Undiagnosed Diabetes and Prediabetes in Yemen: A Growing Public Health Crisis in the Shadow of Conflict

Abstract

Background and Objectives: Type 2 diabetes mellitus (T2DM) is increasing in prevalence worldwide, placing a substantial burden on healthcare systems, particularly in resource-limited settings. In Yemen, limited screening and diagnostic capacity contribute to delayed detection and management. Prediabetes, a reversible state of dysglycemia, carries significant cardiovascular risk and frequently progresses to diabetes. Early identification of both conditions is vital for prevention and public health planning. Materials and Methods: This cross-sectional study, conducted from July 2024 to May 2025 in three medical centers in Ibb Governorate, Yemen, assessed 1045 adults aged 18–60 years without known diabetes or prediabetes. Glycaemic status was classified according to the 2025 American Diabetes Association criteria. Undiagnosed diabetes was defined using three diagnostic combinations: FBS + OGTT, FBS + HbA1c, and OGTT + HbA1c. Results: The prevalence of undiagnosed diabetes was 8.4% (FBS + OGTT) and 9.76% (FBS + HbA1c or OGTT + HbA1c). Prediabetes prevalence was 23.4%, 14.7% and 26.4% based on FBS, OGTT, and HbA1c, respectively. Females represented a higher proportion of undiagnosed diabetes and prediabetes cases. Age was significantly associated with glycemic status across all tests, while gender showed significant associations with FBS and HbA1c. Family history of chronic disease was significantly associated with HbA1c-based classification. Approximately 8–10% of adults in Ibb had undiagnosed diabetes, while up to one-quarter had prediabetes. Age and family history were key predictors of dysglycaemia. Conclusions: These findings highlight the need for targeted, multi-marker screening and early intervention strategies, particularly in relatively stable regions of conflict-affected settings, to prevent progression to diabetes and reduce long-term complications and healthcare burden.