Prevalence of prediabetes in Mexico: a retrospective analysis of nationally representative surveys spanning 2016-2022

Abstract

Background: Characterizing prediabetes phenotypes may be useful in guiding diabetes prevention efforts; however, heterogeneous criteria to define prediabetes have led to inconsistent prevalence estimates, particularly in low- and middle-income countries. Here, we estimated trends in prediabetes prevalence in Mexico across different prediabetes definitions and their association with prevalent cardiometabolic conditions.

Methods: We conducted a serial cross-sectional analysis of National Health and Nutrition Surveys in Mexico (2016-2022), totalling 22 081 Mexican adults. After excluding individuals with diagnosed or undiagnosed diabetes, we defined prediabetes using ADA (impaired fasting glucose [IFG] 100-125 mg/dL and/or HbA1c 5.7-6.4%), WHO (IFG 110-125 mg/dL), and IEC criteria (HbA1c 6.0-6.4%). Prevalence trends of prediabetes over time were evaluated using weighted Poisson regression and its association with prevalent cardiometabolic conditions with weighted logistic regression.

Findings: The prevalence of prediabetes (either IFG or high HbA1c [ADA]) in Mexico was 20.9% in 2022. Despite an overall downward trend in prediabetes (RR 0.973, 95% CI 0.957-0.988), this was primarily driven by decreases in prediabetes by ADA-IFG (RR 0.898, 95% CI 0.880-0.917) and WHO-IFG criteria (RR 0.919, 95% CI 0.886-0.953), while prediabetes by ADA-HbA1c (RR 1.055, 95% CI 1.033-1.077) and IEC-HbA1C criteria (RR 1.085, 95% CI 1.045-1.126) increased over time. Prediabetes prevalence increased over time in adults >40 years, with central obesity, self-identified as indigenous or living in urban areas. For all definitions, prediabetes was associated with an increased risk of cardiometabolic conditions.

Interpretation: Prediabetes rates in Mexico from 2016 to 2022 varied based on defining criteria but consistently increased for HbA1c-based definitions and high-risk subgroups.

Funding: This research was supported by Instituto Nacional de Geriatría in Mexico. JAS was supported by NIH/NIDDK Grant# K23DK135798.

Keywords: Cardiometabolic risk; Glucose metabolism; Insulin resistance; Prediabetes.

Fig. 1

Flowchart of participant selection for each year of the survey. We show the total number of participants surveyed per year, followed by the number of them who completed the health questionnaire. The general population is comprised of subjects ≥20 years old, and the laboratory subset includes those with complete venous blood weights. Lastly, to obtain national estimates of diabetes and prediabetes prevalence we removed individuals with missing A1c/FPG data, with fasting <8 h, or with gestational diabetes. This diagram was designed using resources created by Freepik from www.flaticon.com.

Fig. 2

Change in prevalence of diabetes and prediabetes from 2016 to 2022 in Mexico (a). Participants with prediabetes (either high HbA1c or IFG) are categorized according to the diagnostic criteria they fulfilled (IFG only, high HbA1c only, or both), revealing that changes in prevalence were primarily driven by subjects with high HbA1c (b). The percentage of participants with insulin resistance (HOMA-2IR ≥ 2.5) in each category is also shown (c). Abbreviations. IFG: Impaired fasting glucose. NFG: Normal fasting glucose. IR: Insulin resistance.

Fig. 3

Change in prevalence of prediabetes (either high HbA1c or IFG) from 2016 to 2022 in Mexico stratified by age group (a), sex (b), BMI category (c), waist circumference (d), family history of diabetes (e), indigenous identity (f), DISLI category (g) and area (h). Abbreviations. BMI: Body mass index. DISLI: Density-independent social lag index. IFG: Impaired fasting glucose.

Fig. 4

Prevalence of prediabetes in Mexico from 2016 to 2022 according to different definitions used by the ADA (a) and by other organizations (b). We also present an odds ratio plot displaying the association between each of these definitions with multiple cardiovascular outcomes, adjusted for age, sex, and body mass index. Abbreviations. ADA: American Diabetes Association. CRP: C-Reactive Protein. IEC: International Expert Committee. WHO: World Health Organization. IFG: Impaired fasting glucose.