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

Menarche age and the risk of diabetes: A cross-sectional study in South-Eastern Iran

Background and Aims

Diabetes is a major public health problem worldwide. This study aimed to determine the relationship between menarche age and overt diabetes in southeast Iran.

Methods

This cross-sectional study was conducted on 6094 eligible women between the ages of 35 and 70 participating in the Zahedan Adult Cohort Study. Demographic and background data, fertility, anthropometry, and disease history were collected based on a questionnaire. Menarche age was classified into five categories (under 12 years, 12, 13, 14, 15 years and more). Diabetes is defined as a blood sugar of 126 or more according to the definition by the American Diabetes Association. Data analysis was done using SPSS 26 software. Descriptive analysis was performed with frequency, percentage, mean, and standard deviation; and analytical analysis using chi-square and logistic regression tests. The significance level in this study was p < 0.05.

Results

The participants' mean age was 49.41 ± 8.88, and the mean age at menarche was 13 ± 1.49. 22.8% (1389 women) of participants with diabetes and 77.2% (4705 women) did not have diabetes. The findings showed that the chance of developing diabetes in women with a menarche age <12 years was significantly higher than in women with a menarche age of 13 years (reference) (OR = 1.23, 95% CI: 0.96, 1.51). This relationship was significant after adjusting variables such as body mass index, education level, fertility factors, history of diabetes, and reproductive diabetes (OR = 1.21, 95% CI: 0.90, 1.44, p = 0.04).

Conclusion

Our findings suggest that young age at menarche may be a risk factor for diabetes in adulthood. Further prospective studies are needed to confirm our findings. However, it is suggested to pay attention to it in diabetes screening so that, if possible, by identifying people at risk and implementing prevention programs, the adverse consequences of diabetes can be reduced.

A cost-effectiveness analysis of linagliptin add-on to insulin treatment for patients with type 2 diabetes mellitus and chronic kidney disease in Iran

Purpose

With the high prevalence of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T2DM), determining optimal treatment strategies has become a major concern. Linagliptin is aDPP-4 inhibitor that does not require dose adjustment in patients with renal impairment. This study evaluates the cost-effectiveness of adding linagliptin to insulin therapy in patients with T2DM and mild (stage 2) or moderate (stage 3) CKD from a health system perspective in Iran.

Methods

We developed a cost-utility model using a decision tree and ran it separately for T2DM patients with mild or moderate CKD. Clinical outcomes and health-state utility values were extracted from published studies. Direct medical costs were obtained from national tariffs in Iran in 2021. We adopted an annual time horizon and calculated the difference in costs and quality-adjusted life-years (QALYs) to obtain the incremental cost-effectiveness ratios (ICER). To capture parameter uncertainties, one-way sensitivity analyses were also performed.

Results

In T2DM patients with mild CKD, the linagliptin add-on strategy was associated with an additional $23.69 cost and 0.0148 QALYs per patient, resulting in an ICER of 1600.37 USD/QALY. In moderate CKD, the strategy was associated with $22.59 more costs and 0.0191 more QALYs, and the ICER was estimated at 1182.72 USD/QALY. In both populations, the ICER was mainly driven by the impact of HbA1c on utility, cost of linagliptin, and the reduction in insulin usage by adding linagliptin to the treatment.

Conclusion

With a cost-effectiveness threshold of $1550 USD/QALY in Iran, adding linagliptin to insulin is cost-effective in patients with T2DM and moderate CKD. However, for those with mild CKD, it seems that the associated costs outweigh the expected benefits.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-023-01243-z.

The improvement effect of apple cider vinegar as a functional food on anthropometric indices, blood glucose and lipid profile in diabetic patients: a randomized controlled clinical trial

Background

Numerous medical costs are spent each year on treating and preventing the progression of diabetes. The positive effect of apple cider vinegar (ACV) has been shown on post-prandial hyperglycemia. This study aimed to evaluate the effects of prolonged consumption of ACV on blood glucose indices and lipid profile in patients with type 2 diabetes.

Methods

This study was a randomized clinical trial and the participants were adults with type 2 diabetes. Participants were divided into two groups: ACV and control. The ACV group was treated with 30 ml of ACV per day. Both the intervention and control groups received the same recommendation for a healthy diet. Before and after eight weeks, fasting blood glucose, insulin, hemoglobin A1C, insulin resistance, total cholesterol (Chol), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride were measured.

Results

Fasting blood glucose decreased after intervention in both groups, which was only significant in the ACV group (p = 0.01). There was a significant difference in hemoglobin A1C levels between the two groups (p < 0.001) after eight weeks. LDL was decreased in the ACV group (p < 0.001). Total Chol, LDL/HDL and Chol/HDL ratio decreased after the intervention period in the ACV group compared to the control group (p = 0.003, p = 0.001 and p = 0.001, respectively).

Conclusion

Daily consumption of ACV may have beneficial effects in controlling blood glucose indices and lipid profile in patients with type 2 diabetes.

Clinical trial registration

http://www.irct.ir, identifier IRCT20140107016123N13.

Effectiveness of oral clonidine and gabapentin on peripheral neuropathy in diabetic patients in southwestern Iran: a randomized clinical trial

BACKGROUND

Peripheral neuropathy is not only the most prevalent consequence of diabetes but also the main reason for foot ulceration, disability, and amputation. Therefore, the current study aims to determine the effectiveness of oral clonidine and gabapentin on peripheral neuropathy in diabetic patients.

METHODS

This 12-week, randomized, and parallel-group trial was conducted to compare the efficacy of oral clonidine and gabapentin with gabapentin alone in diabetic patients in southwest Iran during the first half of 2021. Thirty patients with type 2 diabetes with peripheral neuropathy as assessed by a visual analog scale (VAS) and divided into two groups of 15 patients, treated for up to three months. The data were analyzed using SPSS-21 software. In order to report the results, descriptive indices, independent t-test, one-way analysis of covariance (ANCOVA) and analysis of variance with repeated measures were used.

RESULTS

The mean and standard deviation of the age of the participants in the clonidine + gabapentin group was equal to 50.20 ± 7.44, and in the gabapentin group was equal to 50.47 ± 7.57 (t = 0.10, P-value = 0.923). This research showed a significant difference between the clonidine + gabapentin group and with gabapentin group in terms of neuropathic pain and the severity of neuropathic pain (P < 0.001).

CONCLUSIONS

According to this research results, clonidine + gabapentin can reduce neuropathic pain and the severity of neuropathic pain in diabetic patients. Therefore, it is recommended that healthcare professionals with diabetes expertise prescribe these medications to reduce neuropathic pain and its severity.

TRIAL REGISTRATION

This study was registered in the Iranian Clinical Trials System with the ID (IRCT20211106052983N1) on 14/01/2022.

The potential of cardiac biomarkers, NT-ProBNP and troponin T, in predicting the progression of nephropathy in diabetic patients: A meta-analysis of prospective cohort studies

AIMS

A meta-analysis was done to investigate the association of two cardiac biomarkers of N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) and circulating troponin T (TnT) with the progression of diabetic nephropathy (DN).

METHODS

A thorough search of the PubMed, Scopus, and Web of Science databases was done until June 2022. The outcome (progression of DN) was described as either of the followings: a) eGFR decline, b) albuminuria, c) end-stage renal disease, or d) mortality. A pooled analysis of eligible studies was performed using random-effect models to compensate for the differences in measurement standards between the studies. We further carried out subgroup analyses to examine our results' robustness and find the source of heterogeneity. A sensitivity analysis was performed to assess the influence of individual studies on the pooled result and the funnel plot and Egger's test were used to assess publication bias.

RESULTS

For NT-proBNP, 8741 participants from 14 prospective cohorts, and for TnT, 7292 participants from 9 prospective cohorts were included in the meta-analysis. Higher NT-proBNP levels in diabetic patients were associated with a higher probability of DN progression (relative risk [RR]: 1.67, 95% confidence interval [CI]: 1.44 to 1.92). Likewise, elevated levels of TnT were associated with an increased likelihood of DN (RR: 1.57, 95% CI: 1.34 to 1.83). The predictive power of both biomarkers for DN remained significant when the subgroup analyses were performed. The risk estimates were sensitive to none of the studies. The funnel plot and Egger's tests indicated publication bias for both biomarkers. Hence, trim and fill analysis was performed to compensate for this putative bias and the results remained significant both for NT-proBNP (RR: 1.50, 95% CI: 1.31 to 1.79) and TnT (RR: 1.35, 95% CI 1.15 to 1.60).

CONCLUSIONS

The increased blood levels of TnT and NT-proBNP can be considered as predictors of DN progression in diabetic individuals. PROSPERO registration code: CRD42022350491.

Cumulative effects of exercise training and consumption of propolis on managing diabetic dyslipidemia in adult women: a single-blind, randomized, controlled trial with pre-post-intervention assessments

Dyslipidemia is an imbalance of various lipids, and propolis, as a natural resinous viscos mixture made by Apis mellifera L. could improve in this condition. In this single-blind, randomized trial, 60 women with type 2 diabetes and dyslipidemia were divided into four groups: (1) the patients who did not apply the combined training and 500 mg propolis capsules supplement (Control group); (2) subjects performed combined training, including aerobic and resistance training (EXR); (3) subjects received the 500 mg propolis supplement capsules (SUPP); (4) Subjects performed combined training along with receiving the 500 mg propolis supplement capsules (EXR + SUPP). We evaluated the concentration of CTRP12, SFRP5, interleukin-6 (IL6), superoxide dismutase (SOD), malondialdehyde (MDA), adiponectin, and total antioxidant capacity (TAC) before and after the intervention. MDA, TAC, IL6, CTRP12, SFRP5 IL6, adiponectin, and lipid profile levels ameliorated in the EXR + SUPP group. We found that 8 weeks of treatment by combined exercise training and propolis supplement decreased inflammation activity and increased antioxidant defense in women with diabetic dyslipidemia.Trial registration This study was registered in the Iranian Registry of Clinical Trials; IRCT code: IRCT20211229053561N1.

Factors affecting Hemoglobin A1c in the longitudinal study of the Iranian population using mixed quantile regression

Diabetes, a major non-communicable disease, presents challenges for healthcare systems worldwide. Traditional regression models focus on mean effects, but factors can impact the entire distribution of responses over time. Linear mixed quantile regression models (LQMMs) address this issue. A study involving 2791 diabetic patients in Iran explored the relationship between Hemoglobin A1c (HbA1c) levels and factors such as age, sex, body mass index (BMI), disease duration, cholesterol, triglycerides, ischemic heart disease, and treatments (insulin, oral anti-diabetic drugs, and combination). LQMM analysis examined the association between HbA1c and the explanatory variables. Associations between cholesterol, triglycerides, ischemic heart disease (IHD), insulin, oral anti-diabetic drugs (OADs), a combination of OADs and insulin, and HbA1c levels exhibited varying degrees of correlation across all quantiles (p < 0.05), demonstrating a positive effect. While BMI did not display significant effects in the lower quantiles (p > 0.05), it was found to be significant in the higher quantiles (p < 0.05). The impact of disease duration differed between the low and high quantiles (specifically at the quantiles of 5, 50, and 75; p < 0.05). Age was discovered to have an association with HbA1c in the higher quantiles (specifically at the quantiles of 50, 75, and 95; p < 0.05). The findings reveal important associations and shed light on how these relationships may vary across different quantiles and over time. These insights can serve as guidance for devising effective strategies to manage and monitor HbA1c levels.

Improvement of oral health knowledge and behavior of diabetic patients: an interventional study using the social media

BACKGROUND

Diabetic patients are not often aware of relationship between diabetes mellitus (DM) and periodontal diseases, and the researchers recommend further knowledge enhancement of diabetic patients in this regard. This study aimed to enhance oral health knowledge of diabetic adults via an educational intervention.

METHODS

In this interventional study, three private offices of endocrinologists specialized in treatment of DM were selected for the recruitment of participants. In total, 120 diabetic adults (40 from each office) took part in an educational intervention in three groups (patients from each office made up one group): (I) physician-aid, (II) researcher-aid, and (III) social media. In group (I), participants received educational materials (brochure and CD) from their endocrinologist, in group (II) participants received educational materials from researcher. Group (III) joining an educational group in WhatsApp for 3 months. A self-reported standard questionnaire was filled out by the patients before, and after the intervention to assess oral health knowledge. Data were analyzed by SPSS version 21 using independent t-test, Mann-Whitney test, Chi-square test, and ANCOVA.

RESULTS

The mean oral health knowledge score increased in all three groups after the educational interventions (P < 0.001); the highest increase occurred in the social media group. Toothbrushing twice daily or more had the greatest improvement in the physician-aid group compared with the other two groups (P < 0.001). The greatest improvement in dental flossing once daily or more occurred in the social media group (P = 0.01). The mean level of the hemoglobin A1c (HbA1c) decreased in all three groups, but not significantly (P = 0.83).

CONCLUSION

The results showed that educational interventions enhance oral health knowledge, and improve the behavior of diabetic adults. The education via the social media can be an efficient method for knowledge enhancement of diabetic patients.

Pharmacoeconomic evaluation of insulin aspart and glargine in type 1 and 2 diabetes mellitus in Iran

Purpose

The higher costs of insulin analogs including short-acting insulin aspart (IAsp) and long-acting insulin glargine (IGla) have restricted their widespread uptake despite having improved pharmacokinetic and pharmacodynamic properties and patient convenience. This study aims to evaluate the cost-effectiveness of IAsp versus Regular Insulin (RI) and IGla versus NPH Insulin in type 1 and 2 diabetes from the perspective of the Iranian healthcare system.

Methods

Clinical data including HbA1c levels, hypoglycemia, weight gain, and health-related quality of life were derived from the included systematic review and meta-analysis studies. Different methods of pharmacoeconomic evaluation were used for an annual time horizon. Utility decrements for diabetes-related complications were extracted from the literature. Direct medical costs were calculated in 2022 prices. A one-way sensitivity analysis was also performed.

Results

In type 1 diabetes, IAsp was associated with more costs and effects in terms of reducing HbA1c compared with RI. An incremental cost of $83 was estimated to obtain an additional 1% reduction in HbA1c per patient per year. Similarly, an incremental cost of $16 was estimated for IGla compared with NPH. In type 2 diabetes, IAsp and RI were associated with equal efficacy and safety. For IGla versus NPH, the incremental cost-effectiveness ratio was calculated at $1975 per quality-adjusted life-year. The robustness of the result was confirmed through sensitivity analysis.

Conclusion

Insulin analogs, IAsp and IGla, are cost-effective for type 1 diabetes versus human insulins, RI and NPH. For type 2 diabetes, IAsp is not cost-effective when compared with RI. For IGla versus NPH, however, the incremental cost-effectiveness ratio seems to be within the accepted thresholds.

Management goal achievements of diabetes care in Iran: study profile and main findings of DiaCare survey

Aim

This paper presented the methodology and main findings of a population-based survey to determine diabetes care status among type 2 diabetic subjects in Iran. The current study assessed treatment goal achievements in type 2 diabetics, diabetes care service utilization, prevalence of diabetes complications, and psychological effects of diabetes in a representative sample of Iranian population in urban and rural areas.

Materials and Methods

This nationwide study was conducted between 2018 and 2020 as the observational survey entitled "Diabetes Care (DiaCare)". We studied a representative sample of participants with type 2 diabetes, aged 35-75 years, living in urban and rural areas in all thirty- one provinces of Iran. Data were collected by an interviewer in a form of a questionnaire that includes demographic and socioeconomic status, family and drug history, lifestyle, and self-reported psychological status according to a Patient's Health Questionnaire (PHQ). Management goal achievements, diabetes care service utilization, diabetes complications and psychological effects of diabetes were also assessed. Physical measurements were measured based on standard protocol. Fasting blood glucose (FBG), HbA1c, lipid profile, and also urine albumin to creatinine ratio were obtained from all participants of the study.

Results

Overall, 13,334 people with type 2 diabetes in 31 provinces of Iran completed the survey (response rate: 99.6%). In total 13,321 participants, 6683(50.17%) women and 6638(49.83%) men were included in our analysis. Thirteen recruited patients refused after the consenting process and did not respond. The mean age (SD) of total participants was 54.86 ± 9.44 years and 71.50% were from the urban areas. 13.66% of diabetic patients had achieved the triple target of management [controlled HbA1c, blood pressure, and Low-Density Lipoprotein-Cholesterol (LDL-C)] in the whole country. While 28.74% of people had controlled HbA1c and 33.40% of them had controlled FBG. Diabetic subjects living in rural areas had less controlled HbA1c (23.93 vs. 29.48), controlled FBG (29.50 vs. 34.20) and controlled triple targets (10.45 vs. 14.32) than those living in urban areas. Diabetic neuropathy and diabetic foot were more common in women than men, while end-stage of renal disease (ESRD) was more common in men than women.

Conclusions

This population-based study provided representative information about diabetes care in Iran. The high prevalence of diabetes and low proportion of diabetes control in Iran implies that it is necessary to identify factors associated with poor treatment goal achievements. Besides, general improvements in management and care of diabetes are mandatory.

How is healthy eating index-2015 related to risk factors for cardiovascular disease in patients with type 2 diabetes

Background

Cardiovascular disease (CVD) is the primary cause of mortality and disability among diabetes. The aim of this study is to evaluate how healthy eating index-2015 related to risk factors for cardiovascular disease in patients with type 2 diabetes.

Methods

This cross-sectional study was conducted on 490 patients with type 2 diabetes in Tehran, Iran. The healthy eating index-2015 (HEI-2015) used as a diet quality indicator. Dietary intake was assessed by a valid and reliable semi-quantitative food frequency questionnaire (FFQ). Four indicators of CVD risk factor [Castelli risk index-1 and 2 (CRI-II), atherogenic index of plasma (AIP), cholesterol index (CI), and lipid accumulation of plasma (LAP)] were calculated. The anthropometric indices [a body shape index (ABSI), abdominal volume index (AVI), and body roundness index (BRI)] were computed.

Results

After adjusting for potential confounders, it is evident that participants in the highest tertile of HEI had a lower odds ratio of BRI (OR: 0.52; 95% CI: 0.29-0.95; p-trend = 0.03) and AIP (OR:0.56; 95% CI: 0.34-0.94; p-trend = 0.02). Also, HEI and CRI had a marginally significant negative relation (OR: 0.61; 95% CI: 0.38-1; p-trend = 0.05) in crude model, after adjusting the signification disappeared.

Conclusion

In conclusion, our finding shows that more adherence to HEI reduces about 50% of the odds of AIP, BRI among diabetic patients. Further, large-scale cohort studies in Iran need to confirm these findings, including diabetic patients of various racial, ethnic backgrounds, body composition and different components of HEI.

Psychometric properties of multidimensional health locus of control scale, form C among Iranian type 2 diabetes

Objective

This study aimed at examining the psychometric properties of Persian version of Multidimensional Health Locus of Control scale, form C (MHLC-C) among Iranian type 2 diabetes.

Method

This cross sectional study was conducted on 557 type 2 diabetes in eastern city of Iran in 2022. Participants were selected by proportional stratified sampling. The validity of MHLC-C was tested by face validity, content validity, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA).Reliability of MHLC-C was assessed by McDonald omega coefficient, Cronbach's alpha coefficient, and Intraclass Correlation Coefficient.

Results

Based on the results of EFA, 4 factors with eigenvalues greater than 1 were extracted, which explained 61.66% of the variance. In EFA, a question was removed. In CFA, the factor loading of all questions was more than 0.4 and the indexes of the goodness-of-fit were acceptable (for example: X2/df = 4.457, RMSEA: 0.079, CFI = 0.904, and PGFI = 0.663). McDonald omega coefficient and Cronbach's alpha coefficient of MHLC-C were 0.869 and 0.866. The Intraclass Correlation Coefficient of MHLC-C was 0.817. Finally, the MHLC-C with 17 questions and 4 factors of chance (6 items), internal (5 items), other powerful people (3 items), and doctors (3 items) was approved.

Conclusions

The Persian version of the MHLC-C questionnaire, with 17 questions and four factors, is a valid and reliable scale for Iranian type 2 diabetes to assess their health locus of control status.

Individualized Glycemic Control in Type 2 Diabetic Patients in Iran: A Multi-Center Data Analysis

Background

Clinical guidelines and expert committees have recently suggested that the hemoglobin A1C (HbA1c) should be individualized based on various criteria. Data regarding the achievement of individualized glycemic targets in type 2 diabetes mellitus (T2DM) patients is scant in Iran. We intended to provide information found on real-world outcomes from the perspective of an individualized recommendation.

Methods

A cross-sectional analysis was conducted in 15 diabetes centers in Iran between 2013-2017. Two steps cluster sampling selection was used to recruit 1591 patients with T2DM. Considering Ismail-Beigi's individualized strategy, the study population was categorized into five treatment intensities of HbA1c: most intensive (≤6.5%), intensive (6.5-7.0%), less intensive (~7.0%), not intensive (7.0-8.0%), and moderated (~8.0%). The percentage of patients who met their group individualized glycemic targets was estimated as the degree of achievement of each treatment intensity.

Results

The cumulative incidence rate of early microvascular, advanced microvascular, and macrovascular complications was 53%, 25%, and 34%, respectively. Besides, [78% 77.6-79%] of patients did not achieve individualized glycemic targets.

Conclusion

The outcome showed poor individualized glycemic control and a high incidence of diabetes complications. Considering individualized HbA1c targets for Iranian patients with T2DM is an urgent need.

Cost-effectiveness and cost-utility analysis of type-2 diabetes screening in pharmacies in Iran

Background and purpose

Several studies have shown the effectiveness of screening programs in decreasing the costs and disutility of type-2 diabetes and related complications. As there is a growth in the incidence of type-2 diabetes amongst the Iranian population, the cost-effectiveness of performing type-2 diabetes screening tests in community pharmacies of Iran was evaluated in this study from the payer's perspective. The target population consisted of two hypothetical cohorts of 1000 people 40 years of age without a prior diagnosis of diabetes, for the intervention (screening test) and no-screening groups.

Experimental approach

A Markov model was developed to evaluate the cost-effectiveness and cost-utility of a type-2 diabetes screening test in community pharmacies in Iran. A 30-year time horizon was considered in the model. Three screening programs with 5-year intervals were considered for the intervention group. The evaluated outcomes were quality-adjusted life-years (QALYs) for cost-utility-analysis and life-years-gained (LYG) for cost-effectiveness-analysis. To examine the robustness of the results, one-way and probabilistic-sensitivity analyses were applied to the model.

Findings/Results

The screening test represented both more effects and higher costs. The incremental effects in the base-case scenario (no-discounting) were estimated to be 0.017 and 0.0004 (approximately 0) for QALYs and LYG, respectively. The incremental cost was estimated to be 2.87 USD/patient. The estimated incremental-cost-effectiveness ratio was 164.77 USD/QALY.

Conclusion and implications

This study indicated that screening for type-2 diabetes in community pharmacies of Iran could be considered highly cost-effective, as it meets the WHO criteria of the annual GDP per capita ($2757 in 2020).

Prevalence of type 2 diabetes complications and its association with diet knowledge and skills and self-care barriers in Tabriz, Iran: A cross-sectional study

Background and Aims

Diabetes can lead to multiple complications that can reduce the quality of life, impose additional costs on the healthcare systems and ultimately lead to premature death. Proper self-care in diabetic patients can impede or delay the onset of diabetes complications. This study aimed to investigate diabetes complications and their association with diet knowledge, skills, and self-care barriers.

Methods

This was a cross-sectional study. A total of 1139 patients with Type 2 Diabetes Mellitus (T2DM) referring to health centers in Tabriz, Iran, were included from January to July 2019. Data were collected using two questionnaires: (1) a sociodemographic questionnaire and (2) a Personal Diabetes Questionnaire (PDQ). Data were analyzed using SPSS software version 22. χ ² test was used to examine the association between the socioeconomic and disease-related variables and the prevalence of diabetes complications. T-test was used to examine the association between diet knowledge and skills, self-care barriers, and the incidence of diabetes complications.

Results

In this study, 76.1% of patients had at least one complication, and 30.2% had a history of hospitalization due to diabetes complications during the past year. Approximately 49% and 43% were diagnosed with high blood pressure and hyperlipidemia, respectively. Cardiovascular disease was the most common diabetes complication (15.9%) and the cause of hospitalization (11.01%) in patients with diabetes. Barriers to diet adherence, blood glucose monitoring, and exercise were significantly associated with self-reported diabetes complications (p < 0.001). Our results showed no significant association between the number of complications and diet knowledge and skills (p = 0.44).

Conclusion

This study indicated that the prevalence of diabetes complications was higher among patients with more barriers to self-care. In light of these findings, taking appropriate measures to reduce barriers to self-care can prevent or delay the onset of diabetes complications.

Detection of high risk people for diabetes by American diabetes association risk score in PERSIAN Guilan cohort study

BACKGROUND

Diabetes mellitus (DM) is known as one of the most prevalent non communicable diseases with high cost of health services in the world. Present study was conducted to assess the frequency of high risk people for diabetes mellitus based on American Diabetes Association (ADA) risk score among Iranian people.

METHODS

Present study was a cross sectional study on non-diabetic subjects aged 35-70 years from 10,520 PERSIAN Guilan Cohort Study (PGCS). ADA risk score was calculated for every individual through an online calculator. Receiver operating characteristic (ROC) curves was used to assess diagnostic accuracy of the anthropometric indices to identify individuals with high risk ADA score for developing DM, represented by the area under the curve (AUC).

RESULTS

From 7989 study subjects, ADA risk score found 3874 (48.5%) and 1912 (23%) at risk for developing PreDM and DM, respectively. The results of ROC curve analyses showed the highest diagnostic value was related to waist circumference (WC) in total population and Waist to Height Ratio in both sex (0.695 total, 0.743 female, 0.744 male). The cut-points of WC in total population to identifying high risk group were 97 cm.

CONCLUSIONS

A considerable number of populations were classified as high ADA risk for developing DM and PreDM that provide the importance of prevention strategies. Present study showed WC and Waist to Height Ratio have the highest diagnostic value to identify high risk people for DM.

Application of Pender's health promotion model for type 2 diabetes treatment adherence: protocol for a mixed methods study in southern Iran

BACKGROUND

Type 2 diabetes (T2D) mellitus treatment as a chronic disease requires adequate adherence to treatment including controlling blood glucose levels and lifestyle management. The aim of this study is to investigate the factors affecting of adherence to T2D treatment from the perspective of patients and design an intervention program based on Pender's health promotion model (HPM) to increase T2D treatment adherence in Bandar Abbas, a city located in the south of Iran.

METHODS

This mixed method study will consist of qualitative stage, questionnaire design and a randomized, open-label, parallel-group interventional study based on HPM in southern Iran. Sampling for qualitative stage will continue until reaching the saturation. In the intervention stage, participants will be 166 T2D patients referring to the Bandar Abbas Diabetes Clinic will be randomized into intervention and control groups (allocation 1:1). After identifying the factors affecting adherence to treatment in T2D patients by qualitative study and literature review, a questionnaire based on HPM will be designed. In the next stage, 10 sessions of intervention for the intervention group will be designed. To evaluate the effect of the intervention, intervention and control groups will be tested for hemoglobin A1c (HbA1c) before and 3 months after the intervention.

DISCUSSION

This designed study is a program for improving treatment adherence in T2D based on the HPM model and contributes to a better understanding of effective factors in adherence to treatment in T2D patients. The results of this project can be used for macro-diabetic planning.

TRIAL REGISTRATION

This study is registered on the Iranian Registry of Clinical Trials (IRCT20211228053558N1: https://www.irct.ir/trial/61741 ) and first release date of 17th March 2022.

The relationship between glucose intolerance status and risk of hospitalization during two decades of follow-up: Tehran lipid and glucose study

OBJECTIVE

To assess the relationship between glucose intolerance statuses at baseline defined as normal glucose tolerance (NGT), pre-diabetes, newly diagnosed (NDM) and known diabetes mellitus (KDM) and all-cause hospitalization among Iranian men and women during 20 years of follow-up.

RESEARCH DESIGN AND METHODS

This study included 8,014 individuals (3,836 men) ≥30 years from the cohort of Tehran Lipid and Glucose Study. Incidence rate ratios (IRRs) and (95% confidence interval (95% CI) for three groups of pre-diabetes, NDM and KDM was estimated using the Negative Binomial regression model, considering NGT group as reference group. Regression models were adjusted for age, body mass index, hypertension, chronic kidney disease, and cardiovascular disease (CVD).

RESULTS

Among men, compared with NGT group, those with pre-diabetes, NDM and KDM had higher incidence rate for hospitalization, with IRRs (95% CI) of 1.08 (0.96-1.20), 1.38 (1.20-1.57) and 1.96 (1.66-2.26), respectively, after adjusting for confounders. The corresponding values were 1.07 (0.96-1.17), 1.40 (1.21-1.59) and 2.07 (1.72-2.42) for women. Men with diabetes, generally had a higher rate of hospitalization for CVD rather than their female counterparts (IRRs: 1.46; 1.17-1.74). In patients with diabetes, the most common causes of hospitalization were macrovascular complications (i.e. coronary heart disease and stroke). Moreover, among the individuals with diabetes, those with poor glycaemic control (fasting plasma glucose (FPG) >10 mmol/l) had 39% higher rate of hospitalization than those with fair glycaemic control (FPG <10 mmol/l) (1.39; 1.12-1.65), adjusted for confounders.

CONCLUSION

Pre-diabetes, NDM, and KDM were associated with increased hospitalization rates during long-term follow-up. Interventions such as lifestyle modification or pharmacological therapies aiming to slow down the pre-diabetes and fair control of diabetes might potentially decrease the rate of hospitalization.Key messagesNDM and KDM status both increased rate of all-cause hospitalization.CVD and T2DM complication were the most common cause of hospitalization among patients with diabetes.Hospitalization due to recurrent CHD was significantly higher in men with diabetes than their female counterparts.

Estimating willingness to pay for diabetes complications

BACKGROUND

Maximum willingness to pay (WTP) for a health benefit is connected to perceived value. This two-center study aims to analyse diabetic patients' WTP for obtaining a specific preventive treatment package to reduce severe diabetic complications and determine the factors that impact this value.

METHODS

This cross-sectional research included 557 diabetics from two cities in Iran. The WTP for a preventative package minimising major diabetes complications (cardiovascular, renal, ocular, and diabetic foot) by 50% and 100% was tested using eight scenarios. The Diabetes Attitude Scoring Questionnaire (DAS-3) was used to examine patient attitudes toward diabetes. To determine WTP, a two-stage hurdle method was used. The level of significance was fixed to 0.05.

RESULTS

Around 80% of 557 people interviewed (mean age 47.54) stated they wanted to pay for a diabetes prevention package. This package's WTP varied from 169.4 to $374.5 depending on the complication and degree of risk reduction. The largest value diabetic patients willing to pay for preventative packages that reduce the chance of blindness was reported, while the lowest cost was stated for the diabetic foot. WTP is influenced by wealth, location of study, marital status, and attitude toward special training, but not by the type of diabetes, inpatient or outpatient setting, or the complications diabetes patients are impacted by. Patients' diabetes attitudes were mainly negative. The score of the attitude of patients towards diabetes was generally suboptimal.

CONCLUSION

Most diabetic patients were willing to pay for a preventive package and this value was not affected by the type of diabetes and its severity. Our research found that diabetic individuals are willing to pay the most for a preventative package that reduces the chance of blindness, and the least for diabetic foot care. WTP can help health officials allocate resources and manage budgets. The attitude of diabetic patients toward diabetes still needs further interventional research, however.

Translation and psychometric properties of the Persian version of the Audit of Diabetes Dependent Quality of Life (IR-ADDQoL)

BACKGROUND

This study aimed to undertake linguistic validation and assess the psychometric properties of the Persian version of the Audit of Diabetes-Dependent Quality of Life (IR-ADDQoL) questionnaire in Iranian patients with type 1 and type 2 diabetes.

METHODS

The gold-standard linguistic-validation procedure required by the developer of the ADDQoL (see https://www.healthpsychologyresearch.com ) including cross-cultural adaptation was followed. Validity and reliability of the Persian ADDQoL were then evaluated in a cross-sectional study of a sample of 153 patients with diabetes. Exploratory and confirmatory factor analyses were applied to assess structural validity. Internal consistency reliability was assessed.

RESULTS

Both forced one-factor and unforced four-factor solutions were extracted from the exploratory factor analysis that jointly accounted for 48% and 66.53% of the variance observed, respectively. Confirmatory factor analysis indicated an acceptable model fit for the Persian ADDQoL. Cronbach's alpha showed excellent internal consistency for the questionnaire (alpha = 0.931 for the single scale).

CONCLUSION

The Persian ADDQoL (IR-ADDQoL) showed adequate structural validity and excellent internal consistency. Therefore, it could be efficiently used to evaluate the impact of diabetes on quality of life in outcome studies and research settings in Iran.

Prevalence of prediabetes, diabetes, diabetes awareness, treatment, and its socioeconomic inequality in west of Iran

We aim to estimate the prevalence of prediabetes, and diabetes mellitus (DM). We estimated awareness, treatment, plasma glucose control, and associated factors in diabetes, as well as, socioeconomic-related inequality in the prevalence of diabetes and prediabetes. Data for adults aged 35-70 years were obtained from the baseline phase of the Dehgolan prospective cohort study (DehPCS). Diabetes status was determined as fasting plasma glucose (FPG) of ≥ 126 mg/dl and/or taking glucose lowering medication confirmed by a medical practitioner. Prediabetes was considered as 100 ≤ FPG ≤ 125 mg/dl. The relative concentration index (RCI) was used to exhibit socioeconomic inequality in the prevalence of prediabetes and DM. Prevalence of prediabetes and DM, diabetes awareness and treatment, and glycemic control of DM 18.22%, 10.00%, 78.50%, 68.91% and, 28.50%, respectively. Increasing age (p < 0.001), Increasing body mass index (BMI) (p < 0.05), ex-smoker (p < 0.01), family history of diabetes (FHD) (p < 0.001), and comorbidity (p < 0.001) were independent risk factors for DM. Age group of 46-60 (p < 0.05), ex-smoker (p < 0.05), FHD (p < 0.05) were increased chance of awareness. Current smokers (p < 0.05), and higher education increase the chance of glycemic control in DM. Both DM (RCI =  - 0.234) and prediabetes (RCI =  - 0.122) were concentrated significantly among less-educated participants. DM was concentrated significantly among poor (RCI =  - 0.094) people. A significant proportion of DM awareness and treatment can be due to the integration of diabetes into the primary health care system. The high prevalence of prediabetes and diabetes, which is affected by socioeconomic inequality and combined with low levels of glycemic control may place a greater burden on the health system. Therefore, awareness, receiving treatment, and glycemic control in people with diabetes, and the socioeconomic status of people have become increasingly important in the near future.

Barriers Toward the National Program for Prevention and Control of Diabetes in Iran: A Qualitative Exploration

BACKGROUND

Despite the achievements of the national program for the prevention and control of diabetes (NPPCD) over the past two decades, the available evidence indicates a high prevalence of this disease in Iran. This qualitative study aims to investigate barriers to the NPPCD by pursuing the perspectives of relevant policy-makers, planners, and healthcare workers.

METHODS

A grounded theory approach was used to analyze participants' perceptions and experiences. Semi-structured interviews (n=23) and eight focus groups (n=109) were conducted with relevant policy-makers, planners, and healthcare workers in charge of Iran's national diabetes management program. Of the 132 participants, ages ranged from 25 to 56 years, and 53% were female. Constant comparative analysis of the data was conducted manually, and open, axial, and selective coding was applied to the data.

RESULTS

Two main themes emerged from data analysis: implementation barriers and inefficient policy-making/ planning. Insufficient financial resources, staff shortage and insufficient motivation, inadequate knowledge of some healthcare workers, and defects in the referral system were recognized as the NPPCD implementation barriers. Inappropriate program prioritizing, the lack of or poor intersectoral collaboration, and the lack of an effective evaluation system were the inefficient policy-making/planning problems.

CONCLUSION

Current results highlighted that inefficient policy-making and planning have led to several implementation problems. Moreover, the key strategies to promote this program are prioritizing the NPPCD, practical intersectoral collaboration, and utilizing a more efficient evaluation system to assess the program and staff performance.

High incidence of type 1 diabetes, type 2 diabetes and gestational diabetes in Central Iran: A six years results from Semnan health cohort

Introduction

Diabetes incidence has increasingly risen in Iran and other low- and middle-income nations in recent decades. In the Semnan Greater Area of Iran, we evaluate the incidence of type 1 diabetes (T1D), type 2 diabetes (T2D), and gestational diabetes during 2015–2020 as well as their six-year trend.

Methods

This is a retrospective analysis of data (n = 820401) from the Integrated Health System (sib) in Semnan province during 2015–2020. All diabetes cases with diagnostic codes based on the International Classification of Diseases 10 (ICD-10) are listed by year. The Grid Search method was used to obtain the exact number and time of points when the incidence of diseases changes significantly (Joinpoints). Average Annual Percent Change-Annual Percentage Change (AAPC-APC) values and slop changes in the estimated regression line with 95% confidence interval were utilized based on diabetes types to determine Joinpoints. P-value < 0.05 is considered statistically significant.

Results

The proportions of diabetes types (T1D, T2D, and gestational diabetes) among 820401 diabetics were 4.18%, 94.84%, and 0.97%, respectively. APC value denotes that T1D has increased by 12.47% per year on average in this period (P-value < 0.01). The incidence of T2D and gestational diabetes has increased between 2015 and 2020 (APC = 15.02 and APC = 136.138, respectively; P-value < 0.1).

Conclusions

In summary, the incidence of diabetes in Semnan province is constantly increasing. T2D, meanwhile, has a higher proportion. Nevertheless, gestational diabetes had the highest increase annually. Well-designed surveys investigating the reasons for diabetes increment especially gestational ones and its burden are needed.

•

The incidence of diabetes has been increasing in Iran and other low- and middle-income countries over the past decades.

•

The incidence of diabetes in Semnan has been steadily increasing from 2015 through 2020. T2D, meanwhile, has a higher proportion.

•

Although the trends in the incidence of T1D, T2D and gestational diabetes were increasing, gestational diabetes increased more than the other types.

Cost-Effectiveness of Dulaglutide Versus Liraglutide for Management of Type 2 Diabetes Mellitus in Iran

OBJECTIVES

Diabetes mellitus (DM), as one of the most common metabolic diseases, is the ninth leading cause of death globally and imposes heavy costs on the health systems including both costs of treatment and management of secondary complications. This study intended to investigate the cost-effectiveness of dulaglutide compared with liraglutide in the management of patients with type 2 DM in Iran.

METHOD

We conducted a cost-utility analysis using a 5-state Markov model from the health system perspective, over a 10-year time horizon, in 2018 in Iran. Sensitivity of the model has been evaluated through tornado diagram and using one-way sensitivity analysis. In addition, probabilistic sensitivity analysis has been accomplished using Monte Carlo simulation.

RESULTS

The average costs of treatment of patients with type 2 DM using the dulaglutide and liraglutide treatment regimens are 17 577.09 and 18 517.54 US dollars per patient, respectively, over a 10-year time horizon. In terms of effectiveness, the average discounted quality-adjusted life-year rates are estimated at 5.560 and 5.403 for the dulaglutide and liraglutide treatment regimens, respectively. The model is mostly sensitive to the price of dulaglutide and liraglutide, the hemoglobin A1c reduction of liraglutide, and the utility resulting from less injection frequency of dulaglutide, respectively.

CONCLUSION

Dulaglutide, in addition to being more effective, providing 0.156 more quality-adjusted life-years for the patients, reduces costs by 940.45 US dollars per patient over a 10-year time horizon. Therefore, due to the greater effectiveness and lower cost, it is concludable that dulaglutide is the cost-effective (incremental cost-effectiveness ratio = -6028.52) treatment alternative from the health system perspective.

Long-term cost-effectiveness of quality of diabetes care; experiences from private and public diabetes centers in Iran

BACKGROUND

The quality of health care has a significant impact on both patients and the health system in terms of long-term costs and health consequences. This study focuses on determining the long-term cost-effectiveness in quality of diabetes care in two different settings (private/public) using longitudinal patient-level data in Iran.

METHODS

By extracting patients intermediate biomedical markers in under-treatment type 2 diabetes patients(T2DP) in a longitudinal retrospective study and by applying the localized UKPDS diabetes model, lifetime health outcomes including life expectancy, quality-adjusted Life expectancy (QALE) and direct medical costs of managing disease and related complications from a healthcare system perspective was predicted. Costs and utility decrements had derived on under-treatment T2DP from 7 private and 8 Public diabetes centers. We applied two steps sampling mehods to recruit the needed sample size (cluster and random sampling). To cope with first and second-order uncertainty, we used Monte-Carlo simulation and bootstrapping techniques. Both cost and utility variables were discounted by 3% in the base model.

RESULTS

In a 20-year time horizon, according to over 5 years of quality of care data, outcomes-driven in the private sector will be more effective and more costly (5.17 vs. 4.95 QALE and 15,385 vs. 8092). The incremental cost-effectiveness ratio (ICER) was $33,148.02 per QALE gained, which was higher than the national threshold.

CONCLUSION

Although quality of care in private diabetes centers resulted in a slight increase in the life expectancy in T2DM patients, it is associated with unfavorable costs, too. Private-sector in management of T2DM patients, compared with public (governmental) diabetic Centers, is unlikely to be cost-effective in Iran.

Determinants of Self-care Behaviors in Diabetic Patients in Yazd: An Application of the Protection Motivation Theory

Background: Diabetes is an increasingly important public health concern. Self-care behaviors should be improved to help diabetic patients better control the disease, highlighting the importance of understanding the factors that affect a diabetic patient’s self-care behaviors. Therefore, the goal of the present study was to determine factors related to self-care behaviors in patients with type 2 diabetes (T2D) using the protection motivation theory (PMT). Methods: In general, 160 type 2 diabetic patients referring to Yazd Diabetes Research Center were randomly selected and included in this analytical cross-sectional study. The data were gathered by a reliable and valid questionnaire, which is a summary of a multi-question questionnaire. It included PMT constructs and demographic information through interviewing the patients. Finally, data were analyzed using t test, ANOVA, linear regression, and Pearson correlation tests. Results: The mean age of the patients and the mean self-care behaviors were 55.87±9.62 years and 37.56±12.94, respectively. In the regression model, perceived susceptibility (β=0.294, P<0.001) and protection motivation (β=0.247, P=0.003) were significant predictors of diabetes self-care behaviors. This model was able to explain 20% of the variance of these behaviors. Conclusion: PMT is effective in recognizing the determinants of diabetes self-care behaviors; therefore, to increase patients’ motivation to adopt diabetes self-care behaviors, a framework similar to this theory can be used to design educational programs. It is suggested that other studies in the field of self-care be conducted with other educational models in different populations of patients, and their results be compared accordingly.

Cost-Effectiveness Analysis of Group vs. Weblog Telecommunication (Web Tel) Nutrition Education Program on Glycemic Indices in Patients With Non-Insulin Dependent Diabetes Mellitus Type 2: A Randomized Controlled Trial

This a randomized controlled trial study with a cost-effectiveness analysis that aimed to compare the cost-effectiveness of group nutrition education with that of Web-Tel nutrition education in the glycemic control of patients with non-insulin-dependent type 2 diabetes mellitus (T2DM). The study was conducted on 105 patients with T2DM for 3 months in Quds health centre of Bushehr province, Iran. The participants were classified based on age and disease severity (hemoglobin A1c level); then, they were randomly assigned to one of the three groups: group education, Web-Tel education, and the control group using block randomization method. The clinical (intermediate) outcome was changes in hemoglobin A1c (HbA1c). Patients' perspective was adopted, and a deterministic one-way sensitivity analysis was conducted to identify the effects of uncertainties. The results indicated that the expected effectiveness was 0.46, 0.63, and 0.4; the mean costs was 27,188, 5,335, and 634 purchasing power parity (PPP) dollars for group education, Web-Tel education, and the control group, respectively. The incremental cost-effectiveness ratio (ICER) of Web-Tel education vs. the control group was positive and equal to $21, 613.04 PPP; since it was less than three times of the threshold, the Web-Tel education method was considered as a more cost-effective method than the control group. On the other hand, the ICER of group education vs. control group was $447,067 PPP and above the threshold, so group education was considered as a dominated method compared with the control group. In conclusion, considering the ICER, Web-Tel education is a more cost-effective method than the other two and can be used as the first priority in educating patients with T2DM. The present study was registered in Thailand Clinical Trials Registry (TCTR20210331001).

The prevalence and predictors of pre-diabetes and diabetes among adults 40-70 years in Kharameh cohort study: A population-based study in Fars province, south of Iran

Purpose

In this study, the prevalence of diabetes and pre-diabetes (pre-DM) has been estimated; also, some factors related to diabetes and pre-diabetes in the city of Kharameh, southern Iran, were investigated.

Methods

This cross-sectional study was conducted on a total of 10,474 subjects aged 40-70 years who participated in phase one of PERSIAN Kharameh cohort carried out between 2015 and 2016. Eligible individuals were included in the study by census method.

Results

Prevalence of diabetes is 20.17% (95% CI: 19.95-20.39) and that of pre-diabetes is 15.74% (95% CI 15.54-15.93). Multivariate logistic regression results showed that the prevalence of diabetes had a direct relationship with increasing age (p < 0.001), being single (p = 0.005), family history of diabetes (p < 0.001), abdominal obesity (p < 0.001), hypertension (p: < 0.001), and high triglycerides (p: < 0.001); also, it had an inverse relationship with residence in rural areas (p < 0.001), education (p < 0.001), and employment (p < 0.001).Also, the prevalence of pre-diabetes showed a direct relationship with increasing age (60-70 years p = 0.010), being single (p = 0.004), living in rural areas (P < 0.001), having a family history of diabetes ( both P = 0.023), abdominal obesity (P < 0.001), hypertension (P < 0.001), high cholesterol (P < 0.001) and high triglycerides (P < 0.001), and an inverse relationship with female gender (P < 0.001), education (high school P = 0.022), employment (P = 0.010), and smoking habit (P = 0.019). These results were all statistically significant.

Conclusion

The present study shows the high prevalence of diabetes and pre- diabetes in the city of Kharameh. Diabetes prevention policies should be developed and implemented for the public.

Quality of care in type 2 diabetes in Iran; a cross-sectional study using patient-level data

BACKGROUND

Appropriate service delivery, access to high quality of cares and optimal management of type 2 diabetes mellitus (T2DM) can decrease the risk of micro and macro vascular complications and mortality. Therefore, monitoring the quality of diabetes care, including keeping glycemic levels at an optimal level, is crucial. The aim of this study was to evaluate processes and outcome-related quality of care indicators, in T2DM using retrospective patient-level data from 2013 to 2017 in 15 Tertiary Diabetes Care Centers in Iran.

METHOD

A retrospective observational study was conducted among 1985 T2DM patients at public, semipublic and private diabetes centers. Annual tests for HbA1c, serum lipid (LDL), and screening for nephropathy were used to evaluate process-related indicators; and intermediate biomedical markers including HbA1c, blood pressure (BP), and LDL cholesterol, were used to assess outcome-related indicators.

RESULTS

Data were extracted from 15 diabetes centers in five provinces in Iran. 62.7% of the patients were female, and the mean duration of diabetes in the patients was 14.7 years. Evaluation of process-related indicators showed that only 9% of patients took the HbA1c test. The percentage of the patients without annual low-density lipoprotein (LDL) test decreased from 13% in 2013 to 7% in 2017. The results of achieving to all indicators concurrently (ABC care) showed that less than 2% of the patients met the criteria of optimal process-related quality indicators. The mean percentage of the patients with HbA1c under 7%, blood pressure (BP) less than 130/80 mmHg, and LDL less than 100 mg^/dl in the selected provinces were 32.4, 55, and 71 respectively. However, the average of total achievement in ABC goals was 14.2%.

CONCLUSION

Our findings showed that the management of T2DM in all selected provinces was far from the optimal control in both processes and outcome-related indicators and therefore needs serious consideration and improvement.

How mothers of a child with type 1 diabetes cope with the burden of care: a qualitative study

INTRODUCTION

Caregiver burden is a complex construct that depends heavily on the context and culture of the community in which care takes place. This study aimed to explore the lived experience of being mothers of a child with type 1 diabetes aged 6 to 18 years.

MATERIALS AND METHODS

We used a qualitative methodology utilizing conventional content analysis. We conducted 24 interviews with 20 mothers who had a child with type 1 diabetes aged 6 to 17 years.

RESULTS

The mean age of mothers and children were 36.3 and 12.3 years, respectively. The mean of years with the disease was 4.3 years. Thirteen children were girls. The essential theme was coping with the burden of care through personalized coping and active acquisition of social support. The main theme consists of four sub-themes including Crisis in the family and burden of care, Losing the family equilibrium, Personalized coping strategies, and Active acquisition of social support. Mothers used personalized strategies and every support they could get to reach their aim.

CONCLUSIONS

Families of children with type 1 diabetes need extensive and personalized care plans.

The Relationship between Oral and Dental Health Self-care and Hemoglobin A1c in Adults with Diabetes

Statement of the Problem

Due to the mutual relationship between periodontal diseases and diabetes, it seems that adopting oral self-care in a way to prevent and control the progress of periodontal diseases, improves the oral health of diabetic patients as well as their general health.

Purpose

The aim of this study was to investigate the relationship between the oral self-care behaviors and the hemoglobin A1c (Hb A1c) levels in adults with diabetes.

Materials and Method

In this cross-sectional study with convenience sampling, 120 adults between 18 to 50 years old, who had at least two healthy functional teeth, were selected from private endocrinology offices in Tehran in August 2019. The exclusion criteria were illiterate individuals and pregnant women. A standard questionnaire was used which included the information about demographic, diabetes, and self-care behaviors. The outcome variable was the latest Hb A1c rate.

Results

The mean age of participants was 35.8±10.5 years. The average Hb A1c was 7.4± 1.55%. 35.0% of participants brushed their teeth twice a day or more and 60.8% flossed rarely. The proportion of Hb A1c <7% was higher in three groups including the participants who had information about the effect of periodontal disease on diabetes (p= 0.032), participants who brushed twice a day or more (p= 0 .014), and those who used dental floss once a day or more (p< 0.001). The likelihood of having Hb A1c <7% in participants who had information about the effect of periodontal disease on diabetes was about three times more than those who had no information (OR= 3.05, p= 0.036). Furthermore, it was about six times higher in participants who used dental floss once a day or more than those who used rarely (OR= 5.66, p= 0.001).

Conclusion

Results of the present study show that people who had better oral health self-care behaviors had better Hb A1c and diabetes control.

Association of Insulin Receptor Substrate-1 Gene Polymorphism (rs1801278) with Alzheimer’s Disease

Background: Alzheimer’s disease (AD) is the most common form of dementia. AD is also the leading cause of morbidity and mortality due to dementia worldwide. It has been shown that AD is associated with type 2 diabetes mellitus (T2DM) and brain insulin resistance. Rs1801278 is a polymorphism in insulin receptor substrate-1 (IRS-1) gene which changes the amino acid Arg972. This polymorphism has been found to be associated with susceptibility to AD in some populations. Objective: In the present study, our aim was to investigate the association of Arg972 IRS-1 (rs1801278) gene polymorphism and late-onset Alzheimer’s disease (LOAD) in an Iranian population. Methods: In this case-control study, 150 patients with LOAD and 150 unrelated healthy controls were recruited. Polymerase chain reaction (PCR) was performed to amplify a DNA segment of 263 base-pair (bp) length containing the single nucleotide polymorphism (SNP). The PCR product was then incubated with MvaI restriction enzyme to undergo enzymatic cleavage. Electrophoresis was thereafter carried out using agarose gel and DNA safe stain. The gel was ultimately visualized under a UV trans-illuminator. Allelic and genotypic frequencies were then compared. Results: A allele (mutant) of the gene was significantly associated with the risk of AD after adjustment for sex and age (p = 0.04, adjusted OR:1.77, 95% CI:1.00–3.11). Only AA genotype (mutant homozygote) was significantly associated with the risk of AD after adjustment for sex and age (p = 0.01, adjusted OR:2.39, 95% CI:1.22–4.66). Conclusion: SNP rs1801278 is significantly associated with the risk of developing AD in the studied Iranian population.

Policy Implications for Diabetes Prevention and Control: An Experience from Iran

Background: Diabetes and its complications threaten the life of communities at global, national, and sub-national levels. Following the United Nations' call to action and develop a global action plan for the prevention and control of NCDs by The World Health Organization (WHO), all countries have a commitment to halt the rise in diabetes prevalence across the world. But the different situations of disease and risk factors, different priorities, and the context of the health care systems moved the countries to develop adapted targets and action plans. On the same ground, Iran established a national authority construction as the Diabetes Sub-committee which is part of the Iranian Non-Communicable Diseases Committee (INCDC) and incorporated a multi-sectoral mechanism to develop the national service framework for diabetes. Accordingly, this paper is aiming at sharing Iran's experience regarding the policy implications for diabetes prevention and control. Exchange this experience could be beneficiary to other countries to lead a systematic action to prevent disability and mortality due to diabetes.

Incremental Healthcare Resource Utilization and Expenditures Associated with Cardiovascular Diseases in Patients with Diabetes: A Cross-Sectional Study

BACKGROUND

Cardiovascular disease (CVD) is the most prevalent comorbid condition among patients with diabetes. The objective of this study is to determine the incremental healthcare resource utilization and expenditures (HRUE) associated with CVD comorbidity in diabetic patients.

METHODS

In a cross-sectional study, patients receiving antidiabetic drugs were identified using the 2014 database of the Iran Health Insurance Organization of East Azerbaijan province (Iran). The frequency of HRUE was the main outcome. Outcome measures were compared between diabetic patients with and without CVD comorbidity during 2014-2016. The generalized regression model was used to adjust for cofounders because of a highly skewed distribution of data. Negative binomial regression and gamma distribution model were applied for the count and expenditure data, respectively.

RESULTS

A total of 34,716 diabetic patients were identified, of which 21,659 (63%) had CVD comorbidity. The incremental healthcare resource utilization associated with CVD compared to non-CVD diabetic patients for physician services, prescription drugs, laboratory tests, and medical imaging was 5.9±0.34 (28% increase), 46±1.9 (46%), 12.9±0.66 (27%), and 0.16±0.40 (7%), respectively (all P<0.001). Similarly, extra health care costs associated with CVD comorbidity for physician services, prescription drugs, laboratory tests, and medical imaging were 10.6±0.67 million IRR (294.4±18.6 USD) (50% increase), 1.44±0.06 million IRR (40±1.6 USD) (32%), 8.36±0.57 million IRR (232.2±15.8 USD) (58%), 0.51±0.02 million IRR (14.1±0.5 USD) (24%), and 0.29±0.02 million IRR (8±0.5 USD) (22%), respectively (all P<0.001).

CONCLUSION

CVD comorbidity substantially increases HRUE in patients with diabetes. Our findings draw the attention of healthcare decision-makers to proactively prevent CVD comorbidity in diabetic patients.

Trends of Diabetes Mortality in Iran at National and Sub-National Levels from 1990 to 2015 and Its Association with Socioeconomic Factors

Background: Following global commitments to prevent and control non-communicable diseases, we sought to estimate national and sub-national trends in diabetes mortality in Iran and assess its association with socioeconomic factors. Methods: In a systematic analytical study, to assess the correlation between diabetes mortality and socioeconomic factors, we used data obtained from the Death Registration System (DRS), the Spatio-temporal model and Gaussian Process Regression (GPR) levels and the diabetes mortality trends, which were estimated by sex, age and year at national and sub-national levels from 1990 to 2015. Results: Between the years 1990 and 2015, the age-standardized diabetes mortality rate (per 100,000) increased from 3.40 (95% UI: 2.33 to 4.99) to 7.72 (95% UI: 5.51 to 10.78) in males and from 4.66 (95% UI: 3.23 to 6.76) to 10.38 (95% UI: 7.54 to 14.23) in females. In 1990, the difference between the highest age-standardized diabetes mortality rate among males was 3.88 times greater than the lowest (5.97 vs. 1.54), and in 2015 this difference was 3.96 times greater (14.65 vs. 3.70). This provincial difference was higher among females and was 5.13 times greater in 1990 (8.41 vs. 1.64) and 5.04 times greater in 2015 (19.87 vs. 3.94). The rate of diabetes mortality rose with urbanization yet declined with an increase in wealth and years of schooling as the main socio-economic factors. Conclusion: The rising trend of diabetes mortality rate at the national level and the sub-national disparities associated with socioeconomic status in Iran warrant the implementation of specific interventions recommended by the '25 by 25' goal.

Prevalence and Prevention of Rheumatologic Manifestations and their Relationship with Blood Glucose Control in Patients with Type II Diabetes

Background:

Musculoskeletal disorders in diabetic patients are associated with pain and disability, and thus, a significant reduction in quality of life. The current study was conducted with the aim of evaluating the frequency and prevention of rheumatologic manifestations and their association with blood glucose levels in diabetic patients.

Methods:

In this cross-sectional study, a total of 273 patients with type II diabetes, referred to the diabetes clinic, were selected by using the census method. Using a checklist, demographic, and clinical data, including duration of diabetes, blood glucose level, HbA1c, type of diabetes, BMI, history of smoking, blood pressure, serum cholesterol level, triglyceride, HDL, LDL, and musculoskeletal disorder type were analyzed using SPSS20 software application using independent t-test. Modeling was performed to obtain the best fit using logistic regression. The significance level was considered less than 0.05.

Results:

62.6% of patients had at least one of the rheumatologic complications. The most common complication was related to carpal tunnel syndrome (26.4%), followed by muscle contraction (23.8%). By moderating the effects of other variables, the odds ratio for rheumatoid complications was obtained as 1.74 with one unit of increase in HbA1c, which was statistically significant. In examining the influential variables, high age, gender, smoking, and BMI showed statistically significant effects ().

Conclusions:

Given the high prevalence of musculoskeletal disorders in diabetic patients, early diagnosis and timely treatment of the complications are crucial. It is recommended that musculoskeletal examinations be included as an important part of regular care for these patients.

Knowledge discovery in genetics of diabetes in Iran, a roadmap for future researches

Purpose

The pathogenesis of diabetes is considered polygenic as a result of complex interactions between genetic/epigenetic and environmental factors. This review intended to evaluate the scientometric and knowledge gap of diabetes genetics researches conducted in Iran as a case of developing countries, and drawn up a roadmap for future studies.

Methods

We searched Scopus and PubMed databases from January 2015 until December 2019 using the keywords: (diabetes OR diabetic) AND (Iran). All publications were reviewed by two experts and after choosing relevant articles, they were categorized based on the subject, level of evidence, study design, publication year, and type of genetic studies.

Results

Of 10,540 records, 428 articles were met the inclusion criteria. Generally, the number of researches about diabetes genetics rose since 2015. Case-control/cross-sectional and animal studies were the common types of study design and based on the subject, the most frequent researches were about genetic factors involved in diabetes development (38%). Briefly, the top seven genes that were evaluated for T2DM were TCF7L2, APOAII, FTO, PON1, ADIPOQ, MTHFR, and PPARG respectively, and also, CTL4 for T1DM. miR-21, miR-155, and miR-375 respectively were the most micro-RNAs that were evaluated. Furthermore, there were six studies about lncRNAs.

Discussion and Conclusion

Investigation about the genetic of diabetes is progressed although there are some limitations like non-homogenous data from Iran, heterogeneity of ethnicity, and rationale of studies. Compared to the previous analysis in Iran, still, GWAS and large-scale studies are required to achieve better policies for manage and control of diabetes disease.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-021-00838-8.

Integrated Exercise and Glycemic and Peripheral Sensation Control in Diabetic Neuropathy: A Single-Blind, Randomized Controlled Trial

BACKGROUND

Neuropathy control and management is an objective in therapeutic exercises prescribed for patients with Type 2 diabetic peripheral neuropathy. We examined the effects of 12-week integrated exercise (IE) on glycemic control and peripheral sensation criteria in patients with diabetic neuropathy.

METHODS

This study was carried out in 2019-2020 in Janan diabetic society of Najaf Abad in Iran. Based on MNSI scores, we assigned 40 patients into two equal paired random groups (control vs. IE). Pre and posttests were administered before and after three months of intervention.

RESULTS

Repeated measures ANOVA showed no significant interaction effect between the FBS of the groups (P = 0.26) but significant interaction effects were observed between the levels of 2 hrs pp G, 4 pm G, HbA1c, Diapason, Monofilament, and Thermofeel in favor of the IE group (P < 0.05).

CONCLUSIONS

At the beginning of IE, we used massage and foam roller to release pain and improve blood circulation as well as sensation in the neuropathic areas. This may have helped the patients perform the aerobic and resistance exercises more easily. Therefore, better glycemic control and peripheral sensation were achieved. Verification of the long-term effects of this training strategy requires further study. Verification of the long-term effects of this training strategy requires further study.

Time-varying association between physical activity and risk of diabetes in the early and late adulthood: A longitudinal study in a West-Asian country

BACKGROUND

The time-varying association between physical activity (PA) and incidence of type 2 diabetes (T2DM) is still unclear. The present study aimed to investigate this association in the early- and late-adulthood during a 9-year follow-up.

METHODS

This study was conducted on 3905 participants in early and late adulthood, using the Tehran Lipid and Glucose Study (TLGS) dataset. PA was assessed via the Iranian version of Modified Activity Questionnaire (MAQ). The association between trend of PA and incident T2DM was investigated using time-varying Cox's proportional hazard model. Variables including job, education, smoking and body mass index (BMI) were adjusted in the final model.

RESULTS

The distribution of sex- and age-specific levels of PA changed significantly over time. Compared with physically inactive women, for older women with high level of PA, the risk of T2DM was 0.64 (95% CI: 0.43-0.95, P = 0.02) in adjusted model. Moreover, hazard for low PA group was significantly higher than the moderate group, and for these two groups were significantly higher than high PA level (P < 0.05).

CONCLUSION

High PA level can postpone the incident T2DM in early-aged and elderly women, over time. Therefore, gender and age are of great importance in designing the PA modifying programs to prevent T2DM.

Evaluation of the effects of the national diabetes control and prevention program on a sample of iranian people with type 2 diabetes

Diabetes prevention programs have been developed in the different countries and it is therefore necessary to gain a better understanding of factors affecting the effectiveness of these programs for each society. Accordingly, the purpose of this study was to evaluate the effect of the National Diabetes Control and Prevention Program (NDCPP) on the biochemical and anthropometric indices among a sample of Iranian patients with type 2 diabetes mellitus (T2DM). A total of 384 patients with T2DM from the primary health care system of Tehran and Tabriz cities during January to June 2020, were included in the study. A two-part questionnaire consisting of items related to socio-economic and demographic characteristics was used and biochemical and anthropometric indices were measured at the beginning and the end of the 3-month intervention period. There was a significant difference in fasting blood sugar (FBS), hemoglobin glycosides (HbA1 C), systolic blood pressure (SBP) and weight before and after the NDCPP (P <  0.001). Also, there was significant improvement in carbohydrate (P = 0.015) and protein intake (P = 0.027) after the NDCPP compared to before the study. No significant difference was observed in waist circumference (WC) (P = 0.689), body mass index (P = 0.784), diastolic blood pressure (P = 0.647), and other dietary nutrient intake before and after the NDCPP. Repeated measure ANOVA revealed a significant decrease in FBS (Time effect P = 0.019) and weight (Time effect P = 0.006) after the NDCPP. Also, residing in different cities had a significant effect on FBS (time×city effect P <  0.001), HbA1 C (time×city effect P <  0.001), and SBP (time×city effect P = 0.037) after the NDCPP. The NDCPP resulted in weight loss, improved HbA1 C, and FBS. These findings suggested that NDCPP had a positive effect on controlling T2DM among Iranian population and can be considered as a way to prevent complications of T2DM.

Relationship of musculoskeletal diseases with microvascular and macrovascular complications in patients with diabetes in Iran

BACKGROUND AND AIMS

Musculoskeletal manifestations (carpal tunnel syndrome, Dupuytren's contracture, etc.) may occur in poorly controlled and longstanding diabetes. In this study, we evaluated the relationship of musculoskeletal diseases with microvascular and macrovascular complicationsin patients with diabetes.

METHODS

A total of 600 patients with diabetes were enrolled in this cross-sectional study. Demographic data and historical records of the patients were retrieved. Musculoskeletal diseases were assessed by clinical examinations and then confirmed by a rheumatologist.

RESULTS

Out of the 600 patients with diabetes, 61.5% (369/600) were female and 38.5% (231/600) were male. Diabetic retinopathy, diabetic nephropathy, diabetic peripheral neuropathy, CVA, and diabetes related ischemic heart disease were rated as 43.1%, 33.2%, 7.8%, 7.5%, and 39.6%, respectively. Significant gender differences were observed in the rates of diabetic nephropathy [56.28% for women and 43.71% for men (p value < 0.000)], diabetic peripheral neuropathy [72.34% for women and 27.65% for men (p value < 0.002)], and ischemic heart disease [57.98% for women and 42.01% for men(p value < 0.001)].

CONCLUSION

Musculoskeletal diseases usually occur in patients with poorly controlled and long-term diabetes. Due to the clear association of microvascular complications with musculoskeletal disease, more attention should be paid to the early detection of these complications in patients with diabetes.

Personality traits and sexual self-efficacy in diabetic women: The mediating role of marital satisfaction and sexual function

INTRODUCTION

Although the relationship between personality traits and sexual self-efficacy has received theoretical and empirical support, there is little information on how personality affects the sexual self-efficacy of diabetic women. This study aimed to investigate the mediating role of marital satisfaction and sexual function in the relationship between personality traits and sexual self-efficacy in diabetic women.

METHODS

Using a two-stage sampling method, 410 reproductive-aged Iranian women with type 2 diabetes were recruited in this descriptive-analytical study. The participants completed self-administered questionnaires, including the Vaziri Sexual Self-Efficacy Questionnaire, the Female Sexual Function Index, ENRICH Marital Satisfaction Scale, and the Goldberg's Big Five Questionnaire. To analyze the data, structural equation modeling was employed in Amos software version 24.

RESULTS

Results indicated an acceptable fit of the model to the data. Personality trait of openness to experience was associated with sexual self-efficacy directly (β = .02, p = .030) and indirectly through the mediators of marital satisfaction (β = .06, p = .009) and sexual function (β = .18, p = .014). Furthermore, sexual function was associated with sexual self-efficacy directly (β = .50, p = .025) and indirectly through the mediator of marital satisfaction (β = .36, p = .012).

CONCLUSION

Due to the mediating role of marital satisfaction and sexual function, this study has some practical implications for improving the sexual self-efficacy of diabetic women with different personality traits.

Associations between traditional and non-traditional anthropometric indices and cardiometabolic risk factors among inpatients with type 2 diabetes mellitus: a cross-sectional study

Objective

We aimed to evaluate whether traditional and non-traditional adiposity indicators are associated with cardiometabolic risk factors among adult patients with type 2 diabetes mellitus (DM).

Methods

In this cross-sectional study among 240 inpatients with type 2 DM, we determined traditional anthropometric indicators including body mass index, waist circumference, hip circumference (HC), waist-to-hip ratio (WHR), waist-to-height ratio, and non-traditional anthropometric indicators including lipid accumulation product (LAP), visceral adiposity index (VAI), deep abdominal adipose tissue (DAAT), and Després indices. Lipid profile, fasting blood glucose, glycated hemoglobin (HbA1c), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were measured to evaluate cardiometabolic parameters.

Results

In overweight patients, DAAT was positively correlated with total triglycerides. LAP was negatively correlated with serum HDL-C levels. WHR and DAAT were associated with total triglycerides, HbA1c, total cholesterol, total cholesterol/HDL-C, and total triglycerides/HDL-C, after adjustment for age and duration of disease. VAI, DAAT, LAP, and Després index were significant determinants of lipid profile and SBP.

Conclusion

Traditional and non-traditional anthropometric indices are associated with cardiometabolic risk factors in patients with type 2 DM.

The effect of peer support on quality of life among type 2 diabetic patients in deprived areas in Iran: A randomized clinical trial

BACKGROUND

Quality of life (QOL) is one of the effective factors in promoting the health of diabetic patients. In recent years, the role of peer support in the optimal management of diabetes has gained increasing attention. However, contradictory results have been reported from the effectiveness of this method. This study aimed to investigate the effect of peer support on the QOL among type 2 diabetic patients in deprived areas.

MATERIALS AND METHODS

This study was a randomized clinical trial conducted on 80 patients with T2D referring to the diabetes Clinic in Aligoudarz in Iran. Participants were randomly assigned into two groups of 40 patients. Intervention group received a peer Supportive-educational program for 3 months and the control group received routine clinic care. Diabetes QOL brief clinical inventory was used to collect the data. This questionnaire was completed three times at the beginning of the study, immediately after the 3-day training, and after 3 months of peer supportive intervention. The SPSS software (v. 18.0) was used to analyze the data through the Generalized Estimating Equations.

RESULTS

There was no significant difference in mean QOL between the two groups before the intervention (P = 0.891) and immediately after the education (P = 0.076). However, after 3 months of intervention, the intervention group showed a significant improvement in mean QOL compared to those in the control group (P < 0.001).

CONCLUSION

Peer support program can improve the QOL in type 2 diabetic patients in deprived areas. Therefore, this method can be recommended to improve care and educational programs in these patients.

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

BACKGROUND

The Middle East and North Africa (MENA) is postulated to have the highest increase in the prevalence of diabetes by 2030; however, studies on the epidemiology of diabetes are rather limited across the region, including in Iran.

METHODS

This study was conducted between 2016 and 2018 among Iranian adults aged 20 to 65 years residing in Khuzestan province, southwestern Iran. Diabetes was defined as the fasting blood glucose (FBG) level of 126 mg/dl or higher, and/or taking antidiabetic medications, and/or self-declared diabetes. Prediabetes was defined as FBG 100 to 125 mg/dl. Multinomial logistic regression models were used to examine the association of multiple risk factors that attained significance on the outcome.

RESULTS

Overall, 30,498 participants were recruited; the mean (±SD) age was 41.6 (±11.9) years. The prevalence of prediabetes and diabetes were 30.8 and 15.3%, respectively. We found a similar prevalence of diabetes in both sexes, although it was higher among illiterates, urban residents, married people, and smokers. Participants aged 50-65 and those with Body Mass Index (BMI) 30 kg/m² or higher were more likely to be affected by diabetes [RR: 20.5 (18.1,23.3) and 3.2 (3.0,3.6)]. Hypertension [RR: 5.1 (4.7,5.5)], waist circumference (WC) equal or more than 90 cm [RR: 3.6 (3.3,3.9)], and family history [RR: 2.3 (2.2,2.5)] were also significantly associated with diabetes. For prediabetes, the main risk factors were age 50 to 65 years [RR: 2.6 (2.4,2.8)], BMI 30 kg/m² or higher [RR: 1.9 (1.8,2.0)], hypertension and WC of 90 cm or higher [RR: 1.7 (1.6,1.8)]. The adjusted relative risks for all variables were higher in females than males, with the exception of family history for both conditions and waist circumference for prediabetes.

CONCLUSIONS

Prediabetes and diabetes are prevalent in southwestern Iran. The major determinants are older age, obesity, and the presence of hypertension. Further interventions are required to escalate diabetes prevention and diagnosis in high-risk areas across Iran.

Cross-national comparison of psychosocial well-being and diabetes outcomes in adults with type 1 diabetes during the COVID-19 pandemic in US, Brazil, and Iran

BACKGROUND

The COVID-19 pandemic is a global public health emergency, which presents wide-ranging negative impacts on individuals with diabetes. To examine psychosocial well-being and diabetes outcomes in individuals with type 1 diabetes during the COVID-19 pandemic, and investigate how these factors vary in different countries.

METHODS

Between April and June 2020 we employed a cross national comparative research study in the United States (US), Brazil, and Iran to collect data from 1788 adults with type 1 diabetes using web-based survey. Study participants answered questions relevant to diabetes distress, diabetes burnout, depressive symptoms, COVID-19 related changes, and socio-demographic characteristics. They also reported their last Hemoglobin A1c (HbA1c) and daily Time-in-Range (TiR) blood glucose. We analyzed data using comparative tests (Chi-square, Kruskal-Wallis and McNemar test), logistic and linear regression adjusted for fixed effects.

RESULTS

There were significant changes prior and during the pandemic regarding access to diabetes care, diabetes supplies and medications, healthy food and safe places to exercise in all countries (p < 0.05). Participants in Iran experienced higher levels of diabetes distress (57.1%), diabetes burnout (50%), and depressive symptoms (60.9%), followed by Brazil and US (p < 0.0001). US participants reported better glycemic control (HbA1c = 6.97%, T1R = 69.64%) compared to Brazil (HbA1c = 7.94%, T1R = 51.95%) and Iran (HbA1c = 7.47%, T1R = 51.53%) (p < 0.0001). There were also significant relationships between psychosocial well-being, diabetes outcomes, socio-demographic data, and COVID-19 related challenges in overall sample (p < 0.05).

CONCLUSIONS

Regardless of differences among US, Brazil, and Iran, our findings revealed that different countries may experience similar challenges related to the COVID-19 pandemic which can impact negatively diabetes outcomes and psychosocial well-being in individuals with type 1 diabetes. Countries need to consider modifiable variables associated with poor diabetes outcomes and sub optimal psychosocial well-being and target vulnerable population using significant socio-demographic variables.

Warning signals of elevated prediabetes prevalence in the modern Iranian urban population

BACKGROUND

We sought to estimate the prevalence of diabetes mellitus (DM) and pre-DM and their associated factors among a sample of the Iranian urban population between 2017 and 2019.

METHODS

The present investigation is a sub-study on the HAMRAH cohort study, a longitudinal population-based cohort study to assess the 10-year risk of cardiovascular diseases and their related risk factors in the adult population of the Iranian capital, Tehran. Via a multistage cluster randomized sampling method, 2123 adults aged between 30 and 75 years who had no history of cardiovascular diseases were selected for the study. With the aid of the 2010 American Diabetes Association criteria for the definition of DM and pre-DM, age and sex-specific prevalence rates were estimated.

RESULTS

The estimated overall prevalence of DM was 14.3% (95% CI: 13.1%-15.8%): 10.4% known DM (95% CI: 9.1%-11.8%) and 4% newly diagnosed DM (95% CI: 3.1%-5.1%). Pre-DM was detected in about 29.2% of the study participants (95% CI: 22.9-36.3%). Our logistic regression analysis revealed that increasing age, higher systolic blood pressure, higher levels of triglycerides, and lower levels of high-density lipoprotein were significantly associated with DM.

CONCLUSIONS

DM and pre-DM follow a notable incremental pattern among the Iranian urban population. This finding underscores the significance of the need to improve prevention and screening strategies in the Iranian urban population.

The Association Between Serum Magnesium Level and Microalbuminuria in Type 2 Diabetes Mellitus Patients

Background: Diabetic nephropathy occurs in 20 - 30% of diabetic cases globally, and microalbuminuria (MA) is the first symptom of this disorder. Some studies have suggested that there is an association between the serum magnesium (Mg) level and MA. Objectives: Therefore, we investigated the association between the serum Mg level and MA in type 2 diabetes mellitus (T2DM) patients. Methods: We conducted a cross-sectional study on 122 subjects with T2DM. We categorized them into two groups of microalbuminuria (MA) and non-microalbuminuria (NMA) according to their urine albumin-creatinine ratio (UACR). MA was considered as a UACR of 30 to 300 mg/g. Participants were excluded if they had the following conditions: The age of under 16 years, cardiac, renal, or hepatic disorders, using corticosteroids, diuretics, Mg /calcium (Ca) supplements, and antiepileptic drugs, heavy physical activity within 24 hours before the test, pregnant and breastfeeding women, febrile patients, and patients who were unwilling to participate in the study. The analysis was performed using SPSS version 15. A P-value < 0.05 was considered significant. Results: Among the patients, 50.81% were male. Also, the mean body mass index (BMI) of the NMA group was greater than the MA group (29.84 ± 5.64 vs. 27.31 ± 3.14, P-value = 0.003). Mg levels of the MA and NMA groups showed no significant differences (2.13 ± 0.42 and 2.10 ± 0.43, respectively; P-value = 0.67). Overall, data analysis provided no significant difference between Mg level and the urine albumin concentration between the MA and NMA groups (P-value = 0.21 and 0.81, respectively.). Conclusions: Serum Mg level and MA have no significant relationship. Further prospective studies are needed to assay this issue.

Interaction between Apo A-II -265T>C polymorphism and dietary total antioxidant capacity on some anthropometric indices and serum lipid profile in patients with type 2 diabetes mellitus

The present study aimed to investigate the interaction of Apo A-II polymorphism and dietary total antioxidant capacity (DTAC) with lipid profile and anthropometric markers in patients with type 2 diabetes (T2DM) that are at risk for atherosclerosis. This cross-sectional study was conducted on 778 patients with T2DM (35–65 years). Dietary intakes were assessed by a 147-item food frequency questionnaire. DTAC was computed using international databases. Participants were categorised into two groups based on rs5082 genotypes. The gene–diet interaction was analysed by an ANCOVA multivariate interaction model. Total cholesterol, TC; triacylglycerol, TG; high- and low-density lipoprotein, HDL and LDL; TC–HDL ratio; waist circumference, WC and body mass index, BMI were obtained according to standard protocols. Overall, the frequency of CC homozygous was 12⋅1 % among study participants. We found that a significant interaction between rs5082 variants and DTAC on mean WC (P_TEAC = 0⋅044), TC concentration (P_FRAP = 0⋅049 and P_TEAC = 0⋅031) and TC/HDL (P_FRAP = 0⋅031 and P_TRAP = 0⋅040). Among patients whose DTAC was higher than the median intake, the mean of weight, WC and TC/HDL were significantly higher only in individuals with CC genotype. Also, the high DTAC was associated with a lower TC concentration only in T-allele carriers (P_FRAP = 0⋅042). We found that adherence to a diet with high total antioxidant capacity can improve the complications of diabetes and atherosclerosis in the T carrier genotype more effectively than the CC genotype. These results could indicate the anti-atherogenic properties of Apo A-II. However, further studies are needed to shed light on this issue.