Prevalence of Diabetes and Prediabetes, and Achievements in Diabetes Control in Iran; The Results of the STEPS of 2016

Abstract

Background: Using the WHO STEPwise approach to NCD risk factor surveillance (STEPS), first round of Iran’s STEPS completed in 2005. It has been repeated six times afterward. Here we report the results of 2016 round on the population characteristics and prevalence of diabetes and prediabetes, along with an assessment of the country-level performance on diabetes care in Iran. Methods: Using a proportional-to-size cluster random sampling method, the STEPS 2016 included 18947 subjects aged≥25 years who matched the criteria (non-missing information on diabetes self-report, and biomarkers). For the analyses, survey design methods with weighted samples were employed. Different definitions of diabetes (biomarker-based, self-report, anti-diabetes medication use, or a combination) and prediabetes (different cutpoints of the biomarker) were calculated and presented. Results: An estimated 5171035 persons aged≥25 years or 10.6% (95% CI: 10.0%–11.1%) had diabetes according to the serologic diagnosis of diabetes (FPG≥126 mg/dL) or the use of at least one anti-diabetes medication (1896 out of 18947). Employing the serologic diagnosis of diabetes among those who responded no to the self-reported question, 2.7% (2.5%–3.0%) of the population were not aware of their diabetes compared to 11.5% (10.9%-12.0%) who were diabetics according to the just self-reported question. Defining prediabetes as 100≤FPG<126 mg/dL or 5.7≤HbA1c<6.5%, an estimated 15244299 persons had prediabetes (5885 out of 18947). Overall, 52.1% (49.4%–54.7%) of patients with self-reported diabetes were under strict glycemic control (HbA1c<7%). Poor diabetes control (HbA1c>9%) was found in 18.4% (16.3%-20.6%) of the patients with self-reported diabetes. Conclusion: Since 2005, the prevalence of diabetes in Iran has been on a gradual increase in both genders with an increasing gap between females and males.

Diabetes Care Cascade and Compliance with WHO Global Coverage Targets in Iran: Findings of STEPS Survey 2021

“…This study found a higher prevalence of DM among females and a higher prevalence of prediabetes among males. The paradoxical sex difference in the prevalence of DM and prediabetes were consistent with previous STEPS 2016 Survey and other national estimations 9,10,19,20 . It is evident in literature although impaired fasting glucose is more prevalent in males, impaired glucose tolerance is more prevalent in females.…”

“…Previous Iran STEPS Survey 2016 reported the prevalence of DM at 10.6% (10.0-11.1) according to either high FPG or self-report of taking at least one anti-diabetes medication; however, based on other de nitions, the prevalence of DM reached 14.2% (13.6-14.8) 10 . The prevalence of prediabetes in previous STEPS was 16.6% (15.9-17.2) based on 100 ≤ FPG < 126 mg/ dL 10 . In a nationally representative cross-sectional survey of Iranian adults aged 35-70 years as part of the PERSIAN Cohort Study, the sex-and age-standardized prevalence of DM was 15.0% (12.6-17.3), and prediabetes was 25.4% (18.6-32.1) 9 .…”

“…The latest Global Burden of Diseases (GBD) 2019 estimations for Iran reported an age-standardized rate of DM of about 6702 (95% uncertainty interval: 6079-7361) prevalent cases per 100 000 population with nearly doubling during the past 30 years 18 . Previous Iran STEPS Survey 2016 reported the prevalence of DM at 10.6% (10.0-11.1) according to either high FPG or self-report of taking at least one anti-diabetes medication; however, based on other de nitions, the prevalence of DM reached 14.2% (13.6-14.8) 10 . The prevalence of prediabetes in previous STEPS was 16.6% (15.9-17.2) based on 100 ≤ FPG < 126 mg/ dL 10 .…”

“…Iran as a developing country with its transitioning status to the epidemic of NCDs is majorly encountered with the burden of DM 8 . This country includes geographically, ethnically, and socioeconomically diverse regions and populations, and estimations on the prevalence of DM have led to different statistics; however, national surveys showed an estimated prevalence of DM about 10-15% and prediabetes about 25-31% 9,10 . Also, diabetes awareness and control differ between studies as investigated samples and methods vary; therefore, reaching exact estimations is challenging 9,11 .…”

Determinants of multimorbidity in older adults in Iran: a cross-sectional study using latent class analysis on the Bushehr Elderly Health (BEH) program

“…Hypertension was defined as systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, or medication use for hypertension [ 27 ]. Diabetes mellitus was defined as an HbA1C ≥ 6.5% (48 mmol/mol), fasting plasma glucose ≥ 126 mg/dl (7.0 mmol/L), or medication use for diabetes [ 28 ]. Stroke was defined as a permanent change in sensory, motor activity, or other underlying conditions related to cerebrovascular disease [ 29 ].…”