Prevalence of Diabetes and Prediabetes, and Achievements in Diabetes Control in Iran; The Results of the STEPS of 2016

Background: Using the WHO STEPwise approach to NCD risk factor surveillance (STEPS), first round of Iran's STEPS completed in 2005. It has been repeated six times afterward. Here we report the results of 2016 round on the population characteristics and prevalence of diabetes and prediabetes, along with an assessment of the country-level performance on diabetes care in Iran. Methods: Using a proportional-to-size cluster random sampling method, the STEPS 2016 included 18 947 subjects aged >= 25 years who matched the criteria (non-missing information on diabetes self-report, and biomarkers). For the analyses, survey design methods with weighted samples were employed. Different definitions of diabetes (biomarker-based, self-report, anti-diabetes medication use, or a combination) and prediabetes (different cutpoints of the biomarker) were calculated and presented. Results: An estimated 5171 035 persons aged >= 25 years or 10.6% (95% CI: 10.0%-11.1%) had diabetes according to the serologic diagnosis of diabetes (FPG >= 126 mg/dL) or the use of at least one anti-diabetes medication (1896 out of 18 947). Employing the serologic diagnosis of diabetes among those who responded no to the self-reported question, 2.7% (2.5%-3.0%) of the population were not aware of their diabetes compared to 11.5% (10.9%-12.0%) who were diabetics according to the just self-reported question. Defining prediabetes as 100 <= FPG <126 mg/dL or 5.7 <= HbA1c< 6.5%, an estimated 15244299 persons had prediabetes (5885 out of 18 947). Overall, 52.1% (49.4%-54.7%) of patients with self-reported diabetes were under strict glycemic control (HbA1c < 7%). Poor diabetes control (HbA1c > 9%) was found in 18.4% (16.3%-20.6%) of the patients with self-reported diabetes. Conclusion: Since 2005, the prevalence of diabetes in Iran has been on a gradual increase in both genders with an increasing gap between females and males.