An updated systematic review and Meta-analysis of the prevalence of type 2 diabetes in Iran, 1996-2023

Prevalence of macro-vascular complications among type 2 diabetic adults aged 50 and over: results from Ardakan cohort study on aging (ACSA)

Objective

Type 2 diabetes mellitus (T2DM) is a common condition that can lead to adverse macrovascular complications. This study aims to determine the prevalence of macrovascular complications in adults aged ≥ 50 with T2DM in Ardakan city, using data from the Ardakan Cohort Study on Aging (ACSA).

Methods

A cross-sectional investigation involved 5933 participants from the ACSA; of those assessed, 2340 had T2DM. Macrovascular complications, specifically coronary artery disease (CAD), cerebrovascular disease (CVD), and peripheral artery disease(PAD) were identified through medical records and physician assessment. Logistic regression was used to identify risk factors for these complications.

Results

The prevalence of CAD and CVD were 16.9% (95% CI:16.0-19.0) and 4% (95% CI:3.3-5.0), respectively. risk factors for CAD included age over 60 (OR = 1.47, 95% CI: 1.08-2.01, p = 0.01), male gender (OR = 1.87, 95% CI: 1.33-2.62, p < 0.001), former smoking (OR = 1.96, 95% CI: 1.30-2.95, p = 0.001), hypertension (OR = 3.16, 95% CI: 2.23-4.46, p < 0.001), and over ten years of diabetes duration(OR = 2.04, 95% CI: 1.39-2.99, p < 0.001) and For CVD, significant risk factors included male gender (OR = 2.61, 95% CI: 1.52-4.51, p = 0.001) and hypertension (OR = 2.36, 95% CI: 1.27-4.39, p = 0.006).

Conclusion

This study highlights the high prevalence of macrovascular complications in adults over 50 with T2DM in Ardakan. It emphasizes the importance of managing key risk factors such as hypertension and quitting smoking, especially in older adults and males.

Comparison of costs related to health services in two groups of patients with diabetic foot ulcer and patients without this complication: a matched cohort study

Introduction

Diabetic foot ulcer (DFU) is a serious complication of diabetes that significantly increases healthcare expenditure worldwide. The aim of this study is to calculate the average costs for patients with and without DFU over a nine-month period.

Methods

This cost-of-illness study comprised 480 patients, including 160 cases (with DFU) and 320 controls (diabetes only), matched 1:2 by age (± 5 years) and sex. Direct and indirect medical costs were collected over a nine-month period using a questionnaire. We used the Mann-Whitney U test for continuous variables and the Pearson chi-square test for categorical variables. The GLM was also used to predict costs based on demographic and clinical factors. All statistical analyzes were performed using SPSS with a significance level of p < 0.05.

Results

The average total direct medical costs (inpatient and outpatient) were PPP$ 3,493.64 (SD: 2,714.66) for the DFU group and PPP$ 1,353.44 (SD: 110.85) for the diabetes-only group. Medication expenditures were the highest outpatient costs in the DFU group, with a mean of PPP$ 1,079.59 (SD: 247.13) (P < 0.001). Mean transportation costs in the DFU group were PPP$ 299.66 (SD: 240.49), compared with PPP$ 96.01 (SD: 7.83) in the control group. The mean indirect costs were PPP$ 2,256.31 (SD: 1,332.39) for the DFU group and PPP$ 100.78 (SD: 24.63) for the control group. Patients with more advanced ulcer stages (B = 9050.275, p < 0.05) and with middle education levels (B = 208.77, p < 0.05) had significantly higher costs. In contrast, retired individuals had significantly lower costs (B = -459.77, p < 0.05).

Conclusions

Patients with DFU incur substantially higher direct and indirect costs compared to those with diabetes alone. Medication and other service utilization-including blood glucose self-monitoring and consumables such as test strips, blood glucose meters, lancets, and syringes-are key contributors to outpatient expenses. The elevated indirect costs in DFU patients primarily reflect lost productivity. These higher overall costs are largely driven by the severity of the complication. Optimizing treatment strategies to prevent disease progression and avoid costly complications is essential for reducing the financial burden associated with DFU.

Impact of vitamin D on glycemic control and microvascular complications in type 2 diabetes: A cross-sectional study

Vitamin D has been increasingly recognized for its potential role in modulating various health conditions, including diabetes and its complications. Despite growing evidence suggesting that adequate vitamin D levels may reduce the risk of developing type 2 diabetes and its associated microvascular complications, the precise nature of this relationship remains unclear. This study aims to elucidate the connection among vitamin D status, glycemic control, and microvascular complications in patients with type 2 diabetes, thereby highlighting the importance of vitamin D in diabetes management.This analytical cross-sectional study included 199 type 2 diabetic mellitus (T2DM) patients from the Jahrom city endocrinology clinic. Serum 25(OH)D levels were measured, and their microvascular complications (microalbuminuria, retinopathy, neuropathy, macroalbuminuria) and glycemic control (HbA1C) were measured and confirmed according to ADA guidelines and endocrinologist supervision. All analysis were done with SPSS software. The study enrolled 199 type 2 diabetic patients with a mean age of 56.79 ± 10.8 years, of which 63.3% were female and 57.3% had hypertension. The mean BMI was 28.91 kg/m², and 29.1% of participants had vitamin D deficiency. The prevalence of microvascular complications was 25.6% for retinopathy, 14.1% for neuropathy, and 40% for nephropathy. Vitamin D deficiency was notably higher among patients with retinopathy (37.25%), neuropathy (50%), and macroalbuminuria (56.25%). Patients with neuropathy and retinopathy had significantly lesser serum 25(OH)D concentrations compared to patients without these complications. There was a slight inverse correlation between vitamin D levels and both the urine albumin creatinine ratio (r = -0.175, p = 0.018) and HbA1C (r = -0.19, p = 0.007). Although the link between vitamin D levels and retinopathy was not statistically significant (η = 0.903, p = 0.68), the alteration in vitamin D levels was suggestively linked with neuropathy (η = 0.975, p < 0.001).Vitamin D deficiency is prevalent among type 2 diabetic patients and is related to a higher occurrence of microvascular complications and poorer glycemic control. These findings underscore the potential importance of managing vitamin D levels in reducing complications and improving diabetes outcomes. Future studies should investigate whether oral vitamin D supplements consumption can improve glycemic control and reduce microvascular complications in these patients.

Prevalence and Risk Factors of Obesity Among Type 2 Diabetic Participants in Abha, Saudi Arabia: A Cross-Sectional Study

Background: The prevalence of obesity among type 2 diabetic participants is a growing concern globally, including in Abha, Saudi Arabia. This study aimed to investigate the prevalence and its associated risk factors of obesity among type 2 diabetic participants in Abha. Methods: A cross-sectional study targeted 400 type 2 diabetic participants in Abha, Saudi Arabia. A hybrid method (snowball sampling + purposive) techniques were used to obtain an adequate sample size. Data were collected after obtaining telephonic or digital consent; the questionnaire was shared with participants who were able and willing to complete it independently those with type 2 diabetes who wished to participate but were unable to complete the questionnaire on their own. The researcher conducted a telephonic interview and recorded their responses. The questionnaire captured demographic details, Anthropometric history, medical history, lifestyle habits, and type 2 Diabetes (T2DM) specific factors. Data were analyzed using IBM SPSS Statistics for Windows, Version 27.0. Results: The overall prevalence of obesity among the type 2 DM study participants was 46.0%, 115 participants (28.8%) fell into the Obesity Grade I category, 43 (10.8%) as Obesity Grade II, while 26 (6.5%) were classified as Obesity Grade III, the overall median BMI of participants was 29.3 ± 5.88. Significant bio-demographic factors associated with obesity included age, gender, educational level, marital status, and co-morbidities (p < 0.05). Notably, females and older adults exhibited higher obesity rates. Significant lifestyle factors included the frequency and type of physical activity, soft drink consumption, and attempts to control weight. Participants who exercised regularly and avoided soft drinks had lower obesity rates. Multiple logistic regression analysis identified age, gender, co-morbidities, family history of obesity, regular dinner consumption, soft drink consumption, and exercise frequency as significant predictors of obesity (p < 0.05). Conclusions: The study determined a high prevalence of obesity among type 2 diabetic participants in Abha, Saudi Arabia, with significant associations with bio-demographic and lifestyle factors. Interventions targeting weight management, physical activity, dietary habits, and health education are urgently needed to address obesity in this population. Further research is recommended to explore these associations longitudinally and to develop tailored intervention strategies.

Cardio-Metabolic Risk Profile of Women With Endometriosis: A Population-Based Study

AIMS

Endometriosis (EM) and metabolic disorders are frequent health problems among reproductive-aged women worldwide. Cardio-metabolic risk profile of women with EM is not well understood. We aimed to investigate the cardio-metabolic risk profile of Iranian reproductive-aged women with EM.

METHODS

This study included 976 female participants aged 20-45 years of Tehran Lipid and Glucose Study. Endometriosis was diagnosed based on the participants' self-reported previous diagnosis of EM, which was confirmed by reviewing the relevant medical documentation. All biochemical measures (low-density lipoprotein cholesterol [LDL], high-density lipoprotein cholesterol [HDL], triglycerides [TG], and fasting blood glucose concentrations [FBG]) and measurement of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and anthropometric parameters were performed according to the standard protocol of TLGS. Logistic regression analysis was performed to estimate the odds ratio of cardio-metabolic disease.

RESULTS

Of the 976 study participants, 161 individuals (16.5%) had a confirmed diagnosis of endometriosis. There were no significant differences in the median of metabolic parameters among women with and without endometriosis (p > 0.05). The prevalence of metabolic syndrome was significantly higher in women with EM group compared to the non-EM group (21.9% vs. 14.9%). The presence of endometriosis was associated with an increased odds of metabolic syndrome (adjusted odds ratio 1.99 [95% CI 1.20-3.30]; p = 0.007). And endometriosis significantly increased odds of low HDL by 2.07 (1.02-4.20); after adjustment, it still remained significant (p = 0.03). Endometriosis also increased odds of high waist circumstance significantly (1.58 [1.06-2.37]; p = 0.02).

CONCLUSIONS

Women with endometriosis may be at an increased risk of developing metabolic syndrome, high waist circumstance and low HDL compared to their counterparts without the condition. Given the potential cardio-metabolic implications, healthcare providers should consider assessing the metabolic profile of women diagnosed with endometriosis.

Association of dietary and lifestyle inflammatory indices with type 2 diabetes risk in Iranian adults

BACKGROUND

Type 2 diabetes mellitus (T2DM) is often linked to chronic inflammation, which can be influenced by both lifestyle and dietary choices. However, the relationship between the inflammatory potential of diet and lifestyle factors and the risk of developing T2DM remains unclear. The present study aimed to investigate the associations of the empirical dietary inflammatory index (EDII), dietary inflammatory score (DIS), and lifestyle inflammatory score (LIS) with the risk of T2DM among Iranian adults.

METHODS

The current study was conducted on 5714 individuals from Yazd Health Study (YaHS) who were followed up for a mean period of six years. YaHS is a prospective cohort study which has been conducted since 2014. Dietary intakes were collected at baseline using the food frequency questionnaire. The relative risk (RR) of T2DM was calculated by Cox regression analysis across tertiles of EDII, DIS, and LIS, adjusted for potential confounders.

RESULTS

The mean ± SD for the age and body mass index of the study population were 47.0 ± 9.2 years and 26.7 ± 5.1 Kg.m2, respectively. A significant association between LIS and the risk of T2DM was observed (RR: 4.05, 95% CI: 2.61-6.27 P-trend < 0.001). Individuals in the highest compared to the lowest tertile of EDII-LIS (RR: 3.07, 95%CI: 2.01-4.68; P for trend < 0.001) and DIS-LIS (RR: 2.42, 95%CI: 1.69-3.49; P for trend < 0.001) had a higher risk of T2DM. However, no significant association was found between EDII and DIS scores and the risk of T2DM.

CONCLUSION

Greater adherence to LIS, EDII-LIS, and DIS-LIS scores was associated with a higher risk of T2DM, while no significant association was found between EDII and DIS with T2DM risk.

Application of the path analysis model to evaluate the role of distress, mental health literacy and burnout in predicting self-care behaviors among patients with type 2 diabetes

INTRODUCTION

Mental complications of diabetes are one of the main obstacles to the implementation of self -care behaviors that have been less studied. Therefore, this study was conducted to survey the effective factors in predicting burnout and self-care behaviors among patients with type 2 diabetes.

METHODS

In this Path analysis, 1280 patients with type 2 diabetes were selected from Mashhad (Iran) in 2023 to 2024. Four scales, the mental health literacy (MHL) scale, diabetes burnout scale, diabetes distress scale, and self-care behavior scale were used for data gathering. AMOS software checked the direct and indirect paths between the variables.

RESULTS

In the path analysis, variables of MHL and diabetes distress predicted 25% variance of diabetes burnout (R2 = 0.25), and diabetes distress (total effect = 0.491) had the greatest impact on predicting diabetes burnout. Variables of MHL, diabetes distress, and diabetes burnout predicted 12% variance of Self-care behaviors (R2 = 0.12) and MHL (total effect = -0.256), age of onset of diabetes (total effect = 0.199), and diabetes burnout (total effect = - 0.167) had the greatest impact on prediction of self-care behaviors.

CONCLUSION

MHL could reduce diabetes distress and burnout and eventually promote self-care behaviors among patients with type 2 diabetes. Therefore, screening and identifying psychological problems (such as distress and burnout) and designing interventions to increase MHL can ultimately increase the health of patients with diabetes.