro-vascular diabetic complications in Ethiopia remain inconsistent. Methods This systematic review and meta -analysis included 19 eligible studies sourced from PubMed, Science Direct, Scopus, HINARI, and Google Scholar, following the PRISMA 2020 guidelines. The search was limited to studies published between 2015 and 2024. Only observational studies involving patients with type 1 or type 2 diabetes mellitus were included. A structured data extraction checklist was used to collect the necessary information, and statistical analysis was performed using STATA 14. Publication bias was assessed using a funnel plot, along with Egger’s and Begg’s tests at a 5% significance level. Heterogeneity was examined using the Cochrane Q test and I2 statistics. Pooled analyses were conducted using a fixed-effects model. Sensitivity analysis was performed to evaluate the influence of individual studies on the overall outcome. Study quality was assessed using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Results The pooled prevalence of micro-vascular diabetic complications was 39.41% (95% CI: 33.28–45.55). The prevalence across studies ranged from 23.5% to 60.7%. Significant predictors of micro-vascular diabetic complications included advanced age (AOR = 3.09; 95% CI: 2.23–4.29), treatment with both insulin and oral hypoglycemic agents (AOR = 2.61; 95% CI: 1.80–3.79), diabetes duration exceeding five years (AOR = 2.05; 95% CI: 1.70–2.46), coexisting hypertension (AOR = 3.44; 95% CI: 2.70–4.39), urban residency (AOR = 2.24; 95% CI: 1.55–3.23), and lower income (AOR = 1.94; 95% CI: 1.30–2.89). Conclusion More than one-third of patients developed micro-vascular diabetic complications. Effective management of diabetes is essential to mitigate the risk of these complications. Healthcare providers should implement and incentivize systematic hypertension screening within all diabetes care pathways in primary care settings. Additionally, developing community-based diabetes management programs in urban areas and advocating for policies that expand health insurance coverage for low-income patients should be prioritized.