Epidemiology of diabetes mellitus, pre-diabetes, undiagnosed and uncontrolled diabetes in Central Iran: results from Yazd health study

Masoud Mirzaei,Masoud Rahmaninan,Azadeh Nadjarzadeh,Abbas Ali Dehghani Tafti,Mohsen Mirzaei

doi:10.1186/s12889-020-8267-y

Abstract

BackgroundOver the past few decades, the prevalence of Diabetes Mellitus (DM) has risen rapidly in Iran and other low and middle-income countries. We investigated the prevalence of DM, pre-diabetes, undiagnosed and uncontrolled diabetes and its relationship with some associated socioeconomic factors in the Yazd Greater Area in Iran.MethodsYazd Health Study is a longitudinal study conducted to determine the prevalence of non-communicable disease and related risk factors. In a two-step cluster sampling, 10,000 adults aged 20–69 years (200 clusters) were selected. In the recruitment phase, DM was considered if the patients had been either diagnosed DM by a physician or had fasting blood glucose ≥ 126 mg/dL. Chi square test was used for categorical variables to evaluate the differences and logistic regression model was applied to determine the predictors of diabetes.. P-value < 0.05 considered statistically significant.ResultsOf the 9965 individuals recruited, the crude self-reported prevalence of DM was 14.1% (95% CI: 13.4–14.7). The prevalence was higher in women than men (15.6 vs.12.4%), significantly. The age-standardized prevalence of DM was 8%. The prevalence was 14.9% in Yazd local people and 8.6% in those residents migrated from other provinces (P < 0.0001). We showed a significant association between DM prevalence and age, education, marital status, unemployment, insurance status, and positive family history (P < 0.0001). The prevalence of DM diagnosed by phycisians was 16.1% in participants (age-standardized prevalence: 8.3%). The subset analysis showed that 4.8% of patients were not aware of their disease. The prevalence of pre-diabetes was 25.8%. Of those with diabetes, 58.3% were not adequately controlled, which is not statistically significant with socio-economic status.ConclusionThe current study showed a high prevalence of DM in Yazd Greater Area which is closely related to some socio-demographic factors. The high prevalence of pre-diabetes is alarming. Effective strategies for DM prevention should be introduced. The majority of people with diabetes are aware, but half of them are not controlled. The ineffective care plan currently in use, should be reviewed. Patients needs to be encouraged to improve their lifestyle. Active follow-up of patients is recommended to ensure continuity of care.

Highlights

Over the past few decades, the prevalence of Diabetes Mellitus (DM) has risen rapidly in Iran and other low and middle-income countries
High prevalence of diabetes and experience of these interventions for good awareness in Yazd, can help health managers to implement action plans for prevention and control of diabetes between study periods.Overall, we found that only aging was associated with undiagnosed DM indicating that they have a higher level of DM unawareness
The current study showed a high prevalence of DM in Yazd Greater Area, of every five people over 40 years, one has diabetes mellitus

Summary

Introduction

Over the past few decades, the prevalence of Diabetes Mellitus (DM) has risen rapidly in Iran and other low and middle-income countries. With an 8.5% global prevalence of diabetes in 2014; various estimates suggest that the number of affected people will be risen from 422 million to 642 million in the world by 2040 [2, 3]. The prevalence of diabetes has risen rapidly due to an increase in the average age of the community, hereditary background, unhealthy dietary habits, sedentary lifestyle and increased obesity in line with the growth of urbanization [5, 6]. The prevalence of diabetes is estimated to be 8.5% in adults aged over 18 years in 2014 which has increased significantly over the past three decades, especially in low and middle-income countries [2]. In the Eastern Mediterranean Region (EMRO), the average prevalence of diabetes in adult population was 13.7% in 2014, which is the highest prevalence compared to other WHO regions [2]

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