Prevalence and determinants of diabetes and prediabetes in southwestern Iran: the Khuzestan comprehensive health study (KCHS)

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

Background

Diabetes mellitus (DM) poses a significant threat to public health, and the anticipated surge of over 100% in the age-standardized prevalence of type 2 diabetes in Iran between 2021 and 2050 underscores the pressing need for focused attention. The rationale for estimating the prevalence of type 2 diabetes in Iran becomes even more compelling when considering the potential cascading effects on the healthcare system, quality of life, and economic burden. The aim of this study was to estimate the prevalence and trends of DM from 1996 to 2023 in the Islamic Republic of Iran.

Methods

Up to July 2023, without deadlines, the search for appropriate articles in Persian and English. Iranian sources including SID, Magiran, and Element were included in the databases, along with foreign ones like PubMed/MEDLINE, Web of Science, Science Direct, Embase, Scopus, ProQuest, and Google Scholar. Using the JBI quality checklist, the study's level of quality was evaluated. Version 14 of STATA was used to carry out the statistical analysis. The Dersimonian and Liard random-effects models were used because of heterogeneity. To investigate the causes of heterogeneity, subgroup analysis and univariate meta-regression were utilized. Sensitivity analysis was then carried out to see how each study's findings affected the final findings. The prevalence pattern over time was also followed using cumulative meta-analysis.

Results

There were 53 studies in all, with a combined sample size of 1,244,896 people. Men were predicted to have a type 2 diabetes prevalence of 10.80% (95% CI: 9.1-12.4), while women were assessed to have a prevalence of 13.4% (95% CI: 11.6-15.3). Additionally, the prevalence of diabetes was much higher in the 55-64 age group, coming in at 21.7% (95% CI: 17.5-25.0). The anticipated prevalence of diabetes was 7.08% for 1988 to 2002, 9.05% for 2003 to 2007, 9.14% for 2008 to 2012, 15.0% for 2013 to 2017, and 13.40% for 2018 to 2023, among other time periods. Geographically, type 2 diabetes was most prevalent in Khuzestan (15.3%), followed by Razavi Khorasan (14.4%), Qazvin (14.3%), and Yazd (12.6%).

Conclusion

The prevalence of type 2 diabetes was estimated at 10.8%, highlighting variations across gender, age groups, and geographic regions that underscore the necessity for specific interventions. These findings advocate for proactive measures, including tailored screening and lifestyle modification programs. The notable temporal increase from 2013 to 2017 signals the need for policymakers and healthcare practitioners to develop effective strategies, anticipating and addressing the potential future burden on the healthcare system.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023437506, identifier: CRD42023437506.

Age at natural menopause and development of chronic diseases in the female population of Kharameh, Iran: A historical cohort study

Background and Aims

Declines in estradiol levels after menopause have been reported to be associated with several health outcomes. This study aimed to determine the effect of age at natural menopause (ANM) on some of the most common chronic diseases.

Methods

This historical cohort study was performed on 2636 postmenopausal women aged 40-70 years participating in phase one of the PERSIAN cohort study in Kharameh, Iran, during 2015-2017. The effect of early (<45 years), intermediate (45-53 years), and late menopause (>53 years) on chronic diseases such as hypertension, diabetes, ischemic heart diseases, stroke, thyroid diseases, and depression was assessed using classic logistic regression for diseases with an incidence rate of more than 10% and Firth's logistic regression for diseases with an incidence of less than this amount.

Results

The mean age of women was 53.48 ± 8.59. Respectively, early and intermediate menopause was associated with ischemic heart disease (odds ratio [OR = 1.61, 95% confidence interval [CI]: 1.08-2.42; p = 0.020), (OR = 1.57, 95% CI: 1.13-2.21; p = 0.008) and thyroid diseases (OR = 3.10, 95% CI: 1.64-6.24; p < 0.001), (OR = 1.83, 95% CI: 1.02-3.57; p = 0.042). furthermore, early menopause was a risk factor for diabetes (OR = 1.46, 95% CI: 1.07-2.00; p = 0.018), depression (OR = 4.79, 95% CI: 2.20-11.79; p = <0.001) and stroke (OR = 3.00, 95% CI: 1.08-9.32; p = 0.034).

Conclusions

In this study, women with diabetes, ischemic heart diseases, stroke, thyroid disorders, and depression had a younger ANM compared to their healthy counterparts. Therefore, applying appropriate strategies to postpone the age of menopause, can reduce the incidence of these types of chronic diseases.

Prevalence of diabetes and its correlates among Iranian adults: Results of the first phase of Shahedieh cohort study

Background and Aims

The diabetes is one of the most common noncommunicable diseases, the prevalence of which is increasing worldwide. This study aimed to determine the prevalence, and correlates the factors of diabetes in the setting of Shahedieh cohort study in Yazd, Iran.

Method

The present study is a cross‐sectional study conducted on the data of the initial stage of Shahdieh Yazd cohort. This study examined the data of 9747 participants aged from 30 to 73 years. The data included demographic, clinical, and blood test variables. Multivariable logistic regression was used to calculate the adjusted odds ratio (OR), and the risk factors of diabetes were studied. Meanwhile, population attributable risks for diabetes were estimated, and reported.

Results

The prevalence of diabetes was 17.9% (CI95%: 17.1–18.9); 20.5% in women, and 15.4% in men. Based on the results of multivariable logistic regression showed female sex (OR = 1.4, CI95%: 1.24–1.58), waist‐hip ratio (OR = 1.4, CI95%: 1.24–1.58), high blood pressure (OR = 2.1, CI95%: 1.84–2.4), cardiovascular diseases (CVD) (OR = 1.52, CI95%: 1.28–1.82), stroke (OR = 1.91, CI95%: 1.24–2.94), age (OR = 1.81, CI95%: 1.67–1.96), hypercholesterolemia (OR = 1.79, CI95% triglyceride: 1.59–2.02), and low‐density lipoprotein (LDL) (OR = 1.45, CI95%: 1.4–1.51), as risk factors for diabetes. Among the modifiable risk factors, high blood pressure(52.38%), waist‐to‐hip ratio (48.19%), the history of stroke (47.64%), hypercholesterolemia (44.13%), history of CVD (34.21%), and LDL ≥ 130 (31.03%) had the greatest population‐attributable, respectively.

Conclusion

The results showed that some of the main determinants of diabetes are the modifiable risk factors. Therefore, implementing early detection, and screening programs for people at risk and preventive measures, such as lifestyle modification programs, and control of risk factors can prevent this disease.

A Review of Hyperglycemia in COVID-19

Diabetes mellitus (DM) is one of the most common chronic metabolic disorders worldwide, which increases the risk of common and opportunistic infections. Following the coronavirus disease 2019 (COVID-19) pandemic, a higher incidence rate, more severe forms of the disease, and exacerbation of hyperglycemia and its complications have been observed in patients with DM. Moreover, stress-induced hyperglycemia has been observed in many hospitalized nondiabetic patients after contracting COVID-19. Hyperglycemia worsens prognosis in both diabetic and nondiabetic patients. In this study, the mechanism of new-onset or exacerbation of hyperglycemia, the effect of the treatments used for COVID-19 on hyperglycemia, the importance and appropriate method of blood glucose (blood sugar (BS)) control during the disease, and the possible fate of new-onset hyperglycemia after recovery from COVID-19 to some extent is expressed.

Demographic variables, anthropometric indices, sleep quality, Metabolic Equivalent Task (MET), and developing diabetes in the southwest of Iran

Propose

The present study has sought to investigate the prevalence of diabetes and its related risk factors, to examine the relationship between demographic variables, anthropometric indices, sleep quality, and Metabolic Equivalent Task (MET) with diabetes in Khuzestan province, southwest Iran.

Methods

The present study has a cross-sectional design (the baseline data of the Hoveyzeh cohort study as a sub-branch of the Persian Prospective Cohort Study). Comprehensive information from 10,009 adults (aged 35–70 years) was collected from May 2016 to August 2018 through a multi-part general questionnaire containing general characteristics, marital status, education, smoking, sleep quality, MET, and anthropometric indices. Data analysis was performed by SPSS software version 19.

Results

The mean age of the sample was 52.97 ± 8.99 years. 60.3% of the population were women and 67.7% were illiterate. Out of the 10,009 people surveyed, 1,733 stated that they have diabetes (17%). In 1,711 patients (17%) the amount of FBS was ≥126 mg/dl. There is a statistically significant relationship between diabetes and MET. More than 40% had BMI above 30. Anthropometric indices in diabetic and non-diabetic individuals were different. Also, there was a statistically significant difference between the mean duration of sleep and the use of sleeping pills in diabetic and non-diabetic groups (p &lt; 0.05). Based on logistic regression, marital status [OR = 1.69 (95% CI, 1.24, 2.30)], education level [OR = 1.49 (95% CI, 1.22, 1.83)], MET [OR = 2.30 (95% CI, 2.01, 2.63)], height [OR = 0.99 (95% CI, 0.98, 0.99)], weight [OR = 1.007 (95% CI, 1.006, 1.012)], wrist circumference [OR = 1.10 (95% CI, 1.06, 1.14)], waist circumference [OR = 1.03 (95% CI, 1.02, 1.03)], waist-to-hip ratio [OR = 3.41 (95% CI, 2.70, 4.29)], and BMI [OR = 2.55 (95% CI, 1.53, 4.25)], are good predictors for diabetes.

Conclusion

The results of this study showed that the prevalence of diabetes in Hoveyzeh city, Khuzestan, Iran, was almost high. and emphasize that preventive interventions should focus on risk factors, especially socioeconomic status, and anthropometric indicators along with lifestyle.

The prevalence of left ventricular hypertrophy associated with type-2 diabetes in Shiraz, Iran: a cross-sectional study

BACKGROUND

Left ventricular hypertrophy (LVH) is a common diagnosis in patients with cardiovascular disease (CVD). The prevalence of LVH among patients with Type-2 Diabetes Mellitus (T2DM), high blood pressure and aging is higher than the healthy population and has been independently associated with an increased risk for future cardiac event, including stroke. The aim of this study is to identify the prevalence of LVH among T2DM subjects and evaluate its association with related risk factors of CVD patients in the metropolis of Shiraz, Iran. The novelty of this study is that there has been no known published epidemiological study related to the relationship of LVH and T2DM on this unique population.

MATERIALS AND METHOD

This cross-sectional study was designed based on collected data of 7715 free dwelling subjects in the community-based Shiraz Cohort Heart Study (SCHS) from 2015 to 2021, ages 40-70 years. Overall, 1118 subjects with T2DM were identified in the SCHS and after exclusion criteria, 595 subjects remained eligible for study. Subjects with electrocardiography (ECG) results, which are appropriate and diagnostics tools, were evaluated for the presence of LVH. Thus, the variables related to LVH and non-LVH in subjects with diabetes were analyzed using version-22 statistical package for social sciences software program to ensure consistency, accuracy, reliability, and validity for final analysis. Based upon related variables and identifying LVH and non-LVH subjects, the relevant statistical analysis was implemented to ensure its consistency, accuracy, reliability, and validity for final analysis.

RESULTS

Overall, the prevalence of diabetic subjects was 14.5% in the SCHS study. Furthermore, the prevalence of hypertension in the study subjects aged 40-70 years was 37.8%. The prevalence of hypertension history in T2DM study subjects for LVH compared to non-LVH was (53.7% vs. 33.7%). The prevalence of LVH among patients with T2DM as the primary target of this study was 20.7%. Analytical findings comparing both LVH and non-LVH subjects who have T2DM identified significance for variables in the older (≥ 60) mean and categorical age group (P < 0.0001), history of hypertension (P < 0.0001), mean and categorical duration of hypertension in years (P < 0.0160), status of controlled versus uncontrolled hypertension level (P < 0.0120), the mean systolic blood pressure (P < 0.0001) as well as mean duration years of T2DM and categorical duration of diabetes in years (< 0.0001 and P < 0.0060), mean fasting blood sugar (< 0.0307) and categorical status of FBS Level (mg/dl): controlled and uncontrolled FBS status of controlled vs. uncontrolled FBS levels P < 0.0020). However, there were no significant findings for gender (P = 0.3112), diastolic blood pressure mean (P = 0.7722) and body mass index (BMI) mean and categorical BMI (P = 0.2888 and P = 0.4080, respectively).

CONCLUSION

The prevalence of LVH in the study increases significantly among T2DM patients with hypertension, older age, years of hypertension, years of diabetes, and higher FBS. Thus, given the significant risk of diabetes and CVD, evaluation of LVH through reasonable diagnostic testing with ECG can help reduce the risk of future complications through the development of risk factor modifications and treatments guidelines.

Hyperglycemia screening based on survey data: an international instrument based on WHO STEPs dataset

BACKGROUND

Hyperglycemia is rising globally and its associated complications impose heavy health and economic burden on the countries. Developing effective survey-based screening tools for hyperglycemia using reliable surveillance data, such as the WHO STEPs surveys, would be of great importance in early detection and/or prevention of hyperglycemia, especially in low or middle-income regions.

METHODS

In this study, data from the nationwide 2016 STEPs study in Iran were used to identify socioeconomic, lifestyle, and metabolic factors associated with hyperglycemia. Furthermore, the ability of five commonly used machine learning algorithms (random forest; gradient boosting; support vector machine; logistic regression; artificial neural network) in the prediction of hyperglycemia on STEPs dataset were compared via tenfold cross validation in terms of specificity, sensitivity, and the area under the receiver operating characteristic curve.

RESULTS

A total of 17,705 individuals were included in this study, of those 29.624% (n = 5245) had (undiagnosed) hyperglycemia. Multivariate logistic regression analysis showed that older age (for the elderly group: OR = 5.096; for the middle-aged group: OR = 2.784), high BMI status (morbidly obese: OR = 3.465; obese: OR = 1.992), having hypertension (OR = 1.647), consuming fish more than twice per week (OR = 1.496), and abdominal obesity (OR = 1.464) were the five most important risk factors for hyperglycemia. Furthermore, all the five hyperglycemia prediction models achieved AUC around 0.70, and logistic regression (specificity = 70.22%; sensitivity = 70.2%) and random forest (specificity = 70.75%; sensitivity = 69.78%) had the optimal performance.

CONCLUSIONS

This study shows that it is possible to develop survey-based screening tools for early detection of hyperglycemia using data from nationwide surveys, such as WHO STEPs surveys, and machine learning techniques, such as random forest and logistic regression, without using blood tests. Such screening tools can potentially improve hyperglycemia control, especially in low or middle-income countries.

Prediabetes in Syria and Its Associated Factors: A Single-Center Cross-Sectional Study

INTRODUCTION

Prediabetes is a major risk factor for diabetes and many chronic complications, particularly cardiovascular disease (CVD). Risk factors vary among races and demographics. This is the first study to assess prediabetes in Syria and its relevant risk factors.

METHODS

This cross-sectional study was conducted in a primary health clinic in Al-Mouwasat University Hospital, the major Hospital in Damascus, Syria. Interviews, examinations, and blood investigations were carried out by qualified physicians in the clinic.

RESULTS

This study included 406 participants, of which 363 (89.4%) were females, 43(10.6%) were males, 91 (22.4%) had prediabetes, 108 (26.6%) were overweight, and 231 (56.9%) were obese. Older age, positive family history of diabetes, obesity, abdominal obesity in females, high cholesterol, being married, and CVD were statistically significantly associated with prediabetes (p < 0.05). However, prediabetes was not associated with gender, living in the city or country, cigarette smoking, hypertension, diet, triglycerides, or polycystic ovary syndrome (p > 0.05). However, in the multivariable analysis, only high cholesterol, familial diabetes, and waist diameter had significant association.

CONCLUSIONS

Prevalence of prediabetes in our study in Syria was higher than what was estimated by previous studies. While many risk factors were similar to other countries in the regions, other risk factors differed. These results were highly reflective of high burden of prediabetes and diabetes, mainly in relatively young females. Further studies are required to tackle this rising issue as it imposes major complications in the long term, and the high financial burden on the health care system.

Prevalence of prediabetes and associated factors in southwest iran: results from Hoveyzeh cohort study

BACKGROUND

Increasing trend of prediabetes and diabetes is a global public health issue. On the other hand, prediabetes can increase the risk of developing some non-communicable diseases, including type 2 diabetes, cardiovascular disease, hypertension, fatty liver disease, etc. Given that there are modifiable various risk factors for prediabetes, this cross-sectional study aimed to evaluate the prevalence of prediabetes and its risk factors among adults.

METHODS

The present study included the baseline data from the Prospective Epidemiological Research Studies of the Iranian Adult and Neonates (PERSIAN), Hoveyzeh Cohort Study (N = 10,009). The demographic data, lifestyle habits, anthropometric data, and clinical and biochemical parameters were gathered. The odds ratio of prediabetes was assessed by logistic regression.

RESULTS

The final analysis was conducted on 7629 participants. The prevalence of overweight (36.7%), obesity (37.5%), prediabetes (30.29%), abnormal high density lipoprotein (35.4%), cholesterol (33.8%) and triglyceride (39.7%), and HTN (21.3%) were common. In the adjusted analysis, there were higher odds of having prediabetes for overweight (OR = 1.9, 95% CI: (1.19, 3.03), p = 0.007), obesity (OR = 3.18, 95% CI: (1.99, 5.07), p < 0.001), waist circumstance (WC) (OR = 1.024, 95% CI: (1.002, 1.03), p < 0.001), hip circumstance (HC) (OR = 1.01, 95% CI: (1.003, 1.02), p = 0.008), older age (OR = 1.04, 95% CI: (1.04, 1.05), p < 0.001), hypertension (OR = 1.38, 95% CI: (1.21, 1.57), p < 0.001),), glutamic-pyruvic transaminase (OR = 1.013, 95% CI: (1.007, 1.019), p = 0.001), glutamic-oxaloacetic transaminase (OR = 1.01, 95% CI: (1.006, 1.013), p < 0.001), triglyceride = 150-199 mg/dl (OR = 1.32, 95% CI: (1.16, 1.51), p < 0.001), triglyceride ≥ 200 mg/dl (OR = 1.64 (95% CI: 1.44, 1.86), p < 0.001), cholesterol = 200- 239 mg/dl (OR = 1.33, 95% CI: (1.18, 1.49), p < 0.001), and cholesterol ≥ 240 mg/dl (OR = 2.04, 95% CI: (1.72, 2.42), p < 0.001) in general population.

CONCLUSION

The prevalence of prediabetes, overweight, obesity, HTN, and dyslipidemia was common. The greater chances of prediabetes were related to aging, overweight, obesity, HTN, higher liver enzymes, HC, abnormal WC, and dyslipidemia. It seems that practical interventions are necessary to prevent prediabetes.

Family History, Consanguinity and Other Risk Factors Affecting the Prevalence of Prediabetes and Undiagnosed Diabetes Mellitus in Overweight and Obese Yemeni Adults

OBJECTIVE

Overweight and obese adults are at high risk for developing prediabetes and diabetes. The aim of this study was to measure the prevalence of prediabetes (pre-DM) and diabetes (DM) among Yemeni adults who were overweight or obese and had first-degree relatives with DM, consanguinity and other risk factors.

PATIENTS AND METHODS

This cross-sectional study included 612 adults, all with a BMI≥25 kg/m². BMI, blood pressure (BP) and waist circumference (WC) were measured in the clinic. Fasting blood glucose (FBG) was collected for all subjects. The patients either had first-degree relatives with diabetes or not, and the subjects answered a questionnaire regarding the consanguinity of their parents, exercise, khat chewing, smoking, and eating vegetables and fruits daily.

RESULTS

Of the 612 study participants (32% males and 68% females) aged 20-70 years old, 429 (70.1%) had a family history (FM) of DM ± consanguinity of parents, and 183 (29.9%) had no FM of diabetes. Multivariate analysis showed significant risk in those with class III obesity for pre-DM (AOR 3.10 95% CI 1.56-6.18 p value 0.001) and DM (AOR 3.35 95% CI 1.47-7.65 p value 0.004) and those who had siblings with DM had a risk for pre-DM (AOR 1.72 95% CI 1.09-2.71 p value 0.02) and DM (AOR 2.24 95% CI 1.25-4.0 p value 0.007). Khat chewing increased the risk for pre-DM (AOR 1.61 95% CI 1.04-2.48 p value 0.032) and for DM (AOR 2.09 95% CI 1.14-3.82 p value 0.017). Having consanguineous parents plus siblings with DM were associated with a higher risk of DM (p value 0.031).

CONCLUSION

There is a high prevalence of pre-DM and undiagnosed DM among overweight and obese Yemeni individuals. Class III obesity, having siblings with DM, chewing khat, and having consanguineous parents plus siblings with DM all increased the risk. This group should be screened at an early age for early detection of pre-DM and DM.