Projection of Diabetes Population Size and Associated Economic Burden through 2030 in Iran: Evidence from Micro-Simulation Markov Model and Bayesian Meta-Analysis

The impact of personality traits on medication adherence and self-care in patients with type 2 diabetes mellitus: The moderating role of gender and age

OBJECTIVES

This study aimed to investigate the role of the five-factor model of personality (FFM) and the moderating role of gender and age in predicting medication adherence (MA) and self-care behaviors (SCB) among Iranian patients with type 2 diabetes mellitus (T2DM).

METHODS

This study was conducted on 495 patients with T2DM (73.5% female; n = 364) from two major cities of Iran (Tehran and Qom) in 2019. Pearson's correlation coefficient, multiple regression analysis, and conditional process analysis were performed. P < .05 and P < .10 were considered significant for the relationships and moderation analysis, respectively.

RESULTS

Neuroticism indicated a negative association with MA and SCB. Positive associations were found between MA and personality traits, including extraversion, agreeableness, and conscientiousness, whereas extraversion showed a weak correlation with SCB. According to the covariate-adjusted regression model, neuroticism had a negative effect on MA and SCB. Agreeableness had a positive effect on MA and a negative effect on SCB. However, extraversion exerted a negative effect on MA and a positive effect on SCB. Also, the negative effect of neuroticism on MA was highlighted in women, indicating marginally significant moderation effect. The positive effects of extraversion and conscientiousness on MA were moderated by age. The effect of conscientiousness on SCB was positive in young patients and negative in old patients. No interaction effect was observed between age and gender.

CONCLUSION

This study indicated that neuroticism, extraversion, and agreeableness significantly contributed to MA, but not to SCB. However, the effects were conditioned by age for extraversion and conscientiousness to some extent.

Small Molecule Differentiate PDX1-Expressing Cells Derived from Human Endometrial Stem Cells on PAN Electrospun Nanofibrous Scaffold: Applications for the Treatment of Diabetes in Rat

In this study, we designed an engineered tissue and transplanted it to an animal model, trying to take an effective step toward meeting the needs of diabetic patients. Here, human endometrial cells were differentiated into PDX1-expressing cells using a small molecule of Y-27632 on polyacrylonitrile (PAN) electrospun scaffolds and transplanted into diabetic rats. PAN nanofibers were made by electrospinning. RT-PCR and immunocytochemical analysis were performed to express pancreatic precursor (PP) genes. The differentiated cells were then transplanted into the abdominal cavity of diabetic rats with Streptozotocin. In another group of rats, differentiated cells were injected through the tail. Blood glucose was measured 7, 14, and 28 days after transplantation, and rat weight was also measured. The results showed that the expression of PP markers including Sox-17, Ngn3, Pdx1, and NKx2.2 genes was significantly increased in differentiated cells compared to the control group. In diabetic rats receiving differentiated cells, both transplanted and injected, glucose concentration as well as body weight improved compared to the control group. Rats receiving transplants in the peritoneum had a lower blood glucose concentration than those in the cell receiving group by injection, and the cell receiving group in the form of injections was more effective in increasing the body weight of rats than in the other groups. According to the results of the study, the transplantation of PP from endometrium using PAN scaffolding at the site of peritoneum could be recommended for the treatment of diabetes, although further studies are needed to provide a complete cure.

Comparison of SF-36 and WHOQoL-BREF in Measuring Quality of Life in Patients with Type 2 Diabetes

Objective

This study aimed to compare the quality of life (QoL) in patients with type 2 diabetes using two WHOQoL -BREF and SF-36 questionnaires in Iran.

Patients and Methods

In this cross-sectional study, 1847 patients with type 2 diabetes were recruited from rural health-care centers affiliated to Neyshabur County (Iran) in 2012. In addition to demographic information, two questionnaires WHOQoL-BREF and SF-36 questionnaires were used for data collection. Cronbach’s alpha coefficient was used for scale reliability. We conducted an exploratory factor analysis for the investigation of construct validity. Convergent and discriminant validity were analyzed using Spearman correlation coefficient. To determine the relationships between the eight domains of SF-36 and four domains of the WHOQoL-BREF, structural equation modelling was performed.

Results

Cronbach’s alpha coefficients were acceptable for all domains of both WHOQoL-BREF (0.69–0.86) and SF-36 (0.63 −0.92) questionnaires. The principal component analysis showed two separate factors: one for all domains of SF-36 and another for all domains of WHOQoL-BREF. Spearman correlation coefficients of both instruments were partly to strongly correlated with most domains (r ≥0.40). Correlations for domains with similar constructs were stronger than those measuring varied constructs. Structural equation modelling recommended approximately moderate relationships among the SF-36 and WHOQoL-BREF domains.

Conclusion

Our study suggests that SF-36 and WHOQoL-BREF are reliable instruments for clinical and research uses, respectably. However, results of the goodness of fit showed that the WHOQoL-BREF was fitted well. Also, the WHOQoL-BREF can be considered more suitable for the study population.

Aldose reductase (AC)n gene polymorphism in Iranian patients with type 2 diabetic microangiopathy; a case-control study

Aim

(AC)n promoter region of the aldose reductase (ALR) genes polymorphism has been associated with diabetic microvascular complications (MVCs). The aim of this study was to find the relationship between dinucleotide repeat (AC)n polymorphisms of the ALR gene and the occurrence of MVCs, such as diabetic retinopathy, neuropathy, and nephropathy in Iranian type 2 diabetic (T2D) patients.

Methods

This prospective case-control study was performed on T2D patients who were categorized into two groups based on the presence or absence of diabetic microangiopathy. All patients were provided informed consent. After extracting genomic DNA, the (AC)n of the ALR gene was determined using Polymerase chain reaction (PCR).

Results

Thirteen alleles of the (AC)n gene polymorphism were detected including Z + 16, Z + 14, Z + 8, Z + 6, Z + 4, Z + 2, Z, Z - 2, Z - 4, Z - 6, Z - 8, Z - 10, and Z - 12. The frequency of the Z - 4 allele was significantly higher in patients with retinopathy, nephropathy, and autonomic neuropathy compared with those with long-term uncomplicated diabetes (P < 0.001, P < 0.001, P = 0.031, respectively). After controlling for baseline risk factors, we found that the carrier of the Z - 4 allele of ALR (AC)n polymorphism had a higher risk of diabetic retinopathy and diabetic nephropathy (P < 0.001). The homozygosity for the Z - 4 allele was found to be associated with diabetic microangiopathy.

Conclusion

Our results showed that ALR (AC)n gene polymorphism in Iranian patients with type 2 diabetes independently, predispose retinal, renal and neural microvascular to diabetic complications.

Assessing health-care needs of patients with diabetes in Iran's health-care system: A modified Delphi method study

INTRODUCTION

Due to the increasing prevalence of diabetes in the world, the assessment of the patient needs is essential. Understanding the needs of patients will play a very important role in providing an effective training program for patients. This study aimed to explain the health-care needs of patients with diabetes in Iran's health-care system.

MATERIALS AND METHODS

The present study was conducted using a modified Delphi technique in three rounds in 2017-2018. In the first round, patients' needs were extracted based on qualitative interviews and a review of the literature. Then, the second and third rounds were determined through surveys, achieving maximum consensus and grading the importance of the patients' basic needs. Participants selected using purposeful sampling and included 58 diabetes patients, family, and providers of the health system who were referred to urban health centers, rural, and one of the clinics of Darreh Shahr, Ilam Province. For data analysis, qualitative content analysis was used in the first Delphi round and descriptive statistics were used in the second and third rounds.

RESULTS

Regarding health-care needs of patients with diabetes, four main themes included: information and knowledge needs, need for reinforcement/reform of religious-cultural beliefs, need for health self-management, and ultimately supportive needs have emerged.

CONCLUSIONS

According to the results, before designing and developing effective educational programs, the need assessment to improve knowledge, correcting unrealistic attitudes and beliefs, as well as modifying their self-care behaviors and performance in preventing diabetes is recommended.

Efficacy and safety of duloxetine and Pregabalin in Iranian patients with diabetic peripheral neuropathic pain: a double-blind, randomized clinical trial

Purpose

Diabetic peripheral neuropathic pain (DPNP) is one of the most sufferings, disabling, and dominant complications of diabetes. Duloxetine (DLX) and Pregabalin (PGB) are among first-line therapy and the most prescribed drugs for DPNP relief. The effectiveness-risk profile of drugs may differ from region to region due to variations in genetic and health situation of populations. This study aims to evaluate the efficacy and safety of DLX and PGB in a sample of Iranian population with DPNP.

Methods

A double-blind, randomized clinical trial was conducted on 180 type-2 diabetic patients with DPNP≥40 mm according to Visual Analogue Scale (VAS), with other eligibility criteria throughout twelve weeks. We divided the patients randomly into two equal groups: DLX and PGB. Each patient received ten days placebo as a washout period, then blind capsules of DLX (group 1) or PGB (group 2). We assessed the efficacy and safety of drugs by VAS and recorded the Adverse Drug Reactions (ADRs) during the study.

Results

In the DLX group, sixty-six and the PGB group, seventy-eight patients completed the study. The intensity of patients’ pain was improved by both drugs significantly (p˂0.001), but there was no significant difference between the two groups. Average daily doses of DLX and PGB were 42.5 and 235.5 mg, respectively. In the DLX group, 74% of patients and the PGB group, 37% reported ADRs. The discontinuation rates due to ADRs were 19% and 7% correspondingly.

Conclusion

We found that in Iranian patients, the mean effective doses of these drugs are different in comparison with several other studies. Surprisingly intolerance and discontinuation of DLX in our patients were attributed to mild and severe Serotonin Syndrome, which had not much occurred in other studies. Accordingly, despite the same efficacy, PGB was better tolerated than DLX in our patients. Thus we would recommend PGB for DPNP treatment in Iranian patients.

A multidisciplinary team approach in Iranian diabetic foot research group

Diabetic Foot (DF) as a common complication of Diabetes needs to intensive intervention for prevention, management and rehabilitation. In this regard, the Iranian Diabetic Foot Research Group (IDFRG) of Diabetes Research Center of Endocrinology and Metabolism Research Institute (EMRI) of Tehran University of Medical Sciences (TUMS) with multi-disciplinary approach have begun its activity since 2014. The aim of this paper is introducing the IDFRG in four main categories including Education, Research, Knowledge Translation and Clinical Care. According to the strategic plan, Future activities would be considered as five following areas: National Diabetic Foot Research Network (NDFRN) Establishment, Podiatrist Curriculum Development, Iranian Diabetic Foot Registry System (IDFRS) Launch, DF guideline Implementation and last but not least DF Ward Establishment.

NPWT: a gate of hope for patients with diabetic foot ulcers

Non-healing diabetic foot ulcers are a common and costly complication of type 2 diabetes and can result in lower extremity amputation. This case study concerns a 51-year-old man with a 17-year history of uncontrolled type 2 diabetes. He had developed a deep ulcer to the calcaneus of his left foot, which was 12x7 cm in size and infected with multi-drug-resistant Staphylococcus aureus. He was admitted to hospital for the non-healing diabetic foot ulcer and uncontrollable fever and was a candidate for amputation. He was treated with wound irrigation and debridement as well as negative-pressure wound therapy and antibiotic treatment. This strategy was effective and the wound size reduced progressively. The patient recovered well. Medical and wound care teams who deal with non-healing diabetic foot ulcers can benefit from a strategy of combination therapy.

Numerical Study on Stochastic Diabetes Mellitus Model with Additive Noise

This article focuses on the numerical analysis and simulation of the stochastic diabetes mellitus model with additive noise. The existence and uniqueness theorem of the solution under some appropriate assumptions is established. And, the mean square stability and convergence of numerical solutions are proposed, too. The practical use of these theorems is demonstrated in the numerical computations of the stochastic diabetes mellitus model and the value for the forecast of the tendency of diabetes mellitus in a given time.

The correlation between blood oxidative stress and sialic acid content in diabetic patients with nephropathy, hypertension, and hyperlipidemia

This clinical study was designed to find out the correlation between oxidative stress and sialic acid (SA) content of plasma and RBCs in patients with type 2 diabetes. We evaluated SA concentration and oxidative stress biomarkers in healthy subjects and diabetic patients with and without complications in a cross-sectional survey. Significant changes in oxidative stress biomarkers and RBC-SA were revealed in the diabetic patients compared to those in the healthy group. Plasma SA significantly increased with an increase in lipid peroxidation of RBCs (LPO-RBC) (P < 0.001) in the diabetic patients without complication. RBC-SA significantly decreased with an elevation in LPO-RBC (P < 0.001) in all the diabetic patients and those with nephropathy. There was no significant correlation between plasma and RBC-SA and other oxidative stress biomarkers in the diabetic subjects. In multiple logistic regression analysis, RBC-SA was independently related to LPO-RBC in all the diabetic patients and those with nephropathy. We conclude that the induction of LPO-RBC in diabetic patients and those with nephropathy may influence the SA decomposition of RBC membrane, thereby altering its functions and transporter activities. Therefore, LPO-RBC and SA levels in RBCs can be used for prediction of diabetic nephropathy, and further studies to evaluate other factors contributing to desialylation of RBC membrane are justified.

Factors associated with therapeutic target achievement in the control of complications in consequence of diabetes: A hospital-based study in west of Iran

BACKGROUND AND AIM

The goal of diabetes management is to enhance the performance of the surveillance system to perpetuate optimal blood sugar, blood pressure and cholesterol levels in the normal values. This paper aimed to identify factors associated with therapeutic target achievement in the control of complications in consequence of diabetes.

METHODS

In this cross-sectional study, a secondary analysis was performed on data obtained in the surveillance center of patients referred to in Makoo city, West Azerbaijan Province. The main interested variables included Fasting Blood Sugar (FBS), HbA1c, triglycerides, cholesterol, Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL) diastolic and systolic blood pressure, duration of diabetes, family history of diabetes, early and late complications of diabetes, treatment received, history of smoking.

RESULTS

Average age of the patients with diabetes mellitus, insulin-dependent was 35.43 (SD = 17.25) and in patients of diabetes mellitus 53.37 (SD = 10.89), which was significantly different (p-value = 0.001). Frequency amount of fasting blood sugar in diabetes mellitus, insulin-dependent and diabetes mellitus, type II was 64.30% and 66.0%, respectively. Only 19.0% of patients with diabetes mellitus, insulin-dependent and 13.90% of diabetes mellitus, type II breached to the optimum level of blood glucose control.

CONCLUSIONS

This study found that a considerable proportion of subjects with diabetes mellitus, insulin-dependent and diabetes mellitus, type II did not achieve the goals of care guidelines of Iran on secondary prevention of complications related to diabetes, especially vascular complication.

Modeling a Telemedicine Screening Program for Diabetic Retinopathy in Iran and Implementing a Pilot Project in Tehran Suburb

PURPOSE

To model a community-based telescreening program for diabetic retinopathy (DR) in Iran and to implement a pilot project at the Iranian Diabetes Society (IDS) branch in a Tehran suburb.

METHODS

In this mixed model study, a web application called the "Iranian Retinopathy Teleophthalmology Screening (IRTOS)" was launched. The educational course for DR screening was established for general practitioners (GPs). Registered patients in IDS branch were recalled for fundus photography; images were transferred to the reading center via IRTOS to be graded by GPs, and patients were informed about the results via mobile messaging. All images were independently reviewed by a retina specialist as the gold standard. Patients who required further assessment were referred to an eye hospital.

RESULTS

Overall, 604 subjects with diabetes were screened; of these, 50% required referral. The sensitivity and specificity for diagnosis of any stage of DR by trained GPs were 82.8% and 86.2%, respectively, in comparison to the gold standard. The corresponding values for detecting any stage of diabetic macular edema (DME) were 63.5% and 96.6%, respectively.

CONCLUSIONS

Telescreening was an effective method for detecting DR in a Tehran suburb. This screening model demonstrated its capacity for promoting diabetic eye care services at the national level. However, the sensitivity for detecting DME needs to be improved by modifying the referral pathway and promoting the skill of GPs.

The incidence rate of diabetes mellitus (type II) and its related risk factors: A 10-year longitudinal study of Yazd Healthy Heart Cohort (YHHC), Iran

BACKGROUND AND OBJECTIVES

Diabetes Mellitus (DM) is a metabolic disease characterized by chronic hyperglycemia, which occurs due to insufficient production of insulin by the pancreas or resistance to insulin produced by the body. The most dangerous and Long-term complications of diabetes include renal failure, heart failure, cardiovascular disease, stroke, diabetic foot ulcers, and diabetic neuropathy.

MATERIALS AND METHODS

This longitudinal cohort study was conducted on 1641 non-diabetic people of 2000 participants enrolled in phase I of Yazd Healthy Heart project (YHHP) aged 20-74 year-old resident of the city of Yazd. They were selected randomly through cluster sampling method and included in follow up a project for ten years (2004-2014). In order to analyze the data, Chi-Square, independent t-test and logistic regression statistical models were used through the SPSS Ver₂₀.

RESULTS

The incidence rate of DM type II among the people aged 20-74 years in Yazd was 21.4 per 1000 of a population-year. Univariate analysis revealed that the relative risk of DM incidence increased by smoking, increasing BMI, abdominal obesity, hypertension, and increased cholesterol, triglyceride and uric acid levels (p < 0.0001). Variables with a significant p-value < 0.05 using the univariate analysis were included in the logistic regression model. Age, family history of diabetes mellitus in relatives, abdominal obesity, triglyceride values greater than 150 and uric acid more than the 75th percentile were recognized as independent risk factors of diabetes.

CONCLUSION

In the present study, Age, family history of DM, abdominal obesity, high triglycerides, and high uric acid are the most important risk factors for diabetes.

Prevalence of stunting in Iranian children under five years of age: Systematic review and meta-analysis

Background: Children in all countries, especially in developing countries, constitute a vulnerable group. Therefore, attention to their health issues is very important. The aim of this study was to determine the prevalence of stunting in Iranian children under-five years. Methods: All original studies were searched by complex search syntax from international databases including Medline (PubMed), Web of sciences, Google scholar, Scopus, CINHAL and the Iranian databases consist of SID (Scientific Information Database, www.sid.ir), Irandoc (Iranian Research Institute for Information Science and Technology, Irandoc.ac.ir), Iranmedex (www.iranmedex.com), and Magiran (www.magiran.com) from January 1989 to August 2017. Two independent reviewers identified relevant studies in several steps. We employed a random effect model to generate a pooled prevalence. The reported prevalence is presented as percent and 95% confidence interval (CI). Sources of heterogeneity among the studies were determined using subgroup analysis and meta-regression. Results: Finally, 16 studies from different settings remained for meta-analysis in order to have a pooled prevalence estimate, which prevalence of total stunting was 12% (95%CI: 10-14). Subgroup analysis for gender showed that the prevalence of stunting in both boys and girls children were equal to 10% (95%CI: 8-11) and 9% (CI 95% 8-10), respectively. Also pooled prevalence of stunting in southern provinces are higher than other provinces. Conclusion: The prevalence of stunting in some regions of Iran is higher than others. Although, in recent years much effort has been made to address deprivation such as economical, nutritional and social supporting, improvement of the quality of life, there are still nutritional problems in these areas of Iran.

Projection of Diabetes Prevalence in Korean Adults for the Year 2030 Using Risk Factors Identified from National Data

BACKGROUND

A number of studies have reported future prevalence estimates for diabetes mellitus (DM), but these studies have been limited for the Korean population. The present study aimed to construct a forecasting model that includes risk factors for type 2 DM using individual- and national-level data for Korean adults to produce prevalence estimates for the year 2030.

METHODS

Time series data from the Korea National Health and Nutrition Examination Survey and national statistics from 2005 to 2013 were used. The study subjects were 13,908 male and 18,697 female adults aged 30 years or older who were free of liver cirrhosis. Stepwise logistic regression analysis was used to select significant factors associated with DM prevalence.

RESULTS

The results showed that survey year, age, sex, marital, educational, or occupational status, the presence of obesity or hypertension, smoking status, alcohol consumption, sleep duration, psychological distress or depression, and fertility rate significantly contributed to the 8-year trend in DM prevalence (P<0.05). Based on sex-specific forecasting models that included the above factors, DM prevalence for the year 2030 was predicted to be 29.2% (95% confidence interval [CI], 27.6% to 30.8%) in men and 19.7% (95% CI, 18.2% to 21.2%) in women.

CONCLUSION

The present study projected a two-fold increase in the prevalence of DM in 2030 compared with that for the years 2013 and 2014 in Korean adults. Modifiable factors contributing to this increase in DM prevalence, such as obesity, smoking, and psychological factors, may require attention in order to reduce national and individual costs associated with DM.

Economic Impact of Diabetes in Japan

PURPOSE OF REVIEW

The economic burden of diabetes in Japan is already serious and will become greater in the future. We review the economic impact of diabetes in Japan to examine viable options for mitigating its effects.

RECENT FINDINGS

Medical costs for diabetes have been increasing by US $1 million annually, reaching US $11 million in 2009, of which US $7 million was accounted for by people aged 65 years or older. The quality of treatment of diabetes in Japan is higher than in other regions in the world. This can be more effective for achieving glycemic control, but is also more expensive compared with conventional treatment. Because of the high cost of diabetes in Japan, a coordinated response is needed. Intervention trials for people with prediabetes aimed at preventing the occurrence of diabetes seem to be the most cost-effective method for lowering the medical costs of diabetes, rather than the use of new, expensive antidiabetic drugs in patients with established diabetes.

Prevalence, Awareness, Treatment, Control, and the Associated Factors of Diabetes in an Iranian Kurdish Population

AIMS

This study is aimed at estimating the prevalence, awareness, treatment, and glycemic control of diabetes mellitus (DM) and its associated factors in an Iranian Kurdish population.

METHODS

Baseline data of the Ravansar Non-communicable Disease (RaNCD) cohort study, consisting of adults aged 35-65 years, were used. Diabetes was defined as a fasting plasma glucose (FPG) of 126 mg/dl or higher, being on diabetes medication, and/or diabetes confirmed by a health practitioner.

RESULTS

Nine thousand nine hundred ninety-nine participants were assigned to this study. The prevalence of DM, awareness, treatment, and glycemic control of DM were 8.19, 74.97, 74.75, and 32.68, respectively. Based on the adjusted models, increased age (p < 0.01); obesity or overweight (p < 0.01); being ex-smoker (p < 0.05); suffering from dyslipidemia (p < 0.01), hypertension (p < 0.01), or both of them (p < 0.01); and positive family history in the first-degree relatives (p < 0.01) were strongly associated with a high risk of DM, while engagement in regular physical activity (p < 0.05) was a protective factor. Female gender (p < 0.01), being older than 55 years, positive family history in the first-degree relatives (p < 0.01), suffering from both hypertension and dyslipidemia (p < 0.01), and obesity or overweight (p < 0.005) were negatively associated with DM awareness. Being married and widowed (p < 0.05 and <0.05) and a high BMI (p < 0.01) were strong predictors of receiving treatment for DM. Six to nine years of schooling (p < 0.05) and suffering from hypertension (p < 0.05) increased the probability of DM being controlled.

CONCLUSIONS

When the prevalence of DM is notable, awareness and probability of receiving treatment and controlling FPG are of particular importance. A considerable proportion of the patients were aware and on treatment, which may partly be due to improving primary health care services in Iran.

Behavioral and familial predictors of diabetes mellitus in adults aged 20-69 in Yazd, Iran during 2014-2015

INTRODUCTION

The present study aimed to assess the behavioral and familial predictors of diabetes mellitus as well as their interaction in the risk of diabetes mellitus type2.

METHODS

The present cross-sectional study was conducted using the Yazd health study (YaHS) data which was collected in 2013-14. Statistical population of this study consisted of all 9340 individuals aged between 20 and 69 in Yazd City. Logistic regression was used to determine behavioral factors and family history of diabetes and their interaction in the risk of diabetes.

RESULTS

In the present study, age, family history of type 2 diabetes, waist-to-hip ratio, BMI, educational level, physical activity and smoking were considered as the risk factors for type 2 diabetes.There was a significant interaction(negative interaction) between family history of diabetes and other risk factors only for BMI, so that the risk of developing type-2 diabetes was lower in the presence of two risk factors- family history of diabetes and BMI- than the risk of diabetes in the presence of each of these factors.

CONCLUSION

Results of the present study suggested that despite the consideration of family history as an independent risk factor for type 2 diabetes, if it was used as a tool to raise the awareness and sensitivity in people with type 2 diabetes, it would reduce the risk of developing this type of diabetes in people who had other risk factors for type 2 diabetes.

General health status in Iranian diabetic patients assessed by short-form-36 questionnaire: a systematic review and meta-analysis

BACKGROUND

Diabetes mellitus is one of the most prevalent diseases worldwide. Diabetes is a chronic disease associated with micro- and macro-vascular complications and deterioration in general health status. Therefore, the aim of this study was to estimate general health status among Iranian diabetic patients through a systematic review and meta-analysis of study utilizing the Short-Form-36 questionnaire.

METHODS

Searching the EMBASE, PubMed, ISI/Web of Sciences (WOS), MEDLINE via Ovid, PsycoINFO, as well as Iranian databases (MagIran, Iranmedex, and SID) from January 2000 to December 2017. The methodological quality of the studies was evaluated using the "A Cochrane Risk of Bias Assessment Tool: for Non-Randomized Studies of Interventions" (ACROBAT-NRSI). Random-effect model was used and the means were reported with their 95% confidence interval (CI). To evaluate the heterogeneity between studies, I² test was used. Egger's regression test was used to assess the publication bias.

RESULTS

Fourteen studies were retained in the final analysis. The mean general health status using SF-36 in diabetic patients of Iran was 51.9 (95% CI: 48.64 to 53.54). The mean physical component summary was 52.92 [95% CI: 49.46-56.38], while the mean mental component summary was 51.02 [95% CI: 46.87-55.16].

CONCLUSION

The findings of this study showed that general health status in Iranian diabetic patients is low. Health policymakers should work to improve the health status in these patients and take appropriate interventions.

Global Economic Burden of Diabetes in Adults: Projections From 2015 to 2030

OBJECTIVE

Despite the importance of diabetes for global health, the future economic consequences of the disease remain opaque. We forecast the full global costs of diabetes in adults through the year 2030 and predict the economic consequences of diabetes if global targets under the Sustainable Development Goals (SDG) and World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases 2013-2020 are met.

RESEARCH DESIGN AND METHODS

We modeled the absolute and gross domestic product (GDP)-relative economic burden of diabetes in individuals aged 20-79 years using epidemiological and demographic data, as well as recent GDP forecasts for 180 countries. We assumed three scenarios: prevalence and mortality 1) increased only with urbanization and population aging (baseline scenario), 2) increased in line with previous trends (past trends scenario), and 3) achieved global targets (target scenario).

RESULTS

The absolute global economic burden will increase from U.S. $1.3 trillion (95% CI 1.3-1.4) in 2015 to $2.2 trillion (2.2-2.3) in the baseline, $2.5 trillion (2.4-2.6) in the past trends, and $2.1 trillion (2.1-2.2) in the target scenarios by 2030. This translates to an increase in costs as a share of global GDP from 1.8% (1.7-1.9) in 2015 to a maximum of 2.2% (2.1-2.2).

CONCLUSIONS

The global costs of diabetes and its consequences are large and will substantially increase by 2030. Even if countries meet international targets, the global economic burden will not decrease. Policy makers need to take urgent action to prepare health and social security systems to mitigate the effects of diabetes.

The Predictive Effects of Protection Motivation Theory on Intention and Behaviour of Physical Activity in Patients with Type 2 Diabetes

INTRODUCTION:

Theory-based education tailored to target behaviour and group can be effective in promoting physical activity.

AIM:

The purpose of this study was to examine the predictive power of Protection Motivation Theory on intent and behaviour of Physical Activity in Patients with Type 2 Diabetes.

METHODS:

This descriptive study was conducted on 250 patients in Rafsanjan, Iran. To examine the scores of protection motivation theory structures, a researcher-made questionnaire was used. Its validity and reliability were confirmed. The level of physical activity was also measured by the International Short - form Physical Activity Inventory. Its validity and reliability were also approved. Data were analysed by statistical tests including correlation coefficient, chi-square, logistic regression and linear regression.

RESULTS:

The results revealed that there was a significant correlation between all the protection motivation theory constructs and the intention to do physical activity. The results showed that the Theory structures were able to predict 60% of the variance of physical activity intention. The results of logistic regression demonstrated that increase in the score of physical activity intent and self - efficacy increased the chance of higher level of physical activity by 3.4 and 1.5 times, respectively OR = (3.39, 1.54).

CONCLUSION:

Considering the ability of protection motivation theory structures to explain the physical activity behaviour, interventional designs are suggested based on the structures of this theory, especially to improve self -efficacy as the most powerful factor in predicting physical activity intention and behaviour.

Diabetes Care in Iran: Where We Stand and Where We Are Headed

BACKGROUND

The prevalence of diabetes has steadily increased in Iran from the time of the first published nationally representative survey in 1999 and despite efforts and strategies to reduce disease burden.

OBJECTIVES

The aim of the present review was to describe the current status of diabetes care in Iran.

METHODS

A selective review of the relevant literature, focusing on properly conducted studies, describing past and present diabetes care strategies, policies, and outcomes in Iran was performed.

FINDINGS

The quality of diabetes care has gradually improved as suggested by a reduction in the proportion of undiagnosed patients and an increase in affordability of diabetes medications. The National Program for Prevention and Control of Diabetes has proven successful at identifying high-risk individuals, particularly in rural and remote-access areas. Unfortunately, the rising tide of diabetes is outpacing these efforts by a considerable margin.

CONCLUSIONS

Substantial opportunities and challenges in the areas of prevention, diagnosis, and management of diabetes exist in Iran that need to be addressed to further improve the quality of care and clinical outcomes.

Diabetes in Iran: Prospective Analysis from First Nationwide Diabetes Report of National Program for Prevention and Control of Diabetes (NPPCD-2016)

We estimated proportions of different types of diabetes, comorbidities, treatment (the use of oral glucose-lowering agents and insulin), control (hyperglycemia, dyslipidemia and hypertension) and chronic microvascular and macrovascular complications among people with diabetes presenting to the tertiary-care academic diabetes outpatient clinics in Iran. This study is the prospective analysis of data (n = 30,202) from the registry of university-affiliated adult outpatient diabetes clinics in the country during 2015-2016. The proportions of type 1 diabetes, types 2 diabetes, and other types of diabetes were 11.4%, 85.5%, and 1.3%, respectively. The frequencies of drug-naivety, use of oral agents, insulin monotherapy and insulin combination therapy were 2.9%, 60.5%, 11.5%, and 25.1%, respectively. Around 13.2%, 11.9% and 43.3% of patients with diabetes had controlled hyperglycemia, hyperlipidemia and hypertension, respectively. The proportions of retinopathy, nephropathy, peripheral neuropathy, diabetic foot, and ischemic heart disease were 21.9%, 17.6%, 28.0%, 6.2%, and 23.9%, respectively. Despite the wide availability of medications and insulin coverage in Iran, the estimated national control of hyperglycemia, hyperlipidemia and hypertension (especially for young men and old women) remains subpar. The present study further suggests that the frequencies of chronic vascular complications among patients with diabetes are relatively high in Iran.

Current and future economic burden of diabetes among working-age adults in Asia: conservative estimates for Singapore from 2010-2050

Background

Diabetes not only imposes a huge health burden but also a large economic burden worldwide. In the working-age population, cost of lost productivity can far exceed diabetes-related medical cost. In this study, we aimed to estimate the current and future indirect and excess direct costs of diagnosed type 2 diabetes among the working-age population in Singapore.

Methods

A previously-published epidemiological model of diabetes was adapted to forecast prevalence among working-age patients with diagnosed type 2 diabetes in the absence of interventions. The current methodology of the American Diabetes Association was adopted to estimate the costs of diabetes for this population. Diabetes-related excess direct medical costs were obtained from a local cost study while indirect costs were calculated using the human capital approach applied to local labor force statistics. These cost were estimated conservatively from a societal perspective on a per patient basis and projected to the overall Singapore population from 2010 to 2050.

Results

In 2010, total economic costs per working-age patient were estimated to be US$5,646 (US$4,432-US$10,612), of which 42 % were excess direct medical costs and 58 % indirect productivity-related losses. Total cost is projected to rise to US$7,791 (US$5,741-US$12,756) in 2050, with the share of indirect costs rising to 65 %. Simultaneous increases in prevalence imply that the total economic costs of diabetes for the entire working-age population will increase by 2.4 fold from US$787 million in 2010 to US$1,867 million in 2050.

Conclusions

By current projections, diabetes in Singapore represents a growing economic burden. Among the working-age population, the impact of productivity loss will become increasingly significant. Prevention efforts to reduce overall prevalence should also engage stakeholders outside the health sector who ultimately bear the indirect burden of disease.