The aim of this study was to determine the prevalence of diabetes, pre-diabetes, awareness, treatment, disease control and the related factors on diabetes in people over 35 years old in the pilot phase of Azar cohort study in the Northwest of Iran. In this study, the overall prevalence of diabetes and pre-diabetes were 18.2% and 34.8%, respectively.
The prevalence of diabetes in the current study (18.2%) was much higher than its prevalence (8.8%) in the world and (23) 10.7% in the MENA region in 2015 (24). In Iran, some studies have been consistent with the present study. In a study carried out by Lotfi et al. in the Iranian city of Yazd in 2012, the prevalence of diabetes was reported as 16.3% and close to the results of the present study (25). However, according to studies conducted in Gilan and Fars Provinces in Iran, the prevalence of diabetes was reported as 12.4% and 14.1%, respectively, figures lower than our study’s estimate (26, 27). This difference might be due to the difference between the age groups of participants in these studies as well as different criteria that may have been utilized for diagnosing diabetes. The majority of these studies have not used HbA1C to diagnose diabetes.
With the increase of age, the prevalence of diabetes significantly augmented. The present study’s findings are consistent with those in the studies carried out in other parts of Iran (27–29) as well as in other countries (30–33). This signifies the importance of paying attention to diabetes in countries like Iran, whose populations are ageing.
Obesity, abdominal obesity and high triglyceride content had a significant association with the increased prevalence of diabetes, which is accordant with other studies (12, 30, 33, 34).
The subjects’ awareness of having diabetes was 58.4%. In a study conducted by Amiri in the North of Iran, 78.3% of people were aware of their disease, a percentage higher than that obtained in our study (27). In Shirani’s study in the City of Isfahan, 54.6% of people (35) and in Yazdan Panah’s study in City of Ahwaz, 40.4% people were aware of their disease (29). The percentage of awareness in the MENA region in middle-income nations was 50% and 40.7% in low-income countries (24). The findings of other studies carried out in other nations are also consistent with the results of the present study (12, 36, 37). The reasons for a higher level of awareness in the present study might be attributed to higher level of education in the studied population and accessible health care services as well.
The percentage of females’ awareness was significantly higher compared to males, which is agreeing with the results of other studies (12, 27, 30). This increased awareness may be due to the higher interest and attention of females to their health conditions. Subjects with the minimum of one disease were 3.13 (1.47–6.66) times more aware of having diabetes compared to others; these results are consistent with the findings in studies performed in Switzerland (36) and Ahwaz (29). Furthermore, people who were smokers had lower awareness, although this relationship was not statistically significant. Studies carried out in China (32) and Malaysia (38) confirm the findings of the present study.
Among the known cases of having diabetes, 44.3% were receiving treatment, a figure that is less than 79.7% of Mohtasham’s study in North of Iran (27) and other countries (30, 32, 36, 37). As women were significantly more aware of their disease, they were taking drugs more than men. The findings of studies conducted in Iran (27) and China confirm this issue (32, 37).
This study features many advantages. Firstly, it is a population-based study including all people over 35 years of age. Secondly, unlike other studies that estimated the prevalence of diabetes is solely based on FBS or the consumption of diabetes’ medications and people’s self-reports, this study has adopted HbA1C alongside other items to determine the prevalence of diabetes. Thirdly, in this study, standard questionnaires as well as trained interviewers, who were carefully supervised, were constructed and utilized to collect data to confirm the accuracy of measured data. The main weakness of this study was the lack of examining nutritional conditions and economic status of individuals, pivotal factors affecting people’s affliction, awareness, and the treatment and control of diabetes.