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The diabetes cascade of care through the 14 years in Iran: findings of nationwide STEPS surveys 2007–2021

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Abstract

Background

Diabetes as the leading cause of mortality and morbidity, have been increased by about 35% from 2011 to 2015 worldwide. The objective of this study was to assess the trend and pattern of diabetes and prediabetes prevalence in Iran and also evaluate the diagnosis and status of diabetes management.

Methods

The results of this study are extracted from the National Stepwise approach to non-communicable disease risk factor surveillance (STEPS), conducted in 2007, 2011, 2016, and 2021 in Iran. We evaluated all obtained data by questionnaires (demographic, epidemiologic, risk-related behavioral data), physical measurements, and laboratory measures.

Results

The prevalence of diabetes almost doubled from 2007 to 2021 among adults 25 years old and above. Diabetes prevalence increased from 10.85% (95% CI:10.30–11.40) in 2016 to 14.15% (13.42–14.87) in 2021. Prediabetes prevalence increased from 18.11% (17.46- 18,76) in 2016 to 24.81% (23.88–25.74) in 2021. Diabetes diagnosis stayed constant hence; diabetes coverage improved from 56.87% (54.21–59.52) to 65.04% (62.40- 67.69). Despite an enhancement in diabetes diagnosis and coverage, diabetes effective care did not improve significantly during 2016 and 2021, with a number of 35.98% (32.60- 39.36) in 2016 and 31.35% (28.20- 34.51) in 2021.

Conclusion

The prevalence of diabetes and prediabetes in Iran is almost doubled during the past 14 years. Although, several health policies had been developed to improve the screening and quality of diabetes care; there are still significant gaps in the effective control of diabetes. Accordingly, the current care plan should be reviewed.

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Abbreviations

ADA:

American Diabetes Association

COVID-19:

Coronavirus disease 2019

FPG:

Fasting blood glucose

GPAQ 1:

Global Physical Activity Questionnaire version 1

HbA1c:

Glycated hemoglobin A1c

NCD:

Non-communicable disease

NGO:

Non-Governmental Organisation

OHA:

Oral Hypoglycemic Agents

PCA:

Principal component analysis

STEPS:

Stepwise approach to non-communicable disease risk factor surveillance

WHO:

World Health Organization

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Acknowledgements

The authors would like to express their gratitude for their partnership with the Deputy for Research and Technology and the Deputy of Health of the Ministry of Health and Medical Education, the National Institute for Health Research, and the World Health Organization. The authors would also like to thank the Non-Communicable Diseases Research Center’s staff of the Endocrinology and Metabolism Population Sciences Institute of Tehran University of Medical Sciences for their wholehearted cooperation. We are also grateful for the help and guidance of Dr. Mohammad Mehdi Khadembashiri in applying some revisions. This conducted study was an endocrinology and metabolism fellowship thesis project of Dr. Aslan Ameli.

Funding

This study received no grants or funding support.

Author information

Author notes

  1. Aslan Ameli, Ali Sheikhy and Ozra Tabatabaei-Malazy are equally first authors.

    Bagher Larijani and Negar Rezaei are equal Corresponds.

Authors and Affiliations

  1. Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Aslan Ameli, Ali Sheikhy, Ozra Tabatabaei-Malazy, Naser Ahmadi, Aida Fallahzadeh, Mohammad-Mahdi Rashidi, Ali Golestani, Moein Yoosefi, Yosef Farzi, Arezou Dilmaghani-Marand, Negar Rezaei & Farshad Farzadfar

  2. Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Ozra Tabatabaei-Malazy, Bagher Larijani & Farshad Farzadfar

  3. Elderly Health Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran

    Mahbube Ebrahimpur

  4. Department of Mathematics and Statistics, Memorial University of Newfoundland, St. John’s, NL, Canada

    Moein Yoosefi

  5. Digestive Disease Research Center (DDRC), Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran

    Negar Rezaei

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  1. Aslan Ameli
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Contributions

Conceptualization: Aslan Ameli, Negar Rezaei, Bagher Larijani, Farshad Farzadfar. Data Curation: Moein Yoosefi, Naser Ahmadi. Formal Analysis: Naser Ahmadi. Investigation: Bagher Larijani and all of the co-authors. Methodology: Aslan Ameli, Ali Sheikhy, Ozra Tabatabaei-Malazy, Naser Ahmadi, Negar Rezaei, Bagher Larijani. Writing—Original Draft Preparation: Aslan Ameli, Ali Sheikhy, Ozra Tabatabaei-Malazy. All of the authors participated in rewriting and finalizing the article and approved it.

Corresponding author

Correspondence to Bagher Larijani.

Ethics declarations

Ethical considerations

Every participant received detailed information about the survey’s objectives and procedures. Participation in the survey was entirely voluntary, and both verbal and written consent were obtained from each participant. The study received ethical approval from the ethical committee of the National Institute for Health Research (ID: IR.TUMS.NIHR.REC.1398.006).

Conflict of interest

The authors had no conflicts of interest.

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Electronic supplementary material {comment: please change “diabetes” in table-4 supplementary to “prediabetes” I uploaded new file as attachment}

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Ameli, A., Sheikhy, A., Tabatabaei-Malazy, O. et al. The diabetes cascade of care through the 14 years in Iran: findings of nationwide STEPS surveys 2007–2021. J Diabetes Metab Disord 22, 1731–1743 (2023). https://doi.org/10.1007/s40200-023-01308-z

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