Abstract

Diabetes has emerged as a major public health challenge in low-income and low- and middle-income countries 
(LMICs), where its complications contribute disproportionately to morbidity, mortality, and economic burden. 
This narrative review examines the epidemiology, spectrum, and determinants of diabetes-related complications in 
low-income settings, with particular emphasis on microvascular and macrovascular outcomes. Drawing on 
evidence from global and regional studies, the review highlights the high prevalence of diabetic retinopathy, 
nephropathy, neuropathy, cardiovascular disease, cerebrovascular events, and peripheral artery disease, often 
presenting at younger ages and more advanced stages than in high-income countries. Structural barriers including 
weak health system capacity, limited access to essential medicines and diagnostic services, socioeconomic and 
geographic disparities, and inadequate screening and follow-up-significantly impede prevention and management 
efforts. The review further explores prevention and management strategies suited to low-resource contexts, 
including early detection, simplified treatment regimens, integrated complication management programs, 
community-based education, and task-shifting approaches. Despite growing recognition of the burden of diabetes 
complications in LMICs, substantial gaps remain in epidemiological data, screening coverage, and long-term 
outcomes research. Addressing diabetes complications in low-income countries requires coordinated health system 
reform, equitable access to care, strengthened primary health services, and evidence-informed policy interventions 
tailored to local contexts.