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Objective: Limited studies have been conducted on insulin index/load, with inconsistent results regarding the glycemic index/load in relation to cardiometabolic risk factors among people with diabetes. The present study aimed to reveal the association of dietary glycemic index and load and dietary insulin index and load with cardiometabolic risk factors among people with diabetes. Method: This cross-sectional study was performed on 88 adults with diabetes who enrolled in the Cohort Study of Employees of Shiraz University of Medical Sciences. The scores of dietary glycemic index (DGI), dietary glycemic load (DGL), dietary insulin index (DII), and dietary insulin load (DIL) were measured using a 116-item food frequency questionnaire (FFQ). Multivariate linear regressions were used to associate each dietary score with fasting blood glucose (FBG), triglyceride, total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), and systolic and diastolic blood pressure. Results: DGI was significantly associated with serum FBG (β; 0.24, 95% CI; 0.02, 0.46) and triglyceride (β; 0.53, 95% CI; 0.002, 1.06) levels but not TC, HDL, LDL, or blood pressure after adjusting for age, sex, education, marital status, smoking, body mass index, energy intake, physical activity, having other diseases, and family history of diabetes. Neither DGL, DII, nor DIL was significantly associated with each of the cardiometabolic risk factors after controlling for the confounders. Conclusion: A diet with a higher glycemic index accompanied by a higher serum FBG and triglyceride level. Further studies are needed to determine the association of DGL, DII, and DIL with cardiometabolic risk factors. [ABSTRACT FROM AUTHOR]

Background: The current study aims to assess cardiovascular risk factors (CVRFs) among diabetic versus nondiabetic nonalcoholic fatty liver disease (NAFLD) patients. NAFLD is the most common hepatic disorder worldwide which is directly associated with diverse CVRFs such as type 2 diabetes mellitus (T2DM) and metabolic syndrome (MS). Materials and Methods: The current cross-sectional population-based study has been conducted on 1031 NAFLD patients. After excluding 340 prediabetes patients, the NAFLD patients were divided into T2DM and normal blood glucose (NBG). Then, CVRFs were compared between the two groups. Results: Out of 691 NAFLD cases included in the study, 337 (48.8%) patients had T2DM. In the T2DM and NBG groups, the body mass index (BMI) was 31.2 ± 4.6 and 29.9 ± 4.3 kg/m2, respectively (P = 0.001). The waist circumference was 102.2 ± 10.2 and 97.6 ± 10.6 cm, respectively (P < 0.001). The systolic blood pressure was 123.3 ± 15.6 and 119.6 ± 13.6 mmHg, respectively (P = 0.043). The triglyceride levels were 191.9 ± 104.7 and 176.5 ± 89.6 mg/dL, respectively (P = 0.042). Generally, these factors were significantly higher among the diabetic patients. Besides, cardiovascular disease (CVD), hypertension, and MS were statistically more prevalent in NAFLD patients with T2DM (P < 0.001) than nondiabetic NAFLD patients. In multiple logistic regression models, the odds ratio of CVD, hypertension, and MS was 2.18, 2.12, and 6.63 for patients with T2DM compared with NBG, respectively. Adjustment was made for age, sex, BMI, smoking, and physical activity. Conclusion: CVRFs were higher in NAFLD patients with T2DM than NAFLD patients with NBG. [ABSTRACT FROM AUTHOR]

Epidemiological studies on air pollution, diabetes, and hypertension conflict. This study examined air pollution, diabetes, and hypertension in adults in 11 metropolitan areas of Iran (2012-2016). Local environment departments and the Tehran Air Quality Control Company provided air quality data. The VIZIT website and Stepwise Approach to Chronic Disease Risk Factor Surveillance study delivered chronic disease data. Multiple logistic regression and generalized estimating equations evaluated air pollution-related diabetes and hypertension. In Isfahan, Ahvaz, and Tehran, PM2.5 was linked to diabetes. In all cities except Urmia, Yasuj, and Yazd, PM2.5 was statistically related to hypertension. O3 was connected to hypertension in Ahvaz, Tehran, and Shiraz, whereas NO2 was not. BMI and gender predict hypertension and diabetes. Diabetes, SBP, and total cholesterol were correlated. Iran's largest cities' poor air quality may promote diabetes and hypertension. PM2.5 impacts many cities' outcomes. Therefore, politicians and specialists have to control air pollution. [ABSTRACT FROM AUTHOR]

Purpose: Our study investigated the association between dental caries, periodontal diseases, and tooth loss with diabetes mellitus (DM) among the elderly population, representing the first study of its kind in Iran. Methods: This was a cross-sectional community-based study as a part of the second wave of the Birjand longitudinal aging study (BLAS, 2021–2022) for people older than 60. We used the Comprehensive Geriatric Oral Health Assessment Tool (CGOHAT) for the oral health evaluation. Participants were initially categorized into diabetic and non-diabetic groups. Those patients with DM were further categorised into uncontrolled and controlled diabetes based on their HbA1c level. The association between periodontitis, gingivitis, and edentulism with type II diabetes mellitus and uncontrolled diabetes was assessed using logistic regression. Results: Among the 1,011 participants, 324 (32.04%) had DM. The mean ± SD DMFT was 27.06 ± 7.71 and 27.07 ± 7.72 among those with and without DM, respectively (p = 0.976). The M index comprised 85.46% of the total DMFT among those without DM and 84.51% among those with DM. The prevalence of periodontitis was higher among those without DM (110, 32.84%, p = 0.390). The prevalence of gingivitis was higher among those with DM (73, 45.06%, p = 0.617). Among the diabetic group, 137 (42.28%) had controlled DM. Based on the adjusted matched multivariate logistic model, decayed teeth (1.24, 95%CI: 1.06 – 1.46, p-value = 0.006), periodontitis (2.78, 95%CI: 1.02 – 7.56, p-value = 0.044), and moderate tooth loss (5.73, 95%CI: 1.13 – 28.88, p-value = 0.034) were significantly associated with increased odds of uncontrolled DM. Conclusions: Based on the findings of this study, tooth loss was highly prevalent among the elderly Iranians regardless of their diabetes status. Also, periodontitis, tooth loss, and decayed teeth were significantly associated with increased odds of poor glycemic control among those with DM. Thus, it can be concluded that improving the oral health of the geriatric population may be a crucial part of improving the glycemic control among those with diabetes which has been frequently neglected. [ABSTRACT FROM AUTHOR]

Purpose: This cross-sectional study aimed to investigate the potential of voice analysis as a prescreening tool for type II diabetes mellitus (T2DM) by examining the differences in voice recordings between non-diabetic and T2DM participants. Methods: 60 participants diagnosed as non-diabetic (n = 30) or T2DM (n = 30) were recruited on the basis of specific inclusion and exclusion criteria in Iran between February 2020 and September 2023. Participants were matched according to their year of birth and then placed into six age categories. Using the WhatsApp application, participants recorded the translated versions of speech elicitation tasks. Seven acoustic features [fundamental frequency, jitter, shimmer, harmonic-to-noise ratio (HNR), cepstral peak prominence (CPP), voice onset time (VOT), and formant (F1–F2)] were extracted from each recording and analyzed using Praat software. Data was analyzed with Kolmogorov–Smirnov, two-way ANOVA, post hoc Tukey, binary logistic regression, and student t tests. Results: The comparison between groups showed significant differences in fundamental frequency, jitter, shimmer, CPP, and HNR (p < 0.05), while there were no significant differences in formant and VOT (p > 0.05). Binary logistic regression showed that shimmer was the most significant predictor of the disease group. There was also a significant difference between diabetes status and age, in the case of CPP. Conclusions: Participants with type II diabetes exhibited significant vocal variations compared to non-diabetic controls. [ABSTRACT FROM AUTHOR]

Introduction. Ambulatory blood pressure monitoring (ABPM) is a valuable tool for detecting abnormalities in nighttime blood pressure (BP), including non-dipping and nighttime hypertension. These abnormalities are independent predictors of a poor prognosis in patients with chronic kidney disease (CKD). The aim of our study was to analyze ABPM data and evaluate nighttime BP abnormalities in an Iranian CKD population. Methods. This cross-sectional study was conducted on sixty-two patients at stages III and IV of CKD who were referred to a nephrology clinic in Tehran, Iran. The patients were classified as either dippers (19.4%) or non-dippers (80.6%), as well as nighttime normotensives (38.7%) or hypertensives (61.3%), based on ABPM data and in accordance with 2023 ESC/ESH guidelines. We compared demographic data, estimated glomerular filtration rate (eGFR), and daytime BP levels among these groups. Results. The mean age of patients was 56.34 years, with 61.1% of them being male. Daytime pulse pressure was significantly greater in non-dippers compared to dippers (52.67 vs. 44 mmHg, P = .02). We found a significant correlation between the extent of BP dipping and eGFR (R = 0.281, P = .02). Systolic and diastolic daytime BP levels were significantly higher in individuals with nighttime hypertension. Diabetic patients were more likely to be non-dippers and have nighttime hypertension. After adjusting for age, diabetes mellitus, and daytime pulse pressure in a multivariable model, we determined that eGFR independently predicted the extent of BP dipping. Conclusion. Our results showed that both non-dipping and nighttime hypertension are highly prevalent in CKD patients, but they have distinct contributing factors. The eGFR was identified as an independent predictor of BP dipping, whereas nighttime BP levels were primarily determined by daytime BP levels. [ABSTRACT FROM AUTHOR]

This study investigated the association between serum concentrations of Polychlorinated Biphenyls (PCBs) and the risk of type 2 diabetes within the general population. A ten-year follow-up historical cohort study was conducted during 2009–2019 as part of the Bushehr MONICA cohort study in Iran. Of 893 non-diabetes participants at base line, 181 individuals were included in the study. The concentration of nine PCB congeners was measured in individuals' serum samples at baseline, and the risk of type 2 diabetes was determined based on fasting blood sugar at the end of follow-up. Multiple logistic regression models were used to assess the study outcomes after adjusting for covariates. This study included 59 diabetes individuals (32.6%; mean [SD] age: 58.64 [8.05]) and 122 non-diabetes individuals (67.4%; mean [SD] age: 52.75 [8.68]). Multivariable analysis revealed that a one-tertile increase (increasing from 33rd centile to 67th centile) in Σ non-dioxin-like-PCBs (OR 2.749, 95% CI 1.066–7.089), Σ dioxin-like-PCBs (OR 4.842, 95% CI 1.911–12.269), and Σ PCBs (OR 2.887, 95% CI 1.120–7.441) significantly associated with an increased risk of type 2 diabetes. The strongest association was obtained for dioxin-like PCBs. The results highlight a significant correlation between PCB exposure and an increased risk of type 2 diabetes. The evidence suggests that additional epidemiological studies are necessary to clarify the link between PCBs and diabetes. [ABSTRACT FROM AUTHOR]

Background: The current study investigated the relationship between the light triad of personality and self-coherence with treatment adherence in patients with Type 2 Diabetes Mellitus (T2DM) using Structural Equation Modeling (SEM). Psychological well-being was considered a mediator variable in this SEM assessment. Method: A cross-sectional study by convenience sampling was conducted, and 368 patients with T2DM were recruited from 10 private practice and general hospitals from May to November 2021 in Gilan province, Iran. The Reef’s Psychological Well-being Questionnaire, the Light Triad Rating Scale, and Antonovsky’s Sense of Coherence Scale were used for data collection. Structural equation modeling was used to examine the model fitness and identify direct/indirect relationships among variables. Data were analyzed by the SPSS (Version 26) and AMOS software (Version 24). Results: The average score of light triads, sense of coherence, psychological wellbeing, and treatment adherence were 70.36 ± 25.55, 108.25 ± 37.68, 57.03 ± 23.84, and 106.81 ± 39.61, respectively. Model fit statistics suggest that the measurement model fits the data well: χ² (146, N = 368) = 314.011 (p < 0.001). The SEM results showed that the light triad of personality (β = 0.12) and self-coherence (β = 0.14) were positively associated with treatment adherence. Anxiety, the light triad of personality (β = 0.12), and self-coherence (β = 0.14) affect treatment adherence indirectly through psychological well-being. Conclusion: The analysis of the SEM revealed that the suggested model had a suitable goodness of fit. So, using self-coherence and psychological well-being structures in designing interventional programs is recommended to optimize treatment adherence in patients with T2DM. [ABSTRACT FROM AUTHOR]

Aim: Given the high prevalence of diabetes along with its effects and complications, attention to empowerment approaches in this disease care has become increasingly important. The application of theory of planned behavior (TPB) has the potential to develop behavioral change interventions, improving the empowerment of patients with diabetes. The present study aimed to evaluate the application of TBP for empowerment of patients with diabetes in Ahvaz, Khouzestan, Iran. Subjects and methods: In this descriptive-analytical study, 451 patients with diabetes referred to public clinics in Ahvaz (Imam and Golestan hospitals) were included. The participants completed a 3-section questionnaire including demographic information, awareness questions, and questions related to the dimensions of the theory of planned behavior and diabetes empowerment. Data were analyzed based on descriptive and analytical statistics tests using SPSS version 22. Results: Diabetes empowerment and its components were significantly different in terms of gender, ethnicity, educational attainment, occupation, and income, p < 0.05. The components of behavioral intention, attitude, and subjective norms had a significant positive relationship with the diabetic empowerment score, but the component of perceived behavioral control had a significant inverse relationship with the diabetic empowerment score, p < 0.05. According to logistic regression analysis, male gender (B = 0.12), good income (B = 0.03), behavioral intention(B = 0.66), perceived behavioral control (B = –0.09) and subjective norms (B = 0.55) were predictors of diabetes empowerment. Conclusion: Targeting and tailoring educational interventions based on constructs of TPB, regarding the background characteristics of the patients with diabetes, should be recommended. [ABSTRACT FROM AUTHOR]

Background: Diabetic foot ulcer and potential subsequent lower extremity amputation are major complications of diabetes mellitus and are also prominent morbidity factors that could affect patients' quality of life. Objectives: This study aimed to assess the prevalence of diabetic foot amputation and explore correlates of amputation cause and type among subjects with diabetes mellitus in Tehran, Iran. Methods: A descriptive cross-sectional study was conducted to assess the demographic, sociological, and clinical characteristics of subjects who had undergone lower extremity amputation due to diabetic foot ulcers, from 2011 to 2020, in two educational medical centers in Tehran, Iran. We examined the medical records of 4676 individuals who were admitted to Shariati and Sina hospitals due to diabetic foot issues. Information related to patient demographics (age, gender, marital status), social factors (education level, insurance), and clinical data (medical history, laboratory results, and characteristics of diabetic foot ulcers) was collected for subjects who had undergone lower extremity amputation due to diabetic foot ulcer. The collected data was reported using average values, standard deviations and proportions and analyzed using statistical tests. Results: During one decade, 882 out of 4676 (18.8%) patients with diabetic foot ulcers underwent lower extremity amputations of various types in Sina and Shariati hospitals in Tehran, Iran. Of these, 692 (14.5%) were included for further analysis in the study and the rest were excluded due to lack of sufficient recorded data. About 75.9% of the study population was male, and the average age including both sexes was 60 years. About 92.7% were married, and on average, subjects had been afflicted with diabetes mellitus for 15.1 years. Statistical analysis using Pearson's chi-square test showed there was a significant association between the treatment regimen for diabetes mellitus and the type of amputation (P =.01), as well as between the duration of the disease and the cause of amputation (P =.01) and its type (P =.04). Conclusion: diabetes mellitus related treatment regimen and duration of disease are significantly associated with amputation cause and type. Plain Language Summary: Understanding Why and How Diabetic Patients Lose Their Feet: A Study from Tehran, Iran This study explored patients with diabetes in Tehran, Iran, experience foot problems leading to amputation. We looked at the records of 4676 patients over a decade, finding that 18.8% had lower limb amputations. Key factors included treatment methods for diabetes and the duration of the disease, significantly impacting the cause and type of amputation. These insights can guide better care to prevent such serious complications in patients with diabetes. [ABSTRACT FROM AUTHOR]

Background: Given the impact of high intake of sugar-sweetened beverages on type 2 diabetes, intervention to reduce their consumption can be a top priority for any health system. Thus, the purpose of the present study is to simulate the impact of policy options related to reduce consumption of sugar-sweetened beverages (SSBs) on the prevalence and mortality of type 2 diabetes in Iranian men and women. Methods: A discrete event simulation (DES) model was used to predict the effect of several policy options on the prevalence and death from type 2 diabetes in Azar Cohort Databases. Population age- and sex-specific prevalence and incidence rate of diagnosed diabetes were derived from the national health data. The Preventable Risk Integrated Model (PRIME) model was used for coding the input parameters of simulation using R and Python software. Results: The prevalence and mortality rate of type 2 diabetes under the scenario of reduced consumption of SSBs indicated that the highest and the lowest prevalence and mortality rates of type 2 diabetes for men and women were related to no policy condition and replacing SSBs with healthy drinks, like water, respectively. Also, the maximum "number of deaths postponed/ prevented" from type 2 diabetes was related to replacing SSBs with water (n=2015), and an integration of reformulation and applying 10% tax on SSBs (n=1872), respectively. Conclusion: Simulating the effect of different policy options on reducing the consumption of SSBs showed "replacing of SSBs with water" as the most effective policy option in Iranian setting. [ABSTRACT FROM AUTHOR]

Background Diabetes Mellitus (DM) is a prominent health care issue worldwide. One of the most prevalent comorbidities of DM is cardiovascular disease (CVD). The objective of this study was to assess the utilization patterns of cardiovascular medications in patients with DM in Iran from 2013 to 2017. Methods This retrospective cross-sectional study was undertaken using prescription claims data from 2013 to 2017 in Iran. Epidemiological data elements used in this study were obtained from the Global Burden of Disease (GBD) 2019 study. In addition, data on total medication sales were obtained from the national regulatory authority database. The data on medication utilization were analyzed according to the Anatomical Therapeutic Chemical Classification (ATC) /Defined Daily Doses (DDD) international system. Results Based on the findings, Acetylsalicylic acid was the mainstay of treatment with a utilization rate of 191.7 DDD/ patient/ year in 2017, followed by Atorvastatin with 170.0 and Losartan with 115.1. Although there was an increasing trend in the utilization rate of the medications, the rate of Atenolol and Enalapril was constantly declining during the 2013-17 period. On the other hand, Valsartan and Metoprolol were attracting attention. Almost all medication utilization rates increased from the 30--39 age group up to the 80 + age group. Females had a higher utilization rate in each age group during the whole study period. Conclusion The present study reflects that medication utilization patterns were rational, according to the standard treatment guidelines. Utilization patterns of medications that are recommended for both prevention and treatment of CVD in diabetes were observed to be the highest. Implementation of further policies is needed to minimize cardiovascular complications of diabetes. [ABSTRACT FROM AUTHOR]

Opiates can affect glucose metabolism and obesity, but no large prospective study (to our knowledge) has investigated the association between long-term opium use, body mass index (BMI; weight (kg)/height (m)2), and incident type 2 diabetes mellitus (T2DM). We analyzed prospective data from 50,045 Golestan Cohort Study participants in Iran (enrollment: 2004–2008). After excluding participants with preexisting diseases, including diabetes, we used adjusted Poisson regression models to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for T2DM in opium users compared with nonusers, using mediation analysis to assess the BMI-mediated association of opium use with incident T2DM. Of 40,083 included participants (mean age = 51.4 (standard deviation, 8.8) years; 56% female), 16% were opium users (median duration of use, 10 (interquartile range), 4–20) years). During follow-up (until January 2020), 5,342 incident T2DM cases were recorded, including 8.5% of opium users and 14.2% of nonusers. Opium use was associated with an overall decrease in incident T2DM (IRR = 0.83, 95% CI: 0.75, 0.92), with a significant dose-response association. Most (84.3%) of this association was mediated by low BMI or waist circumference, and opium use did not have a direct association with incident T2DM (IRR = 0.97, 95% CI: 0.87, 1.08). Long-term opium use was associated with lower incidence of T2DM, which was mediated by low body mass and adiposity. [ABSTRACT FROM AUTHOR]

Background: Unwanted pregnancies in diabetic women can endanger the mother and the fetus. The present study was conducted to determine contraceptive methods for diabetic women referred to government diabetes clinics in the north of Iran. Methods: A total of 153 diabetic women referred to government clinics in Guilan were included in this cross-sectional study. A questionnaire made by the researcher regarding personal and social information and information related to contraceptive methods was administered. Data were analyzed analytically using SPSS version 19. Results: The findings of the present study revealed that 87.6% of diabetic women used contraceptive methods, of which 44.4% utilized low-effective contraceptive methods (withdrawal method and condoms), and 43.2% opted for highly effective contraceptive methods (tubal ligation, oral contraceptive pill, intrauterine device, and vasectomy). Decision regarding the choice of contraceptive methods was mainly made by couples, followed by consultation with a doctor. Conclusions: A relatively high percentage of diabetic women use less effective contraceptive methods, and the decision to use contraceptive methods is made mainly by couples. Therefore, targeted reproductive health interventions and providing counseling services as part of medical care for diabetic women seem necessary. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery delivers substantial weight loss for obese patients with comorbidities like diabetes mellitus. We aimed to investigate the impacts of bariatric surgery on diabetic markers after 5 years of follow-up. Methods: This is a retrospective study on patients with diabetes and a history of bariatric surgery between 2016-2017. The diabetic markers before and 5 years following surgery, including a lipid profile, glucose level, and the required antidiabetic medications, were evaluated. Results: 34 consecutive patients were included, 30 (88.2%) women, with a mean age of 52.71 ± 8.53 years. The majority (65%) of surgeries were Roux-en-Y gastric bypass (RYGB), and the remaining were one anastomosis gastric bypass (OAGB) and sleeve gastrectomy (SG). The serum levels of diabetic markers reduced during follow-up (P = 0.001), except for high-density lipoprotein levels and serum total cholesterol, which increased (P = 0.011, P = 0.838). Low-density lipoprotein levels reduced, but it was insignificant (P = 0.194). Surgery types had affected the changes of diabetic markers (P > 0.05). Demand for oral medication was reduced significantly, but insulin injection reduction was not significant (P = 0.006 and P = 0.099, respectively). Conclusion: Our study showed favorable bariatric surgery results on patients with diabetes in long-term follow-up. However, dyslipidemia is still a concern. [ABSTRACT FROM AUTHOR]

Background. Diabetes negatively affects patients’ quality of life and increases the use of spirituality as a coping mechanism. Spiritual well-being is regarded as one of the basic concepts for coping with problems caused by this disease. Objectives. This study was conducted to determine the effect of spiritual care on spiritual well-being and quality of life in patients with type-2 diabetes. Material and methods. This randomized clinical trial was conducted on 90 eligible patients with type-2 diabetes visiting a diabetes clinic in Shiraz in southern Iran. Patients were selected by systematic random sampling and divided into the intervention and control groups by block randomization. The intervention group received six sessions of spiritual interventions, and the control group received routine care. Data was collected using the spiritual well-being (SWB) and diabetes quality of life (DQoL) questionnaires, which were completed before and one month after the intervention. The data was analyzed in SPSS-22, using descriptive and inferential statistics, and p < 0.05 was considered significant. Results. In the intervention group, the mean score of the DQoL (54.04 ± 2.3 vs 39.38 ± 4.8; p < 0.001) and SWB (107 ± 10.3 vs 91.7 ± 9.2; p < 0.001) was significantly higher than the control group after the intervention. In dimensions of DQoL and SWB, significant differences were also seen between the two groups (p < 0.001). Conclusions. The development and implementation of holistic care programs in conjunction with spiritual care programs can be beneficial for diabetic patients and help improve their spiritual well-being and quality of life. [ABSTRACT FROM AUTHOR]

Background. Diabetic patients’ delay in visiting a specialist doctor can have significant effects on blood sugar factors. The present study aimed to determine the effects of delay in visiting a specialist doctor in type 2 diabetic patients on glycaemic factors. Material and methods. The patients’ demographic and clinical information included in medical records of 209 type 2 diabetic patients referred to diabetes clinics in Shiraz city, south of Iran, were analysed using logistic mix-model regression. Due to the occurrence of COVID-19 during the follow-up period, data analyses were done separately before and after the pandemic. Results. The mean age of the patients was 63.47 ± 8.89 years, and 67.94% of the type 2 diabetic patients were female. After COVID-19, haemoglobin A1C (HBA1C) of the patients who had delays of < 3, 3–6 and > 6 months in referring to a specialist increased by 1.81 (OR: 1.12–2.93), 2.56 (OR: 1.81–5.56) and 3.69 (OR: 1.79–7.63), respectively, compared to the group without delays. In this period, 2-hour Postprandial Glucose (2-hpp) of the patients with delays of 3–6 and > 6 months and the Fasting Blood Sugar (FBS) of the patients with delays of > 6 months had a significant increase of 1.92 (OR: 1.01–3.65), 2.14 (OR: 1.09–4.21) and 2.36 (confidence interval of 95%: 1.27–4.39), respectively, compared to the patients without delays in visits. The above trends had a non-significant increase before COVID-19, though. Conclusions. Healthcare providers should ensure the continuity of providing services to diabetes patients, especially during health crises, by taking appropriate measures. [ABSTRACT FROM AUTHOR]

Background: Diabetes management self-efficacy (DMSE) positively affects diabetes self-care behaviors and can lead to better glycemic control and improved disease outcomes in diabetes patients. Objectives: This study aimed to evaluate DMSE level and its relationship with medication adherence, glycemic control, and diabetes complications among type 2 diabetes (T2D) patients. Methods: A cross-sectional study was carried out from November 2019 to January 2020 on T2D patients who attended the Diabetes Center of the Kerman University of Medical Sciences. Data were collected using two validated questionnaires including the diabetes management self-efficacy scale (DMSES) to evaluate DMSE level and the eight-item Morisky medication adherence scale (MMAS) to assess adherence to medication. The SPSS statistical software version 22 was employed for data analysis. Results: Of 440 T2D patients entering the study, 72% were female with a mean (SD) age of 59.60 (10.48). The mean(SD) DMSE score of the respondents was 5.76 (1.87). A significant negative correlation was observed between DMSE with HbAlc(r=-0.289, P < 0.0001) and also with FBS(r =-0.229, P < 0.0001), but there was a significant positive correlation between DMSE and adherence to medication (r = 0.208, P < 0.0001). FBS level (β =-0.252, P < 0.0001), number of visits by specialty or subspecialty physicians (β = -0.139, P= 0.002), medication adherence score (β = 0.165, P < 0.0001), neuropathy (β = 0.142, P= 0.002), marital status β = 0.125, P = 0.004), household income (β =-0.126, P = 0.004), and blood glucose checks at home (β = 0.109, P= 0.013) were considered predictors of DMSE score. Conclusions: Diabetes management self-efficacy is considered suboptimal among T2D patients. Patients with higher DMSE have better adherence to medication, better blood glucose control, lower risk of neuropathy, and fewer visits by specialty and subspecialty physicians. [ABSTRACT FROM AUTHOR]

Objective: Type 1 diabetes mellitus (T1DM) results from the autoimmune destruction of insulin-producing beta cells of the pancreas. The objective of the present study was to describe the one year (2019-2020) incidence of T1DM in Hamadan west region of Iran. Materials and Methods: All 25 new patients with T1DM resident of Hamadan and its suburbs registered in Besat Hospital, Hamadan, Iran, from March 2019 to 2020 were prospectively reviewed. Information including age, sex, place of residence (urban or rural), season of diagnosis and season of birth were taken from parents through face-to-face interviews. Results: During 1 year survey, a total of 57 cases of newly diagnosed T1DM were identified in our center. Among these, 25 patients were residents of Hamadan city and suburbs. Based on this15 per 100 000 per year new cases T1DM occurred in the resident population of Hamadan areas, higher in boys than in girls (18 vs. 11 per 100 000). The mean age of diagnosis was 8.03 yr. The peak incidence was observed at the age group of 10-14 years. 92% were urban. Most cases were diagnosed in the autumn (44%). 52% had a history of neonatal jaundice and 16% had stressful life events in the family before the onset of diabetes. Conclusion: Our study showed a relatively high incidence of T1DM according category of the WHO, being greater in boys and in the age group of 10 to 14 years. The incidence is lower than in some Middle Eastern countries. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes and its consequences increase the health system costs. Therefore, prevention and early diagnosis can reduce the cost and consequences. The studies have emphasized the role of education in treatment and people’s awareness of prevention and early diagnosis. Thus, the present study aimed to assess the awareness of people referring to Shiraz health centers with diabetes. Methods: This cross-sectional study was conducted on 270 people aged 12-65 Y/O referred to Shiraz health centers in Iran in 2019. Participants completed an 18-item questionnaire with subscales of demographic data, general information about patients, causes and factors of diabetes, symptoms and diagnosis, prevention and treatment, and consequences and problems. Furthermore, other information, such as the presence of diabetic patients in the family and sources of information, was recorded. Data were analyzed using SPSS software-21. Results: The participants’ mean age was 33.96±10.05; 54.82% were female, and 45.18% were male. The main sources of information were friends and relatives. The mean score of awareness was calculated to be 15.18±5.03. Statistical tests revealed a significant relationship between job, educational levels, age, and source of information with the score of awareness (P<0.001), while this relationship with gender (P=0.068), marital status (P=0.196), and family history (P=0.060) was insignificant. Conclusion: Overall, public awareness of diabetes in Shiraz was found to be moderate. Moreover, it is observed that men, married individuals, as well as older and less educated people exhibited lower levels of awareness. Hence, it is recommended that these factors be taken into account when designing health system programs aimed at educating all communities about diabetes. [ABSTRACT FROM AUTHOR]

Objectives: The aims of this study were investigating the association between DM prevalence and climate conditions and finding probable hot-spot areas. Methods: This ecological study conducted on disease surveillance system of DM data from rural area of two Kashan and Aran-O-Bidgol counties. It is an observational study on the disease surveillance data of health registry system including population characteristics, screened DM cases in 2016. Moran's I and Getis-Ord's index were applied to explore the hot-spot areas, and the spatial regression model were conducted for finding the relationship between climate and DM prevalence whilst adjusting some confounders, using GIS software. Results: The information of 48 cities and villages with 26,800 of ≥30 years people located in three mountainous, plain and dry-desert climates were analyzed. The crude DM prevalence ranged 0-45.4%. The analysis revealed evident hot-spot areas and inverse relationship between altitude and DM prevalence (P<0.05). Conclusion: Residences of dry-desert climate had high DM prevalence and there was a significant inverse relationship between altitude and DM prevalence. [ABSTRACT FROM AUTHOR]

To control diabetes in a society, risk assessment tools are used to predict disease risk. We aimed to assess the value of different risk factors for diabetes mellitus in a remarkable community in the city of Kerman, one of the vast areas in the southeast of Iran, with the final goal of designing a predictive model for diabetes in this region. This study was a cross-sectional study with the aim of investigating the predictive value of risk factors indicating the presence of diabetes in the population of Kerman City based on the guidelines of the American Diabetes Association (ADA) risk assessment tool. The information of 4000 people participating in the comprehensive screening plan for cardiovascular risk factors in Kerman City was extracted by reviewing the relevant data registry. According to the ADA guideline, 32.5% of participants were at risk for diabetes mellitus. The hazard ratio of diabetes mellitus in the subgroup with the ADA final score =5 as compared to those with a lower final score was 1.9. Advanced age, history of gestational diabetes, family history of diabetes mellitus, history of hypertension, low physical activity, and higher body mass index were the main determinants of diabetes mellitus. According to ADA guidelines and the diabetes mellitus risk assessment tool, 32.5% of the population residents in Kerman City are potentially at risk for diabetes mellitus that can be successfully predicted aide by the ADA risk assessment tool. [ABSTRACT FROM AUTHOR]

Purpose: The higher costs of insulin analogs including short-acting insulin aspart (IAsp) and long-acting insulin glargine (IGla) have restricted their widespread uptake despite having improved pharmacokinetic and pharmacodynamic properties and patient convenience. This study aims to evaluate the cost-effectiveness of IAsp versus Regular Insulin (RI) and IGla versus NPH Insulin in type 1 and 2 diabetes from the perspective of the Iranian healthcare system. Methods: Clinical data including HbA1c levels, hypoglycemia, weight gain, and health-related quality of life were derived from the included systematic review and meta-analysis studies. Different methods of pharmacoeconomic evaluation were used for an annual time horizon. Utility decrements for diabetes-related complications were extracted from the literature. Direct medical costs were calculated in 2022 prices. A one-way sensitivity analysis was also performed. Results: In type 1 diabetes, IAsp was associated with more costs and effects in terms of reducing HbA1c compared with RI. An incremental cost of $83 was estimated to obtain an additional 1% reduction in HbA1c per patient per year. Similarly, an incremental cost of $16 was estimated for IGla compared with NPH. In type 2 diabetes, IAsp and RI were associated with equal efficacy and safety. For IGla versus NPH, the incremental cost-effectiveness ratio was calculated at $1975 per quality-adjusted life-year. The robustness of the result was confirmed through sensitivity analysis. Conclusion: Insulin analogs, IAsp and IGla, are cost-effective for type 1 diabetes versus human insulins, RI and NPH. For type 2 diabetes, IAsp is not cost-effective when compared with RI. For IGla versus NPH, however, the incremental cost-effectiveness ratio seems to be within the accepted thresholds. [ABSTRACT FROM AUTHOR]

Purpose: Adoption of international working group on the diabetic foot (IWGDF) guidance on prevention and management of foot problems in patients with diabetes was the study aim. Methods: The ADAPTE process consisted of three main phases of set-up, adoption, and finalization with overall 24 steps was used. In set- up phase, organizing committee by a multidisciplinary approach was established. In adoption phase, comprehensive search in databases and guideline resources was done. According to the inclusion criteria, the 2015IWGDF guidance was selected for adoption process. Quality, currency, content and consistency of the guidance were assessed. Also, consensus on different level of agreement for each recommendation were reported. On finalization phase, the adopted version was reviewed by the guidance developer and the final guidance for local use in Iran was disseminated. Results: The 2015 IWGDF guidance with 77 recommendations was adopted after screening of 1760 documents retrieved from Jan. 2006 to Nov. 2016. An organizing committee was established according to a multidisciplinary approach including 73 members with endocrinology, orthopedic & vascular surgery, dermatology, infectious diseases, physical medicine and rehabilitation specialties, general practitioners and nurses. This guidance obtained a good quality in all six domains of AGREE II instrument (Score ≥ 80%), good currency, content, and consistency. Also, during the third round of Delphi, the consensus on the agreement level of each recommendation were greater than 80% and 77 recommendations of the original guidance were kept in the adopted version. Conclusion: The 2015 IWGDF guidance with 77 recommendations adopted for local use in different health care settings of Iran. [ABSTRACT FROM AUTHOR]

Background: With increasing age and joint-destructive diseases, the need for novel surgeries such as total knee arthroplasty (TKA) has increased. Complications such as pain exacerbation and persistent pain after surgery may occur which increases rehabilitation programs. Factors such as body mass index (BMI), psychiatric disorders, spine diseases, and comorbidities diseases can affect outcomes. Our study was conducted to evaluate the effect of BMI, psychiatric disorders, spine diseases, and underlying diseases on persistent and annoying pain after TKA. Materials and Methods: This is a case-control study that was conducted on patients who underwent TKA in Kashani Hospital in Isfahan City in 2020-2022. Demographic data of patients including age and BMI, diabetes mellitus (DM), history of psychiatric disorders, spine disorders such as spondylolisthesis or disc herniation, and other underlying diseases were obtained. Patients were assigned to case or control groups based on pain complaints after surgery. All patients were evaluated 6 months after the initial surgery. After collecting the study data, they were entered into SPSS software (version 25, IBM Corporation, Armonk, NY, USA) and analyzed. Results: We enrolled 35 patients in the case group and 39 patients in the control group between June 2020 and September 2022, based on the severity of pain measured using a Visual Analog Scale score. Our results show that BMI and DM had a meaningful relationship with pain after surgery (P ≤ 0.01). Other factors did not show a significant difference between groups. Conclusion: Underlying diseases, psychiatric diseases, and spine disorders did not significantly affect the pain after TKA. Patients with DM and higher BMI experienced more persistent pain after TKA. [ABSTRACT FROM AUTHOR]

Background: Anemia is a serious public health problem which may be associated with cardiovascular diseases (CVDs) and brain damage. This survey aims to determine the prevalence of anemia and its association with demographic and biochemical factors and metabolic syndrome in a human sample derived from the MASHAD cohort study. Methods: This survey was conducted on a sub-sample of 9847 individuals aged 35 to 65 as part of the MASHAD cohort study. Demographic characteristics and biochemical and anthropometrics indices were recorded. Data were analyzed using SPSS version 20. Results: Anemia was seen in 11.5% of the population. Anemia was significantly more prevalent in younger subject (P < 0.001), females (P < 0.001) and those with elevated body mass index (BMI) (P < 0.001). Mean high-density lipoprotein (HDL) was higher in anemic participant (P = 0.032). The incidence of anemia was significantly lower in smokers (P < 0.001) and also participant with hypertension (HTN) (P < 0.001), diabetes mellitus (DM) (P < 0.001) and metabolic syndrome (MetS) (P < 0.001). Mean FBG (P < 0.001), TG (P < 0.001), total cholesterol (P < 0.001), LDL (P < 0.001) and uric acid (P < 0.001) were significantly lower in anemic subjects. Cholesterol, MetS, low-density lipoprotein (LDL), BMI, uric acid, diabetes mellitus and also TG remained significantly different after multivariate analysis between anemic and healthy participants. Conclusion: The studied population had a lower prevalence of anemia compared to the previous WHO report for Iranians. Iron deficiency is recognized as the most important cause of anemia in Iran; however, further investigations will be need to confirm this pattern. We demonstrated that anemia is adversely associated with MetS and DM. [ABSTRACT FROM AUTHOR]

Background: Subclinical left ventricular dysfunction is an important predictor of cardiovascular death, detected via the global longitudinal strain (GLS) echocardiographic parameter. While T2DM is associated with a worse GLS, it is not cost-effective to perform 2D speckle tracking echocardiography for all asymptomatic T2DM patients to screen for early signs of subclinical left ventricular dysfunction. Objectives: We aimed to investigate the association of possible risk factors with subclinical left ventricular dysfunction assessed by 2D speckle tracking echocardiography in T2DM patients with normal ejection fraction, excluding patients with comorbidities associated with left ventricular dysfunction such as hypertension or any cardiovascular disease. Methods: This cross-sectional study involved patients aged >18 with type 2 diabetes mellitus (T2DM) and EF ≥ 50% referred to Shohada-e-Tajrish Hospital, Tehran, Iran, from May 2, 2023, to June 21, 2023. Patients with any history or signs and symptoms of heart disease and hypertension were excluded. The correlation of GLS with age, BMI, duration of diabetes, systolic (SBP) and diastolic blood pressure (DBP), and laboratory parameters was assessed using Pearson's correlation test, with P < 0.05 denoting significance. Results: In this cross-sectional study, 118 patients consisting of 70 women (59.32%) and 48 men (40.68%) with T2DM were enrolled. The mean age of the participants was 49.61 ± 5.10 years. The mean GLS was -16.71 ± 2.14%. The GLS correlated positively with BMI (P = 0.038 and r = 0.197), SBP (P = 0.003 and r = 0.268), DBP (P = 0.023 and r = 0.209), homocysteine (P = 0.001 and r = 0.310), HbA1C (P = 0.046 and r = 0.184), LDL (P = 0.034 and r = 0.203), and TG (P < 0.001 and r = 0.375), and negatively with GFR (P < 0.001 and r = -0.363). Conclusions: BMI, SBP, DBP, homocysteine, HbA1C, LDL, TG, and GFR correlated with subclinical left ventricular dysfunction assessed by GLS in patients with T2DM; these markers may offer value in selecting T2DM patients for cost-effective 2D speckle tracking echocardiography screening of subclinical left ventricular dysfunction. [ABSTRACT FROM AUTHOR]

Background: The plants from Salvia genus contain widely distributed species which have been used in folk medicine as well as pharmaceutical and food industries. Methods: The chemical composition of 12 native Iranian Salvia species (14 plants) was identified using gas chromatography-mass spectrometry (GC–MS). Also, the inhibitory activity of all essential oils (EOs) was evaluated toward α-glucosidase and two types of cholinesterase (ChE) using spectrophotometric methods. The in vitro α-glucosidase inhibition assay was performed by the determination of p-nitrophenol (pNP) obtained from the enzymatic dissociation of p-nitrophenol-α-D-glucopyranoside (pNPG) as the substrate. In vitro ChE inhibitory assay was conducted based on the modified Ellman's procedure using the measurement of 5-thio-2-nitrobenzoic acid produced from the hydrolysis of thiocholine derivatives as the substrate, in the presence of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE). Results: Totally, 139 compounds were detected and caryophyllene oxide and trans-β-caryophyllene were the most abundant compounds in all EOs. The yield of EOs extracted from the plants were also calculated in the range of 0.06 to 0.96% w/w. Herein, α-glucosidase inhibitory activity of 8 EOs was reported for the first time and among all, S. spinosa L. was found to be the most potent inhibitor (90.5 inhibition at 500 μg/mL). Also, the ChE inhibitory activity of 8 species was reported for the first time and our results showed that the BChE inhibitory effect of all EOs was more potent than that of AChE. The ChE inhibition assay indicated that S. mirzayanii Rech.f. & Esfand. collected from Shiraz was the most potent inhibitor (72.68% and 40.6% at the concentration of 500 μg/mL, toward AChE and BChE, respectively). Conclusions: It seems that native Salvia species of Iran could be considered in the development of anti-diabetic and anti-Alzheimer's disease supplements. [ABSTRACT FROM AUTHOR]

Background: Clinical guidelines and expert committees have recently suggested that the hemoglobin A1C (HbA1c) should be individualized based on various criteria. Data regarding the achievement of individualized glycemic targets in type 2 diabetes mellitus (T2DM) patients is scant in Iran. We intended to provide information found on real-world outcomes from the perspective of an individualized recommendation. Methods: A cross-sectional analysis was conducted in 15 diabetes centers in Iran between 2013-2017. Two steps cluster sampling selection was used to recruit 1591 patients with T2DM. Considering Ismail-Beigi's individualized strategy, the study population was categorized into five treatment intensities of HbA1c: most intensive (≤6.5%), intensive (6.5-7.0%), less intensive (~7.0%), not intensive (7.0-8.0%), and moderated (~8.0%). The percentage of patients who met their group individualized glycemic targets was estimated as the degree of achievement of each treatment intensity. Results: The cumulative incidence rate of early microvascular, advanced microvascular, and macrovascular complications was 53%, 25%, and 34%, respectively. Besides, 78% [77.6-79%] of patients did not achieve individualized glycemic targets. Conclusion: The outcome showed poor individualized glycemic control and a high incidence of diabetes complications. Considering individualized HbA1c targets for Iranian patients with T2DM is an urgent need. [ABSTRACT FROM AUTHOR]

Background: Cultural and language differences are necessary factors for diabetes management and self-care education programs in patients suffering from diabetes. This study aims to investigate the effectiveness of culture-based self-care intervention on health literacy, quality of life, and glycemic parameters in patients with type 2 diabetes. Materials and Methods: This randomized clinical trial has been carried out in selected centers in Darreh Shahr, Iran; 80 participants were randomly assigned into intervention and control groups. The intervention group received an educational program for 6 sessions twice a week, but the control group only received routine services. Data were collected using health literacy and life quality scales for diabetic patients, which were completed by both groups before, immediately after, and 3 months after the intervention; hemoglobin A1C (HbA1c) was checked before and 3 months after the intervention. SPSS software was also analyzed data using χ2, Fisher's exact, independent t, and repeated measures analysis of variance tests. Results: There were no significant differences between the 2 groups before the study (p >0.05) goes forward. But, mean scores of health literacy (F2,40 = 5.61, p =0.007), quality of life (F2, 40 = 4.09, p =0.01), and HbA1c levels (t, 39 = 6. 91, p <0.001) have shown significant differences between the 2 groups immediately and 3 months after the intervention have been applied. Conclusions: Culturally appropriate intervention should be offered as a part of the nurse' care program for diabetic to control HbA1c, and improve their life quality and health literacy. [ABSTRACT FROM AUTHOR]

The leaves of Ficus johannis Boiss (F. johannis), commonly known as Fig tree, Anjir, and Teen, are used by the folk medicinal practitioners in Iran for controlling hyperglycemia in diabetic patients. This study investigated the pharmacological basis for antidiabetic effect of the ethanolic extract of F. johannis leaves using in vitro and in vivo experimental models. Qualitative screening of phytochemicals, estimation of total phenolic and flavonoid contents, and in vitro antioxidant and α-amylase inhibition assays were performed. Moreover, the High-performance liquid chromatography (HPLC) quantification, acute toxicity, glucose tolerance, and in vivo antidiabetic effect along with the evaluation of gene expressions involved in diabetes mellitus were carried out. Significant quantities of phenolic (71.208 ± 2.89 mgg−1 GAE) and flavonoid (26.38 ± 3.53 mgg−1 QE) were present. Inhibitory concentration (IC50) of the plant extract exhibited an excellent in vitro antioxidant (IC50 = 33.81 µg/mL) and α-amylase (IC50 = 12.18 µg/mL) inhibitory potential. The HPLC analysis confirmed the gallic acid (257.79 mgg−1) as main constituent of the extract followed by kaempferol (22.86 mgg−1), myricetin (0.16 mgg−1), and quercetin (3.22 mgg−1). Ethanolic extract displayed glucose tolerance in normo-glycemic rats. Streptozotocin-induced hyperglycemia declined dose dependently in the extract treated rats with improvement in lipid profile and liver and renal function biomarkers. The F. johannis-treated groups showed an increase in mRNA expressions of glucose transporter 4 (GLUT-4), glucokinase, insulin growth like factor 1 and peroxisomal proliferator activating receptor gamma in pancreas. However, the Glucose-6-phosphatase was downregulated. Present study suggests that the ethanolic extract of F. johannis leaves demonstrates a good anti-diabetic profile by improving insulin sensitivity, GLUT-4 translocation, and carbohydrate metabolism while inhibiting lipogenesis. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic and its associated morbidities are a great global concern. Diabetes mellitus (DM) is associated with adverse clinical outcomes and high mortality in patients with COVID-19. Objectives: This study examined the frequency of DM, newly diagnosed hyperglycemia, and their impacts on hospitalized patients with COVID-19. Methods: This retrospective study examined 810 medical records of PCR-confirmed COVID-19 patients admitted to Razi Hospital, Ahvaz, Iran. The clinical presentations, severity, and impacts of COVID-19 were compared between patients with and without DM. Disease severity was determined based on the NEWS2 scoring system. Results: This study included 810 medical records of COVID-19 patients, of whom 326 had pre-existing DM, and 484 were non-DM. The rates of diabetes and newly diagnosed hyperglycemia were 40.2% and 11.2%, respectively. The most common underlying diseases were hypertension (35.3%), ischemic heart disease (17.9%), and chronic kidney disease (11.9%), which were higher in people with diabetes than non-diabetics. The rate of acute kidney injury was higher in patients with diabetes than in non-diabetics (30.7% vs. 19.2%; P < 0.001) and in patients with severe COVID-19 than in those whose disease was not severe (27.8% vs. 21.5%; P = 0.04). The rates of severe COVID-19 (46.3% vs. 34.7%; P = 0.093), ICU admission (40.7% vs. 27.4%; P = 0.012), and mortality (18.5% vs. 10.5%; P = 0.079) were higher in patients with newly diagnosed hyperglycemia than in euglycemic patients. Conclusions: This study showed that COVID-19 infection is linked with newly diagnosed hyperglycemia and pre-existing DM, both associated with severe COVID-19, more need for ICU admission, and mortality. [ABSTRACT FROM AUTHOR]

Background: The prevalence of diabetes is increasing rapidly worldwide. Nurses work collaboratively with multidisciplinary teams to improve diabetes management. Yet, little is known about nurses' role in nutritional management of diabetes. This study aimed to evaluate nurses' knowledge, attitudes, and practice (KAP) toward nutritional management of diabetes. Methods: This cross-sectional study was conducted with 160 nurses, who were recruited between July 4 and July 18, 2021 from two referral tertiary teaching hospitals in Iran. A validated paper-based self-reported questionnaire was used to assess nurses' KAP. Data were analyzed using descriptive statistics and multiple linear regression analysis. Results: The mean knowledge score of nurses about nutritional management of diabetes was 12.16 ± 2.83, and 61.2% showing a moderate knowledge level on nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11, with 86.92% of participants demonstrating positive attitudes. The mean practice score of study participants was 44.74 ± 7.81, with 51.9% having a moderate level of practice. Higher knowledge scores were observed among male nurses (B = -7.55, p = 0.009) and those with blended learning as a preferred learning method (B = 7.28, p = 0.029). Having an opportunity to provide education to patients with diabetes during shifts affected nurses' attitudes positively (B = -7.59, p = 0.017). Practice scores were higher among nurses who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p = 0.008). Conclusion: Nurses' knowledge and practice in the nutritional management of diabetes should be increased to help improve the quality of the dietary care and patient education they provide these patients. Further studies are needed to confirm the results of this study both in Iran and internationally. [ABSTRACT FROM AUTHOR]

Aims: To investigate the journey of patients with diabetes in the healthcare system using nationally-representative patient-reported data. Methods: Participants were recruited using a machine-learning-based sampling method based on healthcare structures and medical outcome data and were followed up for three months. We assessed the resource utilization, direct/indirect costs, and quality of healthcare services. Results: One hundred fifty-eight patients with diabetes participated. The most utilized services were medication purchases (276 times monthly) and outpatient visits (231 times monthly). During the previous year, 90% of respondents had a laboratory fasting blood glucose assessment; however, less than 70% reported a quarterly follow-up physician visit. Only 43% had been asked about any hypoglycemia episodes by their physician. Less than 45% of respondents had been trained for hypoglycemia self-management. The annual average healthrelated direct cost of a patient with diabetes was 769 USD. The average out-ofpocket share of direct costs was 601 USD (78.15%). Medication purchases, inpatient services, and outpatient services summed up 79.77% of direct costs with a mean of 613 USD. Conclusion: Healthcare services focused solely on glycemic control and the continuity of services for diabetes control was insufficient. Medication purchases, and inpatient and outpatient services imposed the most out-ofpocket costs. [ABSTRACT FROM AUTHOR]

Background and aim: Previous studies have shown that Rheum ribes (R. ribes) could be effective in controlling the blood glucose levels. This study was conducted to determine the effects of R. ribes supplementation on glycemic indices and apolipoproteins in patients with type 2 diabetes mellitus (T2DM). Methods: In the present randomized double-blind controlled trial, 60 type 2 diabetic patients aged 30–60 years with a body mass index (BMI) of 20–30 kg/m2 and hemoglobin A1c (HbA1c) of 6–8% were enrolled. Patients were randomly assigned to receive 450 mg of aqueous R. ribes extract (AG), 450 mg of ethanolic R. ribes extract (EG), or placebo (PG) three times daily for 6 weeks. At the baseline and at the end of the study, blood glucose levels, homeostatic model assessment of insulin resistance (HOMA-IR) and the homeostatic model assessment of β-cell dysfunction (HOMA-B), as well as apolipoprotein A-I (ApoA1) and apolipoprotein B (ApoB) were measured. Results: There was a significant decrease in the serum levels of insulin in AG and EG groups (P = 0.003 and P = 0.001, respectively), HOMA-IR (P = 0.01 and P = 0.001, respectively), HOMA-B (P = 0.002 and P = 0.001, respectively), ApoB (P = 0.006 and P = 0.03, respectively), ApoB/ApoA1 ratio (P = 0.016 and P = 0.04, respectively). However, a significant increase in ApoA1 (P = 0.08 and P = 0.05, respectively) with no significant changes in blood glucose, at the end of study compared to beginning values, were observed. None of the variables showed a significant change in PG. At the end of the study; while there were significant differences in insulin (P = 0.04), HOMA-IR (P = 0.03), HOMA-B (P = 0.01), ApoB (P = 0.02), and ApoB/ApoA1 ratio (P = 0.03) among the groups but ApoA1 had no significant change. Conclusion: Consumption of R. ribes intake could have beneficial effects on insulin resistance and apolipoproteins in type 2 diabetic patients. (Registered at en.irct.ir, identification number: IRCT201410142709N31). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: Diabetes mellitus (DM) is known as one of the most prevalent non communicable diseases with high cost of health services in the world. Present study was conducted to assess the frequency of high risk people for diabetes mellitus based on American Diabetes Association (ADA) risk score among Iranian people. Methods: Present study was a cross sectional study on non-diabetic subjects aged 35–70 years from 10,520 PERSIAN Guilan Cohort Study (PGCS). ADA risk score was calculated for every individual through an online calculator. Receiver operating characteristic (ROC) curves was used to assess diagnostic accuracy of the anthropometric indices to identify individuals with high risk ADA score for developing DM, represented by the area under the curve (AUC). Results: From 7989 study subjects, ADA risk score found 3874 (48.5%) and 1912 (23%) at risk for developing PreDM and DM, respectively. The results of ROC curve analyses showed the highest diagnostic value was related to waist circumference (WC) in total population and Waist to Height Ratio in both sex (0.695 total, 0.743 female, 0.744 male). The cut-points of WC in total population to identifying high risk group were 97 cm. Conclusions: A considerable number of populations were classified as high ADA risk for developing DM and PreDM that provide the importance of prevention strategies. Present study showed WC and Waist to Height Ratio have the highest diagnostic value to identify high risk people for DM. [ABSTRACT FROM AUTHOR]

Introduction: In previous studies, kidney stones was reported as a common complication in general populations. Objectives: This study aimed to evaluate kidney stone incidence and related factors in hemodialysis patients. Patients and Methods: This descriptive-analytical study was conducted on 284 hemodialysis patients in the Zahedan. Demographic and clinical data were collected. The incidence rate of kidney stone was calculated. The correlation between kidney stone incidence with predicting factors was explored by multivariate logistic regression. Results: Results demonstrated that most patients were male, with a mean age of 48.81 ± 16.84 years. The correlation between kidney stone incidence with gender, race, smoking, and blood group was not significant (P > 0.05); however, its correlation with diabetes mellitus, urinary tract infection, age, and body mass index (BMI) was significant (P < 0.05). The kidney stone incidence rate was 23.24%, while diabetes mellitus, urinary tract infection, older age, and higher BMI were the most common predictors. Conclusion: Diabetes mellitus, urinary tract infection, older age, and higher BMI were the common predictors for kidney stone incidence in hemodialysis patients. Identifying kidney stone incidence predictors in patients with hemodialysis can be helping in lower complications. [ABSTRACT FROM AUTHOR]

Aims People with diabetes mellitus (DM] represent a population group that is at high risk of developing a poor prognosis for Covid-19. Having diabetes increases the risk of serious illness, ICU stay, and death from Covid-19. The present study aimed to determine RETN gene polymorphisms as a risk factor in diabetic patients with Covid-19 infection. Instruments & Methods The current study included 150 participants with diabetes, 100 patients of whom had Covid-19 (46 male, 54 female], and 50 had diabetes only (28 male, 22 female]. Five ml of venous blood was collected from participants, then used for examining the blood sugar and HbAlc levels and molecular study. Finding: There was a significant increase in random blood sugar and HbAlC concentrations in diabetic patients infected with Covid-19 compared to diabetic patients only. Regarding the molecular study of the gene encoding the protein resistin, diabetic patients with Covid-19 had a high frequency of single nucleotide polymorphisms compared to diabetic patients only. Polymorphisms of X494T.C, X663A.C, X494T.C, and X663A.C recorded significant differences, while the polymorphisms of rs3219177, X542A.C, and rs3745367 did not show a significant difference. Conclusion Diabetic parameters increase in diabetic patients with covid-19 compared to diabetic patients without Covid-19. In addition, diabetic patients with Covid-19 have a high frequency of single nucleotide polymorphisms of the RETN gene. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: A considerable amount of research funding goes to diabetes management strategies to improve therapeutic goals and reduce the burden of diabetes. A vast amount of the budget is wasted due to unnecessary studies. A scoping review is a pivotal study to overview the available evidence and avoid research waste. In this review, we will try to find out the scope of available studies on diabetes management interventions, identify associated research gaps, and prioritize future studies. Method: We will carry out a study using Arksey and O'Malley's scoping review framework. We will search the Scopus and PubMed databases from 01/01/2015 till 01/01/2020. Only original articles related to pharmacological and non-pharmacological management interventions will be included. These interventional studies should be conducted on the Iranian population. After data extraction, a descriptive data analysis will be used to present information in different charts or tables. We will evaluate related published articles based on their document type, level of evidence, type of diabetes, subject area, interventions types, main findings and outcomes. Discussion: This study represents the first attempt to sum up available studies related to diabetes management interventions performed in Iran. The results of this study will be useful for all the stakeholders and policy-makers involved in diabetes research. It can help clinicians to be informed about studies on management interventions and can guide scientists eager to diabetes research to choose their future research plans based on diabetes research requirements and gaps. [ABSTRACT FROM AUTHOR]

Background: Considering the high prevalence of tuberculosis (TB) in developing countries and the fact that comorbidity with diabetes mellitus (DM) imposes a higher burden on the society, this study was carried out to assess the prevalence of diabetes and its related factors in patients with TB in Mashhad, Iran. Methods: In this study, we enrolled 405 patients over the age of 18 who had been diagnosed with TB between the years 2015 and 2016 according to the documents of the ministry of health. The participants were selected randomly from five health center domains based on the stratified sampling method. The patients were screened for diabetes according to HbA1c over 6.5% or a fasting blood sugar (FBS) level over 126 mg/dL at different time points and the patient's self-report of having DM. Results: The mean age of participants was 51.14 ± 20.52 (19-92 years). The prevalence of DM in patients with TB was 21.2%, of whom 3.5% were newly diagnosed. Among potential factors, age with OR = 3.786 (1.183, 12.113), body mass index with OR = 9.149 (3.182, 26.302), nationality with OR = 2.149 (1.122, 4.117) and TB type with 3.328 (1.44, 7.689) were associated with DM in patients with TB. Conclusion: The prevalence of DM in our study was higher than that observed in other countries. Our study showed associated factors like age, body mass index, and TB type to be very important. Also, the prevalence of DM was different in patients with different nationality. [ABSTRACT FROM AUTHOR]

Background: The prevalence of type 2 diabetes mellitus has increased in the past decades. We investigated the prevalence of diabetes and its awareness, treatment, and control among adult residents of Tehran. Methods: We used the recruitment phase data of the Tehran Cohort study, enrolling a random sample of adult residents of Tehran aged ≥35 years. Diabetes was defined as self-report, current use of glucose-lowering medications, and/or fasting plasma glucose (FPG) ≥126mg/dl. Impaired fasting glucose (IFG) was defined as an FPG of 100-125mg/dl. Awareness was defined as diabetes self-report, treatment as receiving glucose-lowering medications, and glycemic control as FPG <126mg/dl. The age- and sex-weighted estimates were calculated using the 2016 national census. Logistic regression models were used to determine the factors associated with diabetes awareness, treatment, and control. Results: A total of 8151 participants were included. Age- and sex-weighted prevalence of diabetes mellitus and IFG were 16.7% (95% CI: 15.1–18.4) and 25.1% (95% CI: 23.1–27.1), respectively. Diabetes was more prevalent in the eastern and central districts of Tehran. Advanced age (OR per 1-year increase: 1.026, 95% CI: 1.021-1.030), male sex (OR: 1.716, 95% CI: 1.543-1.909), higher BMI levels (OR for BMI ≥35 vs. <20 kg/m2: 4.852, 95% CI: 3.365-6.998), pre-existing hypertension (OR: 1.552, 95% CI: 1.378-1.747), dyslipidemia (OR: 1.692, 95% CI: 1.521-1.883), and chronic kidney disease (OR: 1.650, 95% CI: 1.019-2.673) were associated with an increased odds of diabetes mellitus. On the contrary, diabetes mellitus was less likely in current tobacco (OR: 0.872, 95% CI: 0.765-0.994) and alcohol users (OR: 0.836, 95% CI: 0.703-0.994) compared to non-users. Among diabetic individuals, 82.8% were aware of their condition, 71.9% received treatment, and 31.7% of treated patients had adequate glycemic control. Advanced age and pre-existing comorbidities, including hypertension and dyslipidemia, were associated with higher diabetes awareness and treatment. Furthermore, advanced age, higher levels of education, and female sex were determinants of better glycemic control among treated diabetic participants. Conclusion: There is a high prevalence of diabetes and IFG among adult residents of Tehran. Additionally, more than two-thirds of treated diabetics living in Tehran remain uncontrolled. [ABSTRACT FROM AUTHOR]

Background and Aim: Hearing loss is a highly prevalent symptom in patients with chronic kidney diseases (CKD). Comorbidities such as Diabetes Mellitus is known as the most common cause of CKD and a significant risk factor for sensorineural hearing loss (SNHL). The aim of this study was to compare SNHL among diabetic with non-diabetic hemodialysis patients. Methods: In this study, 33 diabetic patients on hemodialysis were selected from Hami center, Arak, Iran. Non-diabetic subjects were 31 hemodialysis patients without diabetes were matched for age, duration of CKD and hemodialysis. Data were obtained via questionnaire, patients' files, physical examination, otoscopy and tympanometry. Hearing was analyzed using pure-tone audiometry for both groups. Results: In the study, 66.2% of diabetic patients and 52.1% of non-diabetic subjects had SNHL. Results showed that diabetic patient has 1.3 times more likely to have hearing impairment. This difference was not statistically significant. Bilateral mild SNHL was the most prevalent in both groups. No significant difference was reported in SNHL prevalence, mean thresholds of hearing and ear laterality between the groups. Gender and age had a significant effect on hearing loss after adjusting covariables. No significant association was found between diabetes and hearing loss. Conclusion: SNHL was more common in hemodialysis patients with diabetes. Patients with diabetes had poorer hearing thresholds compared to non-diabetic group, with no significant difference between groups. The periodical assessment of hearing and extending audiological care in this high-risk population is recommended due to long-term irreversible symptoms of the disease. [ABSTRACT FROM AUTHOR]

Summary: High rates of infertility in type 2 diabetic (T2DM) men have led to attempts to understand the mechanisms involved in this process. This condition can be investigated from at least two aspects, namely sperm quality indices and epigenetic alterations. Epigenetics science encompasses the phenomena that can lead to inherited changes independently of the genetics. This study has been performed to test the hypothesis of the relationship between T2DM and the epigenetic profile of the sperm, as well as sperm quality indices. This research included 42 individuals referred to the infertility clinic of Royan Institute, Iran in 2019–2021. The study subjects were assigned to three groups: normozoospermic non-diabetic (control), normozoospermic diabetic (DN) and non-normozoospermic diabetic (D.Non-N). Sperm DNA fragmentation was evaluated using the sperm chromatin structure assay technique. The global methylation level was examined using 5-methyl cytosine antibody and the methylation status in differentially methylated regions of H19, MEST, and SNRPN was assessed using the methylation-sensitive high-resolution melting technique. The results showed that the sperm global methylation in spermatozoa of D.Non-N group was significantly reduced compared with the other two groups (P < 0.05). The MEST and H19 genes were hypomethylated in the spermatozoa of D.Non-N individuals, but the difference level was not significant for MEST. The SNRPN gene was significantly hypermethylated in these individuals (P < 0.05). The results of this study suggest that T2DM alters the methylation profile and epigenetic programming in spermatozoa of humans and that these methylation changes may ultimately influence the fertility status of men with diabetes. [ABSTRACT FROM AUTHOR]

Background & Aims As a chronic disease with many complications, diabetes requires adherence to treatment regimen. Despite the importance of adherence, it is not done completely in these patients. Nonadherence to treatment has many personal and social consequences. Adherence in diabetic patients can lead to mortality reduction and success in the treatment of diabetes. Considering that adherence to the treatment regimen is challenging among diabetic patients and less attention has been paid to it in Iran, the present study aims to identify the factors related to adherence to treatment regimen among diabetic patients in Sari, Iran. Materials & Methods This descriptive cross-sectional study was conducted in 2021 on 226 adults with Type 2 diabetes referred to Baghban clinic affiliated to Mazandaran University of Medical Sciences in Sari, Iran who were selected using a continuous sampling method. Data were collected using a demographic form and the diabetes activities questionnaire. Questionnaires were prepared online using Google Forms. Data analysis was performed in SPSS software, version 26. Results The mean age of participants was 53.06±10.81 years. Most of them were female (61.9%) and married (85.8%) with a high school diploma (26.5%) and moderate economic status (69%). Economic status, age, and BMI had a significant relationship with adherence to treatment regimen (P<0.05); Economic status and age had a positive significant relationship while BMI had a negative significant relationship with adherence to treatment regimen. Diabetic patients with better economic status, higher age, and lower BMI had better adherence. Conclusion This study provides a basis for expanding knowledge of adherence to treatment regimens in diabetic patients in Iran. It is necessary for healthcare providers, especially nurses, to pay attention to the factors related to adherence to treatment in diabetic patients in providing care and education to them to have better treatment. [ABSTRACT FROM AUTHOR]

Background: The inflammatory and metabolic responses to mushroom in type 2 diabetes mellitus (T2DM) are unknown. The study aimed to evaluate the effect of Hot Air-dried White Button Mushroom (HAD-WBM) powder on glycemic status, lipid profile, inflammatory markers, and total antioxidant capacity (TAC) in T2DM patients. Materials and Methods: This randomized controlled trial was conducted at Golestan Hospital, Ahvaz, Iran. Eligible patients were adults aged 20-50 with Type 2 diabetes. Patients were assigned to each group using a randomized block design with block randomization (n = 22, in each group). Randomization was performed by an assistant and group allocation was blinded for the investigator and participants. The intervention and control groups received 16 g/day HAD-WBM or cornstarch powder for 8 weeks. The primary outcomes of interest were fructosamine, fasting blood sugar (FBS), insulin, homeostatic model assessment for insulin resistance, and secondary outcomes were triglyceride, low-density lipoprotein (LDL), high-density lipoprotein, very-LDL, cholesterol, high-sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and TAC. Results: After 8 weeks, a significant decrease was observed in fructosamine (-0.228 ± 0.36 vs. 0.03 ± 0.38; P = 0.02) and LDL (-13.05 ± 20.67 vs. 0.81 ± 21.79; P = 0.04) in the HAD-WBM group compared to the control group. No significant changes were observed in fasting insulin and FBS between the two groups. However, a significant within-group reduction (-28.00 ± 42.46; P = 0.006) was observed for FBS in the HAD-WBM group. In the HAD-WBM group, insulin resistance reduced significantly at the end of the study (From 4.92 to 3.81; P = 0.016), but it was not significantly different between the two groups. There was no significant difference in TAC, hs-CRP, and IL-6 between the two groups. Conclusion: Considering the results of this study about the beneficial effects of HAD-WBM on the improvement of glycemic indices and LDL in T2DM patients, it is recommended that HAD-WBM could be used to control T2DM. [ABSTRACT FROM AUTHOR]

Background: To evaluate the prevalence of type 2 diabetes mellitus (T2DM), impaired fasting glucose (IFG), and its cardiometabolic risk factors in the southern Iranian adult population. Methods: This is a population-based cross-sectional survey on 3944 middle-aged and elderly adults (35--70 years) from Bandare- Kong. The participants were recruited from 2016 to 2018 and the first phase data of the Bandare-Kong Cohort as a part of the PERSIAN Cohort were used for analysis. Results: Among the 3944 included adults, the age-adjusted prevalence of T2DM and IFG was 17.40% and 20.61%, respectively. Mean FPG was higher among those older than 55 years, females, rural residents, current cigarette smokers, hypertriglyceridemia, hypercholesterolemia, unemployed and low educational level in subjects with diabetes and pre-diabetes. T2DM and IFG were more prevalent in women and men, respectively. Also, those with higher waist circumference (WC), higher body mass index (BMI), lower educational levels, rural residents, former cigarette smokers, hypertension (HTN), hypercholesterolemia, hypertriglyceridemia and age older 45 years, had a higher T2DM and IFG prevalence. Multivariable regression analysis showed that older age, higher WC, HTN and hypertriglyceridemia and living in rural regions were statistically significant predictors of T2DM and pre-diabetes while BMI ≥ 25 kg/m² was the only significant risk factor for IFG. Conclusion: The current study illustrated that T2DM and IFG have a high prevalence among the middle-aged and elderly adult Iranian population, particularly in rural dwellers. Hence, prevention strategies should be implemented to reduce diabetes and pre-diabetes, especially in rural areas. [ABSTRACT FROM AUTHOR]

Background: Some clinical scoring systems as the quantitative tools have been developed to assess the presence and severity of Diabetic Peripheral Neuropathy (DPN) based on both the patient's complaints and the physicians' findings. This study was aimed at assessing the presence and severity of sural and peroneal nerve neuropathies using Michigan Neuropathy Screening Instrument (MNSI) and United Kingdom Screening Test (UKST) questionnaire compared with electrodiagnosis assessments. Methods: 148 patients with Diabetes Mellitus (DM) including 80 females and 68 males with a mean age of 57.6, 19 type 1DM and 129 type 2 DM were recruited in this study. The findings of the electrophysiological study such as peroneal and sural nerves' conduction delay, velocity and amplitude were gathered. The patients were also assessed regarding the clinical neuropathy status using the two instruments of MNSI and UK. Results: The mean neuropathy score of MNSI and UKST were 2.2 (1.7) and 4.1 (3.0), respectively. Each instrument detected the DPN in 47.3% and 64.9% of the patients, respectively. Also, based on the nerve conduction studies (NCS), the neuropathy of sural and peroneal nerves was found in 54.1% and 79.7%, respectively. Unlike the peroneal nerve, there was a significant agreement between the electrodiagnosis assessment and the screening tools in the diagnosis of sural nerve neuropathy. Conclusion: Given that NCS is a practical, simple, and non-invasive approach and also can determine the level of damage and regeneration in peripheral nerves, sural nerve conduction study is suggested as a convenient option for screening and diagnosing the diabetic neuropathy. [ABSTRACT FROM AUTHOR]

Aim: The study aimed at testing the validity and reliability of the Persian version of the treatment self‐regulation questionnaire (TSRQ‐15) across healthy diet, exercise and medication‐use/glucose‐monitoring among Iranian people with type‐2 diabetes. Design: Cross‐sectional design. Methods: Content validity was investigated by 16 experts. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were employed. Construct validity, convergent/discriminant validity and internal consistency were examined. Concurrent validity was assessed using Spearman's rho correlation across different behaviours. Results: Content validity was confirmed for Persian TSRQ‐15. A three‐factor structure was revealed, in which external regulation and introjected regulations were validated, while amotivation and autonomous failed to show discriminant validity. Internal consistency was sound, and concurrent validity was approved. The Persian version of TSRQ‐15 was shown to be a valid and reliable tool for assessing motivation behind the practice of healthy diet, exercise and medication‐use/glucose‐monitoring in people with type 2 diabetes. [ABSTRACT FROM AUTHOR]