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Background: Type 2 diabetes mellitus (T2DM) is a significant risk factor for non-alcoholic fatty liver disease (NAFLD). Increased fasting blood sugar (FBS), fasting insulin (FI), and insulin resistance (HOMA-IR) are observed in patients with NAFLD. Gut microbial modulation using prebiotics, probiotics, and synbiotics has shown promise in NAFLD treatment. This meta-umbrella study aimed to investigate the effects of gut microbial modulation on glycemic indices in patients with NAFLD and discuss potential mechanisms of action., Methods: A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library until March 2023 for meta-analyses evaluating the effects of probiotics, prebiotics, and synbiotics on patients with NAFLD. Random-effect models, sensitivity analysis, and subgroup analysis were employed., Results: Gut microbial therapy significantly decreased HOMA-IR (ES: -0.41; 95%CI: -0.52, -0.31; P < 0.001) and FI (ES: -0.59; 95%CI: -0.77, -0.41; P < 0.001). However, no significant effect was observed on FBS (ES: -0.17; 95%CI: -0.36, 0.02; P = 0.082). Subgroup analysis revealed prebiotics had the most potent effect on HOMA-IR, followed by probiotics and synbiotics. For FI, synbiotics had the most substantial effect, followed by prebiotics and probiotics., Conclusion: Probiotics, prebiotics, and synbiotics administration significantly reduced FI and HOMA-IR, but no significant effect was observed on FBS., (© 2024. The Author(s).)

Purpose: Overall, thyroid cancer is the most common endocrine malignancy. This cancer is fifth most common cancer among adult women and the second most common cancer in women over 50 years old and it occurs in women 3 times more than men. The present systematic review and meta-analysis were designed with the aim of determining the 5-year survival rate of thyroid cancer in Asian countries in 2022., Methods: The current study is a systematic review and meta-analysis of thyroid cancer survival rates in Asian countries. Researchers in the study searched for articles published in six international databases: PubMed/Medline, EMBASE, Scopus, Google Scholar, ISI (Web of Knowledge), and ProQuest until July 03, 2022. A checklist (The Newcastle-Ottawa Quality Assessment Form) has been prepared in previous studies to evaluate the quality of articles., Results: In general, 38 articles were entered for the meta-analysis. The 5-year survival rate was 95.3%, with a 95% confidence interval of 93.5% to 96.6%. The year of study is a cause of variability in results of 5-year (Reg Coef = 0.145, P < 0.001). According to the results, an increased survival rate across the study period was observed. Human Development Index was a cause of variability in results of 5-year survival rates (Reg Coef = 12.420, P < 0.001). The results of Table 2 showed that women have 4% more 5-year survival rate than men (Hazard ratio: 1.05 CI: 95% 1.04-1.06))., Conclusion: In general, the 5-year survival of thyroid cancer in Asian countries was higher than in European countries, but it is at a lower level than in the United States., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background and Aim: Bowel preparation is a crucial factor affecting the diagnostic accuracy of colonoscopy, and few randomized control trials evaluated enhancement in bowel preparation. In this study, we aimed to evaluate the effectiveness of walking exercises on bowel preparation before a colonoscopy procedure., Methods: The present study is a single-blind randomized controlled trial involving 262 patients scheduled for colonoscopy procedures. These patients were randomly assigned to two groups: an intervention group (n = 131) and a control group (n = 131). In the intervention group, participants followed a predetermined plan that included the consumption of specific liquids and foods, bisacodyl pills, polyethylene glycol powder, and a regimen of walking exercises in preparation for their colonoscopy. Conversely, individuals in the control group followed the same regimen but were not instructed to engage in walking exercises. On the day of the colonoscopy, both groups were assessed for their level of physical activity using a foot counter. Additionally, an experienced gastroenterologist evaluated and compared the bowel preparation between the two groups using the Boston Bowel Preparation Scale (BBPS)., Results: The number of footsteps recorded in the two groups exhibited a significant difference (P < 0.001). Although there was no statistically significant difference between the intervention and control groups in terms of mean BBPS scores (6.26 ± 1.9 vs. 6.29 ± 1.9, P = 0.416), individuals who took more than 6900 steps had significantly higher BBPS scores compared to those with fewer than 6900 footsteps (6.62 ± 1.8 vs. 5.92 ± 1.9, P = 0.003).In the univariate analysis, BBPS was found to be significantly associated with individuals under the age of 50 (OR: 2.45, 95% CI: 1.30-4.61, P = 0.006) and smoking status (OR: 0.41, 95% CI: 0.17-0.94, P = 0.043). In the multivariate analysis, the relationship between BBPS and age below 50 and smoking remained significant (OR: 2.50, 95% CI: 1.30-4.70, P = 0.005, and OR: 0.38, 95% CI: 0.16-0.93, P = 0.034, respectively)., Conclusion: A higher number of footsteps taken especially more than 6900 can significantly enhance bowel preparation; however, walking exercise as an intervention before colonoscopy is not significantly associated with BBPS. Also, older people and smokers seem to have fewer benefits from walking exercises for bowel preparation., Trial Registration: ISRCTN32724024 (Registration date:22/08/2018)., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Background: Hypertension (HTN) is one of the primary risk factors for heart disease and stroke worldwide. The present meta-analysis was aimed to systematically review and statistically estimate the prevalence rate of pre-hypertension (PHTN) and HTN in the Iranian child/adolescent and adult age groups., Methods: In this study, four International databases, including PubMed, Scopus, Web of Science, and Cochrane, as well as three Iranian databases, including SID, Magiran, and IranMedex, were separately investigated for articles published before January 2021. Also, we estimated the pooled effect size for the prevalence of PHTN and HTN in children/adolescent and adult age groups. Stata software (version 14.0) was used for all statistical analyses., Results: From a total of 1185 articles found in database searches, fifty-one were included in the meta-analysis. The prevalence of HTN in the Iranian adult population was 26.26% (25.11 % and 26.22 % for women and men, respectively). Meanwhile, the prevalence of PHTN and HTN in the child/adolescent age group was 8.97% (95% CI 7.33 - 10.61) and 8.98% (95% CI 7.59 - 10.36), respectively., Conclusions: This study provides information which can be used for various purposes, including study designing. Further nationwide surveys should be carried out to obtain accurate information on the HTN prevalence rate, particularly based on the American College of Cardiology /American Heart Association guidelines in the Iranian population., Competing Interests: The authors declare that they have no conflict of interest.

Antibody-drug conjugates (ADCs) are a promising class of cancer biopharmaceuticals that exploit the specificity of a monoclonal antibody (mAb) to selectively deliver highly cytotoxic small molecules to targeted cancer cells, leading to an enhanced therapeutic index through increased antitumor activity and decreased off-target toxicity. ADCs hold great promise for the treatment of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer after the approval and tremendous success of trastuzumab emtansine and trastuzumab deruxtecan, representing a turning point in both HER2-positive breast cancer treatment and ADC technology. Additionally and importantly, a total of 29 ADC candidates are now being investigated in different stages of clinical development for the treatment of HER2-positive breast cancer. The purpose of this review is to provide an insight into the ADC field in cancer treatment and present a comprehensive overview of ADCs approved or under clinical investigation for the treatment of HER2-positive breast cancer., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2023 The American Society of Gene and Cell Therapy. Published by Elsevier Inc. All rights reserved.)

Background: Evidence suggests that menopause can be associated with a variety of negative psychological changes such as depression and anxiety, and improving the mental health status of women during menopause is one of the important priorities and challenges of the health system. The aim of this study was to determine the effect of saffron (Crocus sativus L., Iridaceae) herbal tea on happiness in postmenopausal women., Methods: In this randomized clinical trial which was conducted in 2021, 72 postmenopausal women were enrolled and divided into intervention and control groups. The randomization blocks method was used for random allocation, and the Oxford Happiness Questionnaire was utilized to measure the scores. The intervention included the use of 30 mg of dried stigmas of the saffron plant, which was boiled once (in the morning, in 300 ml of boiling water for 10-15 min) and consumed with white rock candy as one cup of saffron tea daily. To compare the trend of changes and after removing the effect of other variables, generalized estimating equation (GEE) was used., Results: There was no significant difference between the intervention and control groups in any of the quantitative and qualitative characteristics (p > 0.05). The results of paired samples t-test showed that the happiness mean score in the intervention group increased significantly (p < 0.001) from 42.93 ± 8.54 to 61.58 ± 8.24, while in the control group, there was no significant difference between the happiness mean score at the beginning and end of the study (p = 0.861). Also, after applying the treatment program in the intervention group, there was a significant difference between the two groups in terms of the happiness mean scores (p < 0.001)., Conclusion: Saffron herbal tea had a positive effect on reducing depression and increasing the happiness score; thus, it is recommended that it should be used as a complementary treatment in consultation with the treating physician., Trial Registration: The present study was registered with the code of IRCT20210403050818N1 (Registration date: 09/04/2021) in the Iranian Registry of Clinical Trials. It was also approved by the Ethics Committee of Larestan University of Medical Sciences (Approval ID: IR.LARUMS.REC.1399.017)., (© 2023. The Author(s).)

Background: In 2020, COVID-19 spread rapidly in Iran and other parts of the world. Some of the epidemiological aspects of this disease remain unknown; therefore, the present study was designed with the aim of determining the trend of incidence and mortality of COVID-19 from February 2020 to July 2021 in southern Iran., Methods: The present study was a cross-sectional analytical study that included all people who had COVID-19 in the period from February 2020 to July 2021 and whose information had been registered in the Infectious Diseases Center of Larestan city and MCMC unit. The study area included the cities of Larestan, Evaz, and Khonj, located in the south of Fars province in southern Iran., Results: Since the emergence of COVID-19 until July 2021, a total of 23,246 new cases of infection were reported in the southern region of Fars province. The average age of patients was 39.90±18.30 years and the range of ages varied from 1 to 103 years. The results of the Cochran-Armitage trend test showed that the trend of the disease in 2020 was completely upward. The first positive case of COVID-19 was recorded on February 27, 2020. The incidence curve in 2021 is sinusoidal, but in general, the results of the Cochran-Armitage trend test showed that the incidence of the disease increased significantly ( P -trend < 0.001). Most cases were reported in July, April, and the end of March., Conclusion: In general, the incidence rate of COVID-19 has varied sinusoidally from 2020 to mid-2021. Although the incidence of the disease increased, the number of deaths has fallen. It seems that the increase in the number of diagnostic tests and the implementation of the national COVID-19 immunization program have been effective in changing the trend of the disease., Competing Interests: Conflict of interestThere is no conflict of interest., (© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2023, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.)

Aim: In the present study, we aimed to evaluate the effectiveness of group reminiscence on death anxiety and adaptation of the elderly to old age., Methods: This is a clinical trial study. Using simple random sampling method, we divided 32 elderly people into the intervention (n = 16) and control (n = 16) groups. Reminiscence therapy was held in 12 sessions. The study instruments including demographic characteristics questionnaire, Mini Mental Status Examination, Templer Death Anxiety, and aging adjustment questionnaires were filled out by the samples in 3 steps before the intervention, after the last day of the intervention, and 30 days after the end of the interventional sessions., Results: In the intervention group, the mean score of death anxiety and adjustment to old age before the intervention showed a statistically significant difference with the post-intervention stages (P < 0.05); however, in the control group, the mean scores of death anxiety and adjustment to old age in the 3 steps were not statistically significant (P > 0.05). Also, no statistically significant difference was found between the intervention and control groups before the intervention (P > 0.05), but there was a statistically significant relationship in the steps immediately after the last day of the intervention and 30 days after the end of the interventional sessions (P < 0.05)., Conclusion: The findings of the present study indicate that reminiscence therapy is able to effectively reduce the anxiety of death in the elderly; also, reminiscence therapy can be used to improve the adaptation ability of the elderly to old age., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Hematuria is one of the most common symptoms in nephrology and urology. Due to the lack of extensive meta-analysis studies on the epidemiology of hematuria in Iran, this study was conducted to determine the epidemiological status of hematuria in Iran., Methods: In Sep 2020, researchers studied six international databases such as PubMed, ISI/WOS, ProQuest, Embase, Scopus, and Google Scholar for English papers and Iranian databases (SID and MagIran) for Persian papers. Joanna Briggs Institute (JBI) checklist was used to review and control the quality of articles. Heterogeneity between studies was assessed by Cochran's test and its composition using I 2 statistics., Results: After several screening phase, the number of 25 article included to the final analysis. The prevalence of hematuria in the general population and children, in Iran were estimated at 16.4% (95% CI, - 0.05-37.9) and 1.6% (95% CI, 0.9-2.3) respectively. The odds ratio (OR) of women to men in the prevalence of hematuria in the general population 1.74, 95% CI: 1.20-2.52, P =0.003, patients with beta-thalassemia major 2.02, 95% CI: 1.11-3.65, P =0.020, children 2.61, 95% CI: 1.19-5.71, P =0.016, the elderly 1.50, 95% CI: 1.15-1.94, P =0.002, and taxi drivers 3.73, 95% CI: 2.58-5.38, P <0.001 was obtained., Conclusion: The prevalence of hematuria in the general population is relatively high. Hematuria is a good predictor for detecting of bladder cancer and Idiopathic hypercalciuria and the physician should attention to microscopic hematuria., Competing Interests: Conflict of interest The authors declare that there is no conflict of interest., (Copyright © 2022 Khosousi et al. Published by Tehran University of Medical Sciences.)

Background: Brucellosis is known in Iran as an endemic disease; however, its incidence is not the same in all provinces and is higher in some areas., Objective: The present study was designed to determine the epidemiological status and trend of brucellosis in the period from 2015 to 2020 in the south of Fars province, Southern Iran., Methods: This is a cross-sectional analytical study. This study included all patients with brucellosis in the period from 2015 to 2020 whose information had been registered in the Infectious Diseases Center of Larestan city. To collect the data, we used a checklist that included information such as age, gender, number of cases by year and month, occupation, and nationality of the patients with brucellosis. The rate of brucellosis incidence during these years was analyzed using the Cochran-Armitage trend test. P-value less than 0.05 was considered significant., Results: The average annual incidence of the disease was 8.94 per 100 000 population. It has decreased from 26.83 (per 100 000 people) in 2015 to 1.83 (per 100 000 people) in 2020. The results of Cochrane-Armitage process test showed that the reduction in the incidence of the disease from 2015 to 2020 was significant (PTrend = 0.001). The trend of the disease by month also showed that the majority of cases occurred between December and February, with the highest incidence of the disease in February (9.93 per 100 000 people) and the lowest in May (1.1 per 100 000 people) (P = 0.001)., Conclusion: Although the results of the present study indicated a decrease in the incidence of the disease in the southern region of Fars province, due to the fact that the disease is common between humans and livestock, there is the possibility of scattered and irregular epidemics in each period., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2022 The Author(s).)

Background: Novel coronavirus disease-19 (COVID-19) was declared as a global pandemic in 2020. With the spread of the disease, a better understanding of patient outcomes associated with their symptoms in diverse geographic levels is vital. This study aimed to evaluate clinical outcomes of COVID-19 patients by disease symptoms in Ilam province, Iran., Methods: This was a cross-sectional study. Data were collected from integrated health system records for all hospitals affiliated with the Ilam University of Medical Sciences between 26-Jan-2020 and 02-May-2020. All patients with a confirmed positive test were included in this study. Descriptive analyses, chi-square test, and binary logistic regression model were performed by using SPSS version 22., Results: The mean age of participants was 46.47 ± 18.24 years. Of the 3608 patients, 3477 (96.1%) were discharged, and 129 (3.9%) died. 54.2% of the patients were male and were in the age group of 30-40 years. Cough, sore throat, shortness of breath or difficulty breathing, and fever or chills were the most common symptoms. Patients with symptoms of shortness of breath, abnormal radiographic findings of the chest, and chest pain and pressure were relatively more likely to die. According to binary logistic regression results, the probability of death in patients with shortness of breath, abnormal chest radiographic findings, and chest pain was 1.34, 1.24, and 1.32 times higher, respectively, than for those without., Conclusion: Our study provides evidence that the presentation of some symptoms significantly impacts outcomes of patients infected with SARS-CoV-2. Early detection of symptoms and proper management of outcomes can reduce mortality in patients with COVID-19., (© 2021. The Author(s).)

Background: The prevalence of hookah smoking in the Islamic Republic of Iran is increasing among females, especially in the southern cities., Aims: The aim of this study was to investigate the factors influencing hookah tobacco smoking among females in the Islamic Republic of Iran., Methods: In this qualitative study, 52 females who use hookah were selected (25-71 years old) from the cities of Evaz and Gerash and were interviewed. The participants were selected using purposive sampling and the data were gathered using semi-structured interviews. Data analysis was performed using the conventional approach of qualitative content analysis., Results: Most participants were aged between 25 and 35 years old and 55.8% were married. Three main themes were identified from the qualitative data including: personal factors, family factors and social factors., Conclusions: The findings of this study indicate that the reasons for hookah smoking were based on complex interactions between individual, family, and social factors. In order to successfully reduce hookah smoking in females it is necessary to consider an approach that uses these social factors., (Copyright © World Health Organization (WHO) 2020. Open Access. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO license (https://creativecommons.org/licenses/by-nc-sa/3.0/igo).)

Background: Malaria is one of the major human health problems that have become increasingly important in recent decades., Objective: The present study aimed to identify the epidemiological status of malaria in the years 2006-2018 in the southern region of Fars province in southern Iran., Methods: This is a cross-sectional descriptive-analytical study. The study population consisted of all persons with malaria referred to the Center for Disease Control in the four cities of Larestan, Gerash, Evaz and Khonj in the south of Fars province, Southern Iran, between 2006 and 2018. Frequency (%) was used to report descriptive statistics and mean and standard deviation for quantitative variables. The trend of malaria incidence during these years was analyzed using the Cochran Armitage Test. The significance level was considered 5%., Findings: A total of 190 cases of malaria in the period of 2006 to 2018 occurred in the southern region of Fars province; 77.9% were men, more than 95% were Afghans, and most of them were workers. The incidence of malaria in one hundred thousand people per month showed that most of the new malaria cases were in the months of July to October. The peak incidence was in August, with 19.88 cases per 100,000 people. Cochran-Armitage test results showed that this trend was not statistically significant (P = 0.399), despite an almost upward trend in malaria incidence in the south of Fars province., Conclusion: The results of this study showed that the trend of malaria in the south of Fars province was ascending; therefore, increasing surveillance activities to prevent and control malaria in such area is of utmost importance., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)

Background: The prevalence of depression and anxiety is increasing among the elderly around the world. It is believed that lavender can stabilize the people's mood, so this study was designed to evaluate the effect of lavender on anxiety and depression of the elderly., Methods: This study was a single blind clinical trial with a control group. The participants in the study consisted of 60 elderly subjects (30 in each group) who referred to the Health Center of Larestan city in the south of Iran in 2019. The intervention consisted of using 2 g of lavender teabag, which was prescribed to be used 2 times as decoction in the morning and night. The duration of the intervention was 2 weeks. The eligible participants were randomly assigned to the intervention and control groups using balanced block randomization with a block size of ten. The control group did not receive any placebo. Data collection tools in this study included demographic information questionnaire, Beck Depression and Spiel Berger Anxiety Inventory. Chi-square test and independent t-test were used to analyze the data. The significance level was considered 5 %., Results: The two groups were similar in terms of age, gender, educational level and marital status and there was no significant difference. The mean score of depression in the intervention group before and after drinking lavender herbal tea was 17.80 ± 1.49 and 16.33 ± 1.49, respectively. The mean score of depression between intervention and control groups after drinking herbal tea were 16.33 ± 1.49 and 18.33 ± 1.84, respectively. This indicated the effect of herbal tea on reducing depression (P < 0.001). Also, mean difference of intervention and control groups after drinking herbal tea in terms of depression and anxiety (state and trait) were (-2.00, 95 % CI (-2.86, -1.13)), (-6.40, 95 % CI (-9.43, -3.36)) and (-4.13, 95 % CI (-7.66, -0.60)), respectively., Conclusion: The results of the present study showed that consumption of lavender herbal tea can reduce depression and anxiety scores and since it is inexpensive and accessible, it is suggested to be used as a complementary treatment in reducing anxiety and depression., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Prostate cancer is one of the most common health issues among men, especially older men. In recent years, incidences of prostate cancer is increasing., Objective: The aim of this study was to provide a comprehensive estimate of the survival of prostate cancer in Asian countries., Methods: We searched five international databases including Medline/PubMed, Scopus, Embase, Web of Knowledge and ProQuest until June 1, 2018. The Newcastle-Ottawa Quality Assessment was used to evaluate the quality of selected papers. The review protocol was registered in PROSPERO (CRD42019117044)., Results: A total of 714 titles were retrieved. Thirty-seven studies met the inclusion criteria. Based on the random-effect model one-year, five-year and ten-year survival rate of prostate cancer were 81% (95% CI 77.8-84.2), 61.9% (95% CI 59.5-64.3) and 36.2% (95% CI 9.2-63.2) respectively. Survival rates based on HDI level for five-year were 30.07, 43.43 and 70.84 percent for medium, high and very high levels, respectively., Conclusion: According to the results of our study, the prostate cancer survival rate in Asian countries is relatively lower than in Europe and North America., Competing Interests: The authors have no competing interests to declare., (Copyright: © 2020 The Author(s).)

Colorectal cancer (CRC) is the second most common cause of cancer-related deaths worldwide. Survival rates are among the most important factors in quality control and assessment of treatment protocols. This study was aimed to assess the survival rate of colorectal cancer in Eastern Mediterranean Region Countries. In the present study we comprehensively searched 6 international databases including PubMed/Medline, ProQuest, Scopus, Embase, Web of Knowledge and Google Scholar for published articles until November 2018. The Newcastle-Ottawa Quality Assessment Form for Cohort Studies was applied to evaluate the quality of included studies. The heterogeneity of papers was assessed with the Cochran Test and I-Square statistics. Meta-regression test was performed based on publication year, sample size and Human Development Index (HDI) of each study. Among the total of 1023 titles found in the systematic search, 43 studies were eligible to be included in the present meta-analysis. According to the results, the 1-year, 3-year and 5-year survival rate of patients with Colorectal Cancer was 88.07% (95% CI, 83.22-92.92), 70.67% (95% CI, 66.40-74.93) and, 57.26% (95% CI, 50.43-64.10); respectively. Furthermore, Meta-regressions did not show significant correlations between survival rate and year, sample size or Human Development Index. Survival rates, especially the 5-year survival rate in the EMRO were less than European countries and the USA. Documented and comprehensive evidence-based findings of the present meta-analysis can be used to enhance policies and outcomes of different medical areas including prophylaxis, treatment and health related objectives in colorectal cancer.

Background: Many patients with type 2 diabetes are uncontrolled on maximum oral treatment. The early introduction of insulin can lower diabetes-related complications. This study aimed to evaluate type 2 diabetes patients' demographic characteristics, clinical factors, and attitude toward insulin therapy initiation., Methods: In the present cross-sectional study, 457 patients were selected from 12 diabetes clinics in the southern Iranian city of Shiraz in 2017. Adult patients (>30 y) with type 2 diabetes indicated to use insulin for the first time (insulin-naive) were asked to complete a researcher-designed questionnaire. The data were analyzed using SPSS 19. The relationships between insulin and the tendency to use insulin, demographic characteristics, and clinical data were evaluated using the χ 2 or t test and logistic regression. The significance level was considered at 0.05., Results: The mean age of the participants was 55.16±8.76 years and 67.4% were female. Despite physician recommendations, 60.2% of the patients were disinclined to use insulin. Those unwilling to initiate insulin therapy had more misconceptions. In the multivariate analysis, the chances of insulin noncompliance were increased by 4.63-fold among the patients without supplementary insurance (P<0.001), by 2.38-fold among those with a nondiabetic diet (P=0.002), and by 6.75-fold among the illiterate ones (P<0.001)., Conclusion: Based on the results, the factors affecting insulin noncompliance in our insulin-naive patients with type 2 diabetes included insurance coverage, illiteracy, and nondiabetic regimens as well as misconceptions about and irrational fear of insulin injection. Overall, our results indicate the need for further education and financial support for patients and health staff.