Burden of type 2 diabetes mellitus and its risk factors in North Africa and the Middle East, 1990-2019: findings from the Global Burden of Disease study 2019.

BACKGROUND: The prevalence of Type 2 Diabetes Mellitus (T2DM) in the North Africa and Middle East region is alarmingly high, prompting us to investigate the burden and factors contributing to it through the GBD study. Additionally, there is a lack of knowledge about the epidemiological status of T2DM in this region, so our aim is to provide a comprehensive overview of the burden of T2DM and its associated risk factors. METHODS: Using data from the 2019 Global Burden of Disease Study, we calculated the attributable burden of T2DM for each of the 21 countries in the region for the years 1990 and 2019. This included prevalence, mortality, disability-adjusted life years (DALYs), and risk factors. RESULTS: Between 1990 and 2019, there was a significant increase in the age-standardized incidence (79.6%; 95% Uncertainty Interval: 75.0 to 84.5) and prevalence (85.5%; [80.8 to 90.3]) rates of T2DM per 100,000 populations. The age-standardized mortality rate (1.7%; [-10.4 to 14.9]), DALYs (31.2%; [18.3 to 42.2]), and years lived with disability (YLDs) (82.6%; [77.2 to 88.1]) also increased during this period. Modifiable risk factors, such as high body mass index (56.4%; [42.8 to 69.8]), low physical activity (15.5%; [9.0 to 22.8]), and ambient particulate matter pollution (20.9%; [15.2 to 26.2]), were the main contributors to the number of deaths. CONCLUSION: The burden of T2DM, in terms of mortality, DALYs, and YLDs, continues to rise in the region. The incidence rate of T2DM has increased in many areas. The burden of T2DM attributed to modifiable risk factors continues to grow in most countries. Targeting these modifiable risk factors could effectively reduce the growth and disease burden of T2DM in the region.

Inequalities in the prevalence, diagnosis awareness, treatment coverage and effective control of diabetes: a small area estimation analysis in Iran.

OBJECTIVE: This study aims to assess geographic inequalities in the prevalence, awareness of diagnosis, treatment coverage and effective control of diabetes in 429 districts of Iran. METHODS: A modelling study by the small area estimation method, based on a nationwide cross-sectional survey, Iran STEPwise approach to surveillance (STEPS) 2016, was performed. The modelling estimated the prevalence, awareness of diagnosis, treatment coverage, and effective control of diabetes in all 429 districts of Iran based on data from available districts. The modelling results were provided in different geographical and socio-economic scales to make the comparison possible across the country. RESULTS: In 2016, the prevalence of diabetes ranged from 3.2 to 19.8% for women and 2.4 to 19.1% for men. The awareness of diagnosis ranged from 51.9 to 95.7% for women and 35.7 to 100% for men. The rate of treatment coverage ranged from 37.2 to 85.6% for women and 24.4 to 80.5% for men. The rate of effective control ranged from 12.1 to 63.6% for women and 12 to 73% for men. The highest treatment coverage rates belonged to Ardebil for women and Shahr-e-kord for men. The highest effective control rates belonged to Sanandaj for women and Nehbandan for men. Across Iran districts, there were considerable differences between the highest and lowest rates of prevalence, diagnosis awareness, treatment coverage, and effective control of diabetes. The concentration indices of diabetes prevalence, awareness of diagnosis, and treatment coverage were positive and significant for both sexes. CONCLUSION: Findings of this study highlight the existence of inequalities in diagnosis awareness, treatment coverage, and effective control of diabetes in all Iran regions. More suitable population-wide strategies and policies are warranted to handle these inequalities in Iran.

The impact of gender patient-physician concordance on interpersonal processes of care and patients' outcomes in the diabetes care setting.

OBJECTIVE: To investigate whether patient-physician gender concordance influences the patient's perceptions of interpersonal processes of care and patient outcomes in Muslim patients with diabetes. METHODS: We conducted a cross-sectional telephone survey involving 4152 randomly selected patients using electronic diabetes records. Outcome measures included perceptions of interpersonal processes of care, adherence to medications, and HbA1c. Linear mixed regression models were used to explore the associations between the outcome variables and patient gender and gender concordance. RESULTS: The best processes of care were observed consistently for female concordant dyads. In adjusted mixed models, lower Hurried Communication was associated with female concordant (-0.91, p < 0.001) and female physician-male patient dyads (-0.82, p = 0.007). Higher Elicited Concerns was associated with female concordant (0.65, p = 0.003) and female physician-male patient dyads (0.59, p = 0.013). Higher Explained Results and Compassionate/Respectful were associated with female concordant dyads (0.83, p < 0.001, and 0.55, p = 0.010 respectively). Lower HbA1c was independently linked with female concordant dyads (-0.84, p < 0.001). CONCLUSION: This study highlights the importance of female gender concordance on perceptions of interpersonal processes of diabetes care and glycemic control. PRACTICE IMPLICATIONS: Strengthening physicians' communication skills with female patients should be taken into consideration.

Changes in clinic visits and diabetes and metabolic control in patients with type 2 diabetes during COVID-19 pandemic: A real world evidence.

PURPOSE: The study aim was to evaluate the effects of public lockdown during the covid-19 pandemic on glucose and metabolic parameters as well as body weight control in type 2 diabetic patients. METHODS: This study was conducted in two outpatient Diabetes Clinics and analyzed data available in database of Diabetes Clinic. Data related to a year before covid-19 pandemic and a year during covid-19 pandemic was collected from the database and analyzed. Patients with type 2 diabetes included in the analysis if they had referred to Diabetes Clinics both before and during covid-19 pandemic. Demographic information and data about metabolic status were collected from the records of previous outpatient Clinic visits and compared RESULTS: Finally 9440 patients with mean age of 61.08 ± 11.62 referred to Diabetes Clinics in both the year before and the year of the corona pandemic. Mean FBS and HbA1c in diabetes patients reduced significantly from 155.37 ± 62.93 and 7.97 ± 1.74 before pandemic, respectively to 138.77 ± 45.39 and 7.54 ± 1.34, respectively during covid-19 outbreak. During covid-19 pandemic, all metabolic parameters including glycemic and lipid profile (except for triglyceride) and BMI (body mass index) reduced significantly statistically, but, these changes were not clinically significant. However, triglyceride level increased statistically significantly but again it was not significant clinically. CONCLUSION: During COVID-19 lockdown, glycemic and metabolic control of diabetes patients have improved significantly except for triglycerides.

The effect of personalized intelligent digital systems for self-care training on type II diabetes: a systematic review and meta-analysis of clinical trials.

AIMS: Type 2 diabetes (T2D) is rising worldwide. Self-care prevents diabetic complications. Lack of knowledge is one reason patients fail at self-care. Intelligent digital health (IDH) solutions have a promising role in training self-care behaviors based on patients' needs. This study reviews the effects of RCTs offering individualized self-care training systems for T2D patients. METHODS: PubMed, Web of Science, Scopus, Cochrane Library, and Science Direct databases were searched. The included RCTs provided data-driven, individualized self-care training advice for T2D patients. Due to the repeated studies measurements, an all-time-points meta-analysis was conducted to analyze the trends over time. The revised Cochrane risk-of-bias tool (RoB 2.0) was used for quality assessment. RESULTS: In total, 22 trials met the inclusion criteria, and 19 studies with 3071 participants were included in the meta-analysis. IDH interventions led to a significant reduction of HbA1c level in the intervention group at short-term (in the third month: SMD = - 0.224 with 95% CI - 0.319 to - 0.129, p value < 0.0; in the sixth month: SMD = - 0.548 with 95% CI - 0.860 to - 0.237, p value < 0.05). The difference in HbA1c reduction between groups varied based on patients' age and technological forms of IDH services delivery. The descriptive results confirmed the impact of M-Health technologies in improving HbA1c levels. CONCLUSIONS: IDH systems had significant and small effects on HbA1c reduction in T2D patients. IDH interventions' impact needs long-term RCTs. This review will help diabetic clinicians, self-care training system developers, and researchers interested in using IDH solutions to empower T2D patients.

National and sub-national burden and trend of type 1 diabetes in 31 provinces of Iran, 1990-2019.

The aim of the study was to report the burden of type one diabetes mellitus (T1DM) by sex, age, year, and province in Iran over the past 30 years, according to data provided by the global burden of disease (GBD) study. Incidence, prevalence, death, disability-adjusted life-years (DALYs), years of life lost, and years lived with disability due to T1DM by age groups and sex was reported for 31 provinces of Iran from 1990 to 2019 with their 95% uncertainty intervals (UI). In 2019, national age-standardized incidence (11.0 (95% UI: 8.9-13.5)), prevalence (388.9 (306.1-482.1)), death (0.7 (0.6-0.8)), and DALYs (51.7 (40.9-65.1)) rates per 100,000 wre higher than 1990 except for death. Also, the mortality to incidence ratio reduced in all provinces over time particularly after 2014 as well. GBD data analysis showed that age-standardized incidence and prevalence rates of T1DM have increased, the death rate reduced, and DALYs remained unchanged during the past 30 years in Iran and its 31 provinces. death rate reduced and DALYs remained unchanged during the past 30 years in Iran and its 31 provinces.

COVID-19-specific worries among people with type 2 diabetes following the continuation of the pandemic and occurrence of multiple waves of COVID-19 in Iran.

Purpose: To assess COVID-19-specific diabetes worries, and to determine characteristics of people with high levels of these worries among people with type 2 diabetes (T2D) following the continuation of the pandemic and occurrence of multiple waves of COVID-19 in Iran. Methods: An interviewer-based, cross-sectional study was conducted using 500 T2D people in a diabetes specialty clinic. The questionnaire package comprised five parts: sociodemographic and clinical characteristics, COVID-19-specific worries, diabetes-related distress, feelings of isolation and changes in diabetes-specific behaviors. Clinical history and serum measurements were collected from electronic medical records. Descriptive statistics and logistic regressions were performed in the study. Results: Worries related to COVID-19 pandemic were highly prevalent in T2D people. Around 60% were worried about being severely affected due to diabetes if infected with COVID-19 and being described as a high-risk group for COVID-19, and more than half about being possibly faced with lack of diabetes medications. Logistic regressions demonstrated that being female, higher age, diabetes-related complications, duration of diabetes, insulin use, feeling isolation, diabetes-related distress and having changed self-management behaviors were associated with being more worried about diabetes and COVID-19. Conclusion: Diabetes-related worries relating to the COVID-19 were strongly associated with poorer psychosocial status. Findings emphasize the importance of conveying up-to-date information regarding diabetes and COVID-19 that patients want and need to know, also of providing emotional support associated with COVID-19-specific diabetes worries.

Physical Activity Behavior During the COVID-19 Outbreak in Individuals with Type 2 Diabetes: Role of Social Support and Other Covariates.

Objectives: This study was performed to investigate whether social support and other psychological predictors were associated with physical activity during the prolonged social isolation due to the coronavirus disease 2019 outbreak in Iran. Methods: This cross-sectional study was performed on 494 individuals with type 2 diabetes (T2D) in a diabetes specialty clinic. The questionnaire package comprised five parts, including sociodemographic and clinical characteristics, physical activity level, diabetes-specific social support, feelings of isolation, and diabetes-related distress. Clinical and hemoglobin A1c data were obtained from electronic medical records. Descriptive statistics, Pearson's chi-square test, and multivariable logistic regressions were conducted to analyze the data. Results: Approximately 71% of the participants participated in low/insufficient levels of physical activity. The participants who received support from family/friends (odds ratio [OR] = 1.77; 95% confidence interval [CI]: 1.47 - 2.74), diabetes care team (OR = 1.42; 95% CI: 1.15 - 1.77), and neighbors (OR = 1.53; 95% CI: 1.20 - 2.08) were more likely to have sufficient physical activity than those who did not receive these supports. There was also an association between physical activity behavior with feelings of isolation and diabetes distress. Conclusions: This study points to the importance of social support as an amplifier mechanism for the maintenance of physical activity behavior in individuals with T2D during critical times.

Type 2 Diabetes Burden and Diabetes Distress: The Buffering Effect of Patient-centred Communication.

OBJECTIVES: Our aim in this study was to assess the moderating role of patient-centred communication as a source of social support in the relationship between burden of diabetes and diabetes distress. METHODS: Individuals with type 2 diabetes (N=1,267) completed validated tools of diabetes distress and multiple aspects of patient-centred communication. A path approach was used to evaluate the moderating role of patient-centred communication in the relationship between diabetes burden, as indicated by prescription of insulin and presence of complications, and distress. RESULTS: Lower Hurried Communication, higher Elicited Concerns/Responded, higher Explained Results/Medications, greater Patient-centred Decision-making and Compassionate/Respectful were significantly associated with lower distress after controlling for burden. Hurried Communication, Explained Results/Medications and Patient-centred Decision-making moderated the relation between insulin and diabetes distress. CONCLUSIONS: Our findings support the stress-buffering hypothesis of patient-centred communication and imply that aspects of patient-centred communication may protect against diabetes-related distress.

The effect of metformin on cognitive function: A systematic review and meta-analysis.

Most people are familiar with metformin as a diabetic treatment option. Different positive benefits have been found for it, in addition to its anti-diabetes properties. Cognitive function enhancement is the most recent characteristic that has been studied. This study aimed to look at the evidence on the effects of metformin on cognitive performance. Web of Science, PubMed, Scopus, the Cochrane Library, EMBASE, and PsycINFO databases were searched systematically. After eliminating duplicates and irrelevant documents, the findings were screened. The documents that remained were scanned and data were extracted. Nineteen studies were qualified for meta-analysis after evaluating 3827 identified records. There was no significant relationship between metformin therapy and cognitive performance in none of the studies including cross-sectionals, cohorts, and clinical trials (p > 0.05). Results show that metformin has no significant effect on improving cognitive function or protecting against any dementia including vascular dementia and Alzheimer's disease, and cognitive impairment as well.

Therapeutic effects of dietary antioxidative supplements on the management of type 2 diabetes and its complications; umbrella review of observational/trials meta-analysis studies.

Background: Controversial data on the effects of vitamins (V) and nutrients on the management of type 2 diabetes mellitus (T2DM) is available. Thus, it is aimed to clarify the role of vitamins and nutrients through an umbrella review regarding the available observational/ trials meta-analyses. Methods: All meta-analyses of observational and clinical trials conducted on the impact of vitamins and nutrients in T2DM published until 5th June 2021 in PubMed or Web of Sciences were included in this review. Also, the meta-analysis on children, pregnant women, type 1 DM, or in vivo/in vitro studies was excluded. Search results were reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) flowchart. Results: The overall of 93 papers (99 studies) consisting of 75 trials and 24 observational studies were included. Most studies were conducted on the effect of VD and alpha-lipoic acid (ALA) in both genders. Consumption of VD or its analogous; 20 IU/d to 450,000 IU/once for 3 weeks to 7 years showed to have a positive effect on the parameters of glucose hemostasis. Moreover, an inverse association was observed between VD level and T2DM risk. Daily consumption of 1200 mg VC for at least 12 weeks improved lipid profile and glucose hemostasis parameters. Furthermore, VB and medications for diabetic polyneuropathy (DPN) increased nerve conduction velocity. Vitamins K and E were showen to not have significant impact on T2DM. ALA had a beneficial effect on DPN symptoms after 2-4 weeks of intake of at least 300 mg/d. T2DM risk was reduced by doubling ALA intake. The effective daily doses of chromium, zinc and coenzyme Q10 on lipid profile and glucose hemostasis parameters were > 200 mg, < 25 mg, and < 200 mg, respectively. Conclusion: This umbrella review suggests that dietary vitamins and nutrients can result in protective impacts the complications associated with T2DM. However, due to discrepancies between the results of the trials and observational studies is essential to conduct long-term high-qualified studies to prove the beneficial therapeutic effects of the vitamins and nutrients on T2DM and its complications.

National and subnational survey on diabetes burden and quality of care index in Iran: a systematic analysis of the global burden of disease study 1990-2019.

Purpose: Diabetes care is one of the major healthcare problems . This study aimed to introduce a recently-developed Quality of Care Index (QCI) for type 2 diabetes and utilized it to compare different genders, age groups, and Iranian provinces. Methods: From the Global Burden of Disease 1990-2019 database, we obtained primary epidemiologic measures and combined them to build four secondary indices, all indicating the quality of care provided to patients. We utilized the principal component analysis (PCA) method to calculate the substantial component named QCI (with a scale of 0-100). Gender inequality was shown by the gender disparity ratio (GDR), defining female to male QCI. Results: National QCI ranged from 43.0 in 1990 to 38.6 in 2019. By excluding the more frequent outlier province; Tehran as the Capital of Iran, the QCI score reached 50.27 in 2019. The GDR decreased from 1.04 to 0.95. QCI indicated rather more favorable conditions in Iranian provinces with a higher socio-demographic index (SDI). Conversely, provinces with a lower SDI had worse QCI. In 2019, Tehran, the capital of Iran, with the highest (58.5), and South Khorasan with the lowest QCIs (0.4) were the two Iranian provinces' extremes. Moreover, the elderly QCI improved in 2019. Conclusion: During 1990-2019, there are remarkable disparities between Iran's provinces, genders and age groups. The equitable and widespread provision of facilities should be considered along with the decentralization of healthcare resources. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01108-x.

Burden of type 1 diabetes mellitus in the North Africa and Middle East Region, 1990-2019; findings from the global burden of disease study.

AIMS: We aimed to report the burden of type 1 diabetes mellitus (T1DM) in the North Africa and Middle East region and its 21 countries from 1990 to 2019. METHODS: Information related to incidence, prevalence, mortality, disability-adjusted life-years (DALYs), and years lived with disability (YLDs) of T1DM was acquired from the 2019 Global Burden of Disease study. The burden was estimated by sex, age groups, and socio-demographic index (SDI) in 21 countries. RESULTS: Over the past 30 years, regional incidence, prevalence, mortality, and DALYs of T1DM increase by 188.7%, 304.8%, 43.7%, and 71.6%, respectively. While the age-standardized incidence and prevalence rates increased by 84% and 91%, the mortality and DALYs rates decreased by 34% and 13%. During these years, the contribution of YLDs to total DALYs increased considerably (from 17% to 42%). The highest increase in the incidence and prevalence rates occurred in high SDI countries. Moreover, the Mortality to Incidence Ratio (MIR) decreased in the region countries. CONCLUSIONS: Despite progress made in diabetes care, there is a persistently increasing burden of T1DM in the region countries. This indicates that T1DM is still one of the major health challenges in the region countries, especially in high SDI Arab countries.

Patient-physician interpersonal processes of care at the time of diabetes treatment intensification and their links to patient outcomes.

OBJECTIVE: To investigate how patient-physician interpersonal processes of care are related to levels of diabetes-related distress, diabetes medication-taking behavior, and HbA1c during conversations with patients about intensifying medication. METHODS: We randomly recruited 1270 patients from diabetes specialty clinics in Tehran, Iran who were taking an additional oral diabetes medication or starting insulin during the prior 3 months. This interviewer-administered cross-sectional survey assessed multiple aspects of patient-physician interpersonal processes, diabetes-related distress, and diabetes medication-taking. Clinical history and HbA1c were collected from electronic medical records. Regression estimates and Structural Equation Modeling were used to test associations. RESULTS: Some communication scales indicated a significant relationship with total diabetes distress (P < 0.001). Diabetes medication-taking was associated with less diabetes distress (adjusted odds ratio [aOR]=0.45, P < 0.001), lower Hurried Communication (aOR=0.72, P = 0.013), higher Elicited Concerns (aOR=1.30, P = 0.012), and higher Explained Results (aOR=1.41, P < 0.001) scores. SEM analyses showed medication-taking behavior was associated with a 0.68 decrease in HbA1c. Hurried Communication and diabetes distress were directly associated with HbA1c. CONCLUSION: Aspects of patient-physician interpersonal processes at the time of intensifying diabetes treatment may be related to experiencing less distress, effective medication-taking, and improved HbA1c. PRACTICE IMPLICATIONS: The results are intended to inform communication strategies that physicians might incorporate into practice.

Journey of Nursing in COVID-19 Crisis: A Qualitative Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) pandemic has exposed nurses to a rapidly changing patient care practice. This study explored nurses' experiences in caring for COVID-19 patients. METHODS: Eighteen nurses, head nurses, and clinical supervisors employed in one of the hospitals affiliated to the Shahid Beheshti Medical University to participate in this qualitative content analysis study. Data were collected through interviews and field notes. The data were analyzed with conventional content analysis. RESULTS: Data analysis of nurses' experiences with respect to COVID-19 patients resulted in the extraction of information on 5 major categories: "security in care-giving," "healing hands, empty hands," "mental and physical problems," "multiple feelings," and "self-reassurance" and 11 subcategories. CONCLUSION: We found that giving care to COVID-19 patients entailed complex, intermingled, and interrelated physical, mental, and emotional aspects that underwent changes over time so that it can be called "journey of nursing in COVID-19 crisis." The findings of this study further revealed that nurses' experiences, feelings, and thoughts underwent modifications gradually, over time. They believed that they have undergone development in caregiving and experienced deeper aspects of nursing care.

Withdrawal reasons of randomized controlled trials on type 2 diabetes: a systematic review.

PURPOSE: Type 2 diabetes mellitus (T2DM) is the subject of numerous randomized controlled trials (RCTs). The validity of RCTs may be threatened by attrition bias due to the discontinuation of the study. The aim of this systematic review is to evaluate the reasons of patient's withdrawal from these RCTs. METHODS: A systematic literature search on PubMed, Cochrane Library, Web of Science, and Scopus databases was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. The aim was to obtain all relevant blinded RCTs published before January 2017 in which the effectiveness of synthetic drugs, vitamins/minerals were compared to that of placebo or active control in T2DM. The quality of RCTs was assessed using the Jadad score. The frequency of withdrawal reasons was presented based on treatments with placebo/active control, national/international level of the studies, and publication year. Meta-analysis was not performed due to the heterogeneity. RESULTS: Overall, 1368 articles comprising of 640,780 subjects were included. In the majority of the RCTs (75.0%), the intervention and the placebo arms were compared. Most of the included studies (96%) were classified in the high-quality category (Jadad score≥3). The highest proportion of reported withdrawal cases was found in international studies, national RCTs conducted in Japan, and RCTs published in 2011. The withdrawal reasons were reported for 91,669 (63.75%) of the total 143,794 participants who had withdrawn from these studies. The main reported reasons were "adverse effects" (24.04%), "withdraw consent" (16.10%), and "missing data" (11.08%). Variations in the reported withdrawal reasons were based on the country or published year. RCTs with triple blinded design as well as those in which anti-hyperlipidemia and anti-obesity medications were applied, showed significantly higher probability of reported the withdrawal. CONCLUSION: High proportion of reported discontinuation in blinded RCTs on patients with T2DM was related to drug adverse effects. Overall, the total number and reason of drop out were unsatisfactory.

Patient-physician communication in the context of diabetes care: Adaptation and assessment of psychometric properties of a Persian version of the interpersonal process of care survey (P-IPC).

AIMS: To examine the psychometric characteristics and explore the preliminary validity of the Persian version of the Interpersonal Processes of Care Survey (P-IPC) to assess patient-physician communication in the context of diabetes care. METHODS: After adapting, translating, examining content validity, and pretesting the questionnaire, it was administered to 300 patients with diabetes. Confirmatory factor analysis identified the factor structure (scales). Variability, item-scale correlations, reliability, and construct validity of the final scales were examined. RESULTS: Factor analysis supported the hypothesized second-order factor model with 27 of the 29 items:11 first-, and 7 second-order common factors. Scale scores were calculated for the 7 second-order factors. Internal-consistency reliability for the 7 scales ranged from 0.60 to 0.90 and 2-week test-retest correlations ranged from 0.89 to 0.96. The communication and interpersonal style domains of the P-IPC demonstrated high ceiling effects suggesting good patient-physician communication. The P-IPC scales differentiated between patients in the language-concordant and language-discordant groups, and patterns of correlations with three patient satisfaction measures corresponded to hypotheses. CONCLUSION: The P-IPC includes all of the second-order scales identified in the original IPC. Evidence of its reliability and validity suggest it can be useful for assessing patient-physician communication in the context of diabetes care.

Evaluation of insulin resistance and metabolic syndrome in patients with polycystic ovary syndrome.

AIM: Polycystic ovary syndrome (PCOS) is associated with the clustering of states including insulin resistance (IR), obesity, elevated blood pressure, and dyslipidemia that are termed as metabolic syndrome (MBS). This study was designed to assess the differences between homeostatic model assessment (HOMA) values in PCOS and healthy women. METHODS: In a case-control study, 55 women with PCOS and 59 women with normal cycles (control group) aged 15-40 years old were evaluated. In all the subjects (after obtaining written informed consent), blood pressure, body weight, height, body mass index (BMI), waist /hip ratio(WHR) and fasting blood glucose (FBG), triglycerides (TG), HDL, C-peptide, insulin, HOMA Index, and FGIR (fasting glucose to insulin ratio) were measured. RESULTS: In this study, the prevalence of MBS was significantly higher in PCOS group compared with the control group (p = 0.028). There were no significant differences in age, waist/hip ratio, fasting glucose, insulin, and C-peptide levels between patients with PCOS and control group. Furthermore, the prevalence of impaired fasting glucose (IFG) and the mean of HOMA and FGIR did not differ significantly between PCOS and control group. CONCLUSION: Criteria of MBS are frequently present in young women with PCOS and may be more useful as a prognostic factor than IR indexes in this age group. We suggest evaluation of IR in older age women with PCOS.

Ottawa charter framework as a guide for type 2 diabetes prevention and control in Iran.

The growth of T2DM in Iran is predicted to be even greater than the global trend. So a new public health movement to effectively prevent and manage T2DM is required more than ever. The solution has lain in the heart of the Ottawa Charter, the first international conference on health promotion more than 30 years ago. The charter contains five useful actions to facilitate the process of diseases prevention and control: 1) building healthy public policy, 2) creating supportive environments, 3) strengthening community action, 4) developing personal skills, and 5) reorienting health care services toward promotion of health. The charter articulates health in all policies and their frameworks. The aim of this review is to examine how the five actions have been implemented in Iran and can serve as a guide to prevent and control diabetes. Several national case studies will be examined to illustrate the challenges facing Iran's health system. It enables the identification and sharing of best practice between countries.

A peer support intervention in improving glycemic control in patients with type 2 diabetes.

OBJECTIVE: This study aims to assess the effectiveness of a peer support intervention, in which patients with T2DM were provided ongoing self-management support by trained peers with diabetes directed at improving self-care behaviors, self-efficacy and life quality. METHODS: In this randomized controlled trial, 200 patients referred to a diabetes specialty clinic were allocated to peer support or control group. Participants in both groups received usual education by diabetes educators. Intervention participants worked with the trained volunteer peers who encouraged participants to engage in daily self-management and to discuss and share their experiences and challenges of diabetes management. The primary outcomes were HbA1c, BMI, self-care behaviors, self-efficacy and life quality RESULTS: After 6 months, patients in the peer support group experienced a significant decline in mean A1c value (P=0.045). Also, mean diabetes self-management scores, mean self-efficacy scores and mean quality of life scores significantly improved in peer support group compared to control group (P values <0.001). CONCLUSION: Peer support activities can be successfully applied in diabetes self-management, especially in areas with a shortage of professionals and economic resources. PRACTICE IMPLICATIONS: Peer support strategies should be integrated into our healthcare system to meet minimum needs of people with T2DM in Iran.