Nationwide Epidemiology of Diabetes and Prediabetes in Iran: A Registry- Based Cross-Sectional Study, 2023

Diabetes is a condition where the body struggles to manage the sugar it gets from food. Normally, a hormone called insulin acts like a key, unlocking cells so they can absorb sugar for energy. When this system fails, sugar builds up in the blood, which can damage the heart, kidneys, eyes, and nerves over time. Before a person develops full-blown diabetes, they often pass through a stage called prediabetes, where blood sugar levels are higher than normal but not yet high enough to be diagnosed as the disease. This middle ground is a critical warning sign; it is a moment when lifestyle changes can still prevent the condition from becoming permanent. Because diabetes affects so many people and places a heavy burden on families and hospitals, health officials need accurate, up-to-date maps of where the problem is most severe to know how to help.

In 2023, researchers in Iran undertook a massive effort to draw one of the most detailed maps of this health landscape ever created for the country. Instead of surveying a small group of people, they analyzed data from nearly forty million adults who participated in a nationwide health campaign. This campaign was a coordinated push to check blood pressure and blood sugar levels across the entire nation, from rural villages to big cities. The goal was to move beyond estimates and look at the actual numbers of people living with diabetes, those on the brink of it, and how well the current medical system is managing the disease. By looking at such a vast amount of real-world data, the team could see patterns that smaller studies might miss, offering a clear picture of the health of the Iranian adult population.

The results revealed that diabetes and prediabetes are affecting a significant portion of the country. Among adults aged eighteen and older, about eleven percent were found to have diabetes, while roughly twelve percent were in the prediabetes stage. When the researchers adjusted these numbers to account for the age of the population, the rates were slightly lower but still substantial, with about nine percent having diabetes and nearly eleven percent having prediabetes. A striking finding was that women were more likely to have diabetes than men. While the rates of prediabetes were similar between the sexes, the gap in diagnosed diabetes was clear, with women showing higher prevalence in every age group studied.

Age played a major role in who was affected. The likelihood of having diabetes rose steadily as people got older, peaking in the sixties and seventies before dipping slightly in the oldest age groups. This pattern suggests that the risk accumulates over a lifetime. The study also confirmed that having a family history of diabetes or having experienced gestational diabetes (high blood sugar during pregnancy) significantly increased a person's risk. Women who had gestational diabetes were found to be much more likely to develop diabetes later in life compared to those who did not.

Despite the high number of people affected, the study found that the public is quite aware of the problem. About eighty percent of those with diabetes knew they had the condition, a figure that was higher for women than for men. Furthermore, most people who knew they had diabetes were receiving treatment, with about sixty-four percent of them taking medication to lower their blood sugar. However, a critical gap remained in how well that treatment worked. Only about half of the people taking medication successfully brought their blood sugar levels down to the target range. This means that while many Iranians are aware of their condition and are trying to treat it, the treatment is not always effective enough to fully control the disease.

The researchers also looked at how people's health changed over time. They found that a small but significant number of people with normal blood sugar levels had progressed to prediabetes or diabetes since their last check. Conversely, some people with prediabetes managed to return to normal levels, showing that the condition is not always a one-way street. However, the number of people whose condition worsened was higher than the number who improved. The study highlighted that while the country has made progress in identifying and treating diabetes, the final step of ensuring that treatment actually controls the disease remains a challenge. The data suggests that future efforts need to focus not just on finding more cases, but on helping those who are already diagnosed achieve better control, particularly among men and older adults who are at the highest risk.