Who Diabetes Mellitus Indonesia?

The number of people with diabetes mellitus in Indonesia is estimated at around 10 million people with a prevalence rate of 6.2% (7) and this disease is one of the causes of death in Indonesia (8, 9). So this causes Indonesia to occupy the top ten with the highest rate of diabetes mellitus in the world in 2013 (10).

How common is diabetes in Indonesia?

Background – Diabetes in Indonesia is considered a major health problem and has been a concern since the early 1980s, With more than 10 million people living with diabetes, Indonesia has a prevalence rate of 6.2% and diabetes is one major cause of death,

Indonesia was rated as one of the top ten countries globally with a high number of individuals living with diabetes in 2013, It is predicted that the same pattern will continue unless interventions to prevent and manage diabetes are implemented. To address the alarming numbers of Indonesian people with diabetes, diabetes experts have developed guidelines for preventing and managing diabetes,

Managing diabetes is crucial to prevent people from experiencing severe complications such as neuropathy, nephropathy, retinopathy, microvascular and cardiovascular disease, Pharmacologic therapies such as oral medications and insulin, and non-pharmacologic therapies such as lifestyle modifications are still considered contemporary interventions for managing diabetes,

1. These interventions can only be implemented and achieved through diabetic educational programs that promote self-care management,
2. Healthcare services in Indonesia provide some effective diabetes educational programs,
3. The availability of certified diabetic educators is limited in Indonesia resulting in a dearth of skilled health care professionals (HCPs) to provide education to people with diabetes,

There is little evidence available about the process of how people with diabetes learn about their disease after they have received diabetes related information informally or formally through structured educational interventions in the Indonesian context.

Which country has the highest incidence of diabetes according to the World health Organization?

– Latest data shows the top five countries with the highest general population are approximately:

China — over 1 billion India — over 1 billionU.S. — 338 millionIndonesia — 275 million Pakistan — 235 million

The IDF Global Diabetes Atlas provides estimated and projected prevalence rates of diabetes around the world. Its most recent data from 2021 shows that China has the largest number of adults with diabetes, aged 20–79 years, followed by India and Pakistan.

• Furthermore, the IDF anticipates that these countries will continue to have the largest number of people with diabetes in 2045.
• China currently has 140.9 million people with diabetes, which is set to increase to 174.4 million by 2045.
• Experts estimate there are also 72.8 million people in China with undiagnosed diabetes.

However, the countries with the largest number of people with diabetes mentioned above do not automatically have the highest prevalence of the condition. The highest comparative prevalence rates in 2021 were reported for Pakistan (30.8%), French Polynesia (25.2%), and Kuwait (24.9%).

What is diabetes mellitus According to who?

WHO / Panos / Atul Loke People getting their fasting sugar checked for diabetes at government initiated Kamala Raman Nagar dispensary. © Credits Diabetes is a chronic, metabolic disease characterized by elevated levels of blood glucose (or blood sugar), which leads over time to serious damage to the heart, blood vessels, eyes, kidneys and nerves.

The most common is type 2 diabetes, usually in adults, which occurs when the body becomes resistant to insulin or doesn’t make enough insulin. In the past 3 decades the prevalence of type 2 diabetes has risen dramatically in countries of all income levels. Type 1 diabetes, once known as juvenile diabetes or insulin-dependent diabetes, is a chronic condition in which the pancreas produces little or no insulin by itself.

For people living with diabetes, access to affordable treatment, including insulin, is critical to their survival. There is a globally agreed target to halt the rise in diabetes and obesity by 2025. About 422 million people worldwide have diabetes, the majority living in low-and middle-income countries, and 1.5 million deaths are directly attributed to diabetes each year.

Both the number of cases and the prevalence of diabetes have been steadily increasing over the past few decades. Symptoms of type 1 diabetes include the need to urinate often, thirst, constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Symptoms for type 2 diabetes are generally similar to those of type 1 diabetes but are often less marked.

As a result, the disease may be diagnosed several years after onset, after complications have already arisen. For this reason, it is important to be aware of risk factors. Type 1 diabetes cannot currently be prevented. Effective approaches are available to prevent type 2 diabetes and to prevent the complications and premature death that can result from all types of diabetes.

These include policies and practices across whole populations and within specific settings (school, home, workplace) that contribute to good health for everyone, regardless of whether they have diabetes, such as exercising regularly, eating healthily, avoiding smoking, and controlling blood pressure and lipids.

The starting point for living well with diabetes is an early diagnosis – the longer a person lives with undiagnosed and untreated diabetes, the worse their health outcomes are likely to be. Easy access to basic diagnostics, such as blood glucose testing, should therefore be available in primary health care settings.

How do diabetics cope with distress?

Having diabetes can be overwhelming at times. The good news is that there are things you can do to cope with diabetes and manage stress. – When all of this feels like too much to deal with, you may have something called diabetes distress. This is when all the worry, frustration, anger, and burnout makes it hard for you to take care of yourself and keep up with the daily demands of diabetes.

Pay attention to your feelings. Almost everyone feels frustrated or stressed from time to time. Dealing with diabetes can add to these feelings and make you feel overwhelmed. Having these feelings for more than a week or two may signal that you need help coping with your diabetes so that you can feel better. Talk with your health care providers about your feelings. Let your doctor, nurse, diabetes educator, psychologist, or social worker know how you’ve been feeling. They can help you problem-solve your concerns about diabetes. They may also suggest that you speak with other health care providers to get help. Talk to your health care providers about negative reactions other people may have about your diabetes, Your health care providers can help you manage feelings of being judged by others because you have diabetes. It is important not to feel that you have to hide your diabetes from other people. Ask if help is available for the costs of diabetes medicines and supplies. If you are worried about the cost of your medicines, talk with your pharmacist and other health care providers. They may know about government or other programs that can assist people with costs. You can also check with community health centers to see if they know about programs that help people get insulin, diabetes medicines, and supplies (test trips, syringes, etc.). Talk with your family and friends. Tell those closest to you how you feel about having diabetes. Be honest about the problems you’re having in dealing with diabetes. Just telling others how you feel helps to relieve some of the stress. However, sometimes the people around you may add to your stress. Let them know how and when you need them to help you. Allow loved ones to help you take care of your diabetes. Those closest to you can help you in several ways. They can remind you to take your medicines, help monitor your blood sugar levels, join you in being physically active, and prepare healthy meals. They can also learn more about diabetes and go with you when you visit your doctor. Ask your loved ones to help with your diabetes in ways that are useful to you. Talk to other people with diabetes. Other people with diabetes understand some of the things you are going through. Ask them how they deal with their diabetes and what works for them. They can help you feel less lonely and overwhelmed. Ask your health care providers about diabetes support groups in your community or online. Do one thing at a time. When you think about everything you need to do to manage your diabetes, it can be overwhelming. To deal with diabetes distress, make a list of all of the tasks you have to do to take care of yourself each day. Try to work on each task separately, one at a time. Pace yourself. As you work on your goals, like increasing physical activity, take it slowly. You don’t have to meet your goals immediately. Your goal may be to walk 10 minutes, three times a day each day of the week, but you can start by walking two times a day or every other day. Take time to do things you enjoy. Give yourself a break! Set aside time in your day to do something you really love; it could be calling a friend, playing a game with your children or grandchildren, or working on a fun project. Find out about activities near you that you can do with a friend.

Remember that it’s important to pay attention to your feelings. If you notice that you’re feeling frustrated, tired, and unable to make decisions about your diabetes care, take action. Tell your family, friends, and health care providers. They can help you get the support you need.

What culture is most affected by diabetes?

Learn about type 2 diabetes risk and tips for prevention and management. People of certain racial and ethnic groups are more likely to develop prediabetes and type 2 diabetes, including African American, Hispanic or Latino, and Asian American people. Learn why risk for Hispanic or Latino people is higher, and some ways to prevent type 2 diabetes or manage diabetes if you already have it.

Hispanic or Latino people make up a diverse group that includes people of Cuban, Mexican, Puerto Rican, South and Central American, and other Spanish cultures, and all races. Each has its own history and traditions, but all are more likely to have type 2 diabetes (17%) than non-Hispanic White people (8%).

But that 17% is just an average for Hispanic or Latino groups. The chance of having type 2 diabetes is closely tied to background. For example, if your heritage is Puerto Rican, you’re about twice as likely to have type 2 diabetes as someone whose background is South American.

Where is the diabetes capital of the world?

India is often referred to as the ‘Diabetes Capital of the World’, as it accounts for 17%percent of the total number of diabetes patients in the world.

Why is diabetes so high in Asia?

Asians have a strong ethnic and genetic predisposition for diabetes and have lower thresholds for the environmental risk factors. As a result, they develop diabetes at a younger age and at a lower body mass index and waist circumference when compared with the Western population.

What country has the highest rate of diabetes in Europe?

Germany had the highest prevalence of diabetes in Europe among their adult population with 15.3 percent living with diabetes in 2019, Portugal followed with the second highest share at 14.2 percent. On the other hand, Ireland was the country with the lowest prevalence of diabetes in Europe at 4.4 percent.

Is diabetes high in Asia?

Home to 60% of the world’s population, Asia Pacific is undergoing rapid socioeconomic, technological, and cultural transitions. While these transitions have reduced poverty, they have come with considerable health consequences. – Amongst the 422 million people globally affected with diabetes in 2014, over 230 million were from Asia, with most cases originating from China, India, Indonesia and Japan.1,2 The severity of this problem is best illustrated in China, where a recent national study found that around 15% of adults were reported to have diabetes and 50% were reported to have prediabetes.3 Of particular concern is how diabetes is affecting a younger demographic in Asia, where the largest number of people with diabetes are 40-59 years old – compared to other countries in the world where people with diabetes are generally over the age of 60.4 Physiologically, evidence has shown that Asian people are more likely to develop diabetes than their Caucasian counterparts even when controlling for body mass index (BMI) and waist circumference.5 This is thought to be partly due to their propensity to store fat viscerally rather than subcutaneously, which is not captured in the traditional anthropometry measures of adiposity such as BMI.6 Asian people are more insulin resistant than non-Asians, even in relatively lean subjects, with increased concentrations of free fatty acids and inflammatory markers.7 Research has shown that Asian subjects exhibit higher glucose excursion during an oral glucose challenge, suggesting lower beta-cell function to overcome insulin resistance than non-Asians.

1. These biological differences put Asian people at higher risk of developing diabetes.8,9 There are life-threatening consequences to diabetes, especially in young adults who may face a lifelong disease.
2. These adults face major therapeutic challenges as they often have poor risk factor control, poor follow-up rates within the healthcare system, and poor treatment compliance.

In a nine-year follow-up study of over 2,000 Chinese people diagnosed before the age of 40 years, 10% had type 1 diabetes, 60% were overweight type 2 diabetes patients, and 30% were normal-weight type 2 diabetes patients.10 Overweight type 2 diabetes patients had the worst metabolic profile with a 15-fold higher risk of cardiovascular disease and a five-fold higher risk of kidney failure as compared to people with type 1 diabetes.

In Asian countries where access to healthcare is limited, it is more difficult to treat diabetes-related medical conditions such as end-stage kidney disease, stroke, sepsis and leg amputation, which commonly are the leading causes of death in diabetic patients.11 In more developed Asian countries that have a better provision of medical treatments, coronary heart disease, heart failure, chronic kidney disease and cancer have become the major causes of premature mortality and morbidity, for those diagnosed with type 2 diabetes.

Rapid modernisation from an energy-scarce to an energy-dense living environment has led to high rates of diabetes and obesity. Depending on the different combinations of external factors: nutrition, lifestyle, psychosocial stress, and access to healthcare, genetically predisposed Asians (who have increased visceral adiposity, insulin resistance and impaired β-cell function) can exhibit different health outcomes ranging from good quality of life to increase in mortality rates.12,13 For instance, through nutrition per se, the consumption of a low glycaemic index (GI) breakfast and afternoon snack i.e.

low GI multigrain bread and low GI rice grain was capable of moderating 24-hr blood glucose profiles, minimising glycaemic excursions and reducing food intake in healthy Asian males.14 Such simple dietary intervention may be an acceptable approach in improving overall blood glucose control and energy balance in Asian people.

As the multidimensional nature of societal, technological and behavioural factors continues to unfold in Asia, Asian people can rise to the challenge by implementing notable prevention measures and lifestyle modification programmes, leveraging information technology for care integration, and establishing a diabetes registry for quality assurance, all for driving collaborative efforts to ‘fight’ diabetes.

WHO standards for diabetes?

Prevention – Lifestyle measures have been shown to be effective in preventing or delaying the onset of type 2 diabetes. To help prevent type 2 diabetes and its complications, people should:

achieve and maintain a healthy body weight;be physically active – doing at least 30 minutes of regular, moderate-intensity activity on most days. More activity is required for weight control;eat a healthy diet, avoiding sugar and saturated fats; andavoid tobacco use – smoking increases the risk of diabetes and cardiovascular disease.

WHO criteria for diagnosis of diabetes mellitus?

Methods and criteria for diagnosing diabetes –

1. Diabetes symptoms (e.g. polyuria, polydipsia and unexplained weight loss for Type 1) plus:
   • a random venous plasma glucose concentration ≥ 11.1 mmol/l or
   • a fasting plasma glucose concentration ≥ 7.0 mmol/l (whole blood ≥ 6.1 mmol/l) or
   • two hour plasma glucose concentration ≥ 11.1 mmol/l two hours after 75g anhydrous glucose in an oral glucose tolerance test (OGTT).
2. With no symptoms diagnosis should not be based on a single glucose determination but requires confirmatory plasma venous determination. At least one additional glucose test result on another day with a value in the diabetic range is essential, either fasting, from a random sample or from the two hour post glucose load. If the fasting random values are not diagnostic the two hour value should be used.

Why do diabetics get anxiety?

– There’s a strong connection between diabetes and anxiety. People with diabetes may want to manage stress through healthy lifestyle choices such as diet, exercise, and other stress-relieving activities. If you begin seeing symptoms that aren’t manageable with such changes, consult with your doctor. They can help you determine the best strategies for managing your anxiety.

Can stress trigger diabetes?

Can stress cause diabetes? – Stress alone doesn’t cause diabetes. But there is some evidence that there may be a link between stress and the risk of type 2 diabetes, Our researchers think that high levels of stress hormones might stop insulin-producing cells in the pancreas from working properly and reduce the amount of insulin they make.

1. In turn, this might contribute to the development of type 2 diabetes.
2. We’re also looking into whether people who release too much cortisol have a higher risk of type 2,
3. Overeating when you’re stressed could also be a factor in how people develop type 2 diabetes.
4. Some people react to stress by eating more and this can lead to them putting on a lot of weight.

We’ve got more information on managing feelings when it comes to food,

What ethnicity is most likely to get diabetes?

You’ve likely heard the warning: If you don’t watch your diet and exercise regularly, you’re raising your risk for type 2 diabetes as well as prediabetes. What you may not know is that ethnicity also plays a major role. That’s right. African Americans, Hispanics, American Indians, and some Pacific Islanders and Asian Americans are all at higher risk for type 2 diabetes than Caucasians, according to the American Diabetes Association (ADA). Chef Daniel Thomas helped his dad, Weldon, overcome prediabetes using these nutritious tips, including this berry that can make your snacks work for you. Until recently, researchers couldn’t make sense of it. They believed that genes were to blame — meaning people of certain races were simply destined to develop diabetes — but a study published in 2017, in the Journal of the American Medical Association (JAMA), suggests that’s not the case. AARP Membership — $12 for your first year when you sign up for Automatic Renewal Get instant access to members-only products and hundreds of discounts, a free second membership, and a subscription to AARP the Magazine. Join Now “Far and away, the leading factor for type 2 diabetes appears to be obesity,” says study coauthor Mercedes Carnethon, professor and vice chair of the Department of Preventive Medicine at Northwestern University’s Feinberg School of Medicine.

“Factors we collectively refer to as the social determinants of health — our financial resources, access to health care, level of education and the neighborhoods we live in — all of these contribute to the development of obesity and common complications of being overweight, such as diabetes.” Consider the consequences of living in a community that doesn’t have easy access to health care, nutritious foods or spaces that lend themselves to physical activity.

“These things lead people to make choices that result in a higher risk of obesity,” says Carnethon. “That’s really what drives the disparities in the development of diabetes among ethnic groups.” Now for the encouraging part. There’s plenty you can do, no matter your race, to reduce your risk of developing diabetes,

Does any country have a cure for diabetes?

With all the research on diabetes and advances in diabetes treatments, it’s tempting to think someone has surely found a diabetes cure by now. But the reality is that there is no cure for diabetes – neither type 1 diabetes nor type 2 diabetes, (Although lifestyle changes can achieve remission in type 2 diabetes in some cases.) However, there are treatments, including simple things you can do daily, that make a big difference.

Is diabetes common in Iran?

1. Introduction Diabetes is a metabolic disease with multifactorial etiology characterized by chronic hyperglycemia caused by impaired insulin secretion or its function, Diabetes is one of the health challenges of recent decades that imposes a tremendous economic burden on society,

The World Health Organization (WHO) has declared diabetes a latent epidemic because of the growing number of diabetic people worldwide. It has called on all countries to fight the epidemic since 1993. Based on WHO estimation, the number of people with diabetes will reach from 135 million in 1995 to 300 million in 2025.

This increase will be equal to 170% in developing countries and 42% in developed countries, Diabetes is also expected to increase in the elderly in developed countries and people of working age in developing countries, Therefore, although diabetes is considered a problem in developed countries, its impact in reducing life expectancy is greater in developing countries,

Experts believe that the recent prevalence of diabetes in society is not explicitly related to changes in the genetic and ethnic characteristics of a society but in the lifestyle and modernization of society. Changing the lifestyle can increase the prevalence of diabetes in people with a similar genetic predisposition to diabetes,

‌Three in four (79%) of people with diabetes live in low and middle-income countries, Diabetes is the seventh leading cause of death in the United States and has always been one of the top ten leading causes of death in Iran, In a study in six countries, including Bahrain, South Korea, and Armenia, the death rate from diabetes increased from 1985 to 2010 by an average of 3.2% per year,

Besides, the number and causes of death are vital to diagnosing society’s health status, and death data in different age and gender groups can indicate how the economic conditions prevail in society. Also, the effectiveness of health care programs and intervention programs to promote health is known with changes in mortality rates,

The use of such data plays an essential role in monitoring health programs, allocating resources, prioritizing intervention programs, setting epidemiological research priorities, establishing health policies, and conducting medical research, Therefore, in this study, we intend to examine the diabetes mortality rate in Iran from 2006 to 2010 and its five-year trend.2.

Materials and Methods This analytic cross-sectional study was performed using mortality data in Iran from 2006 to 2010 published by the Ministry of Health, Data were collected through various sources such as the Civil Registry Office, cemeteries, hospitals, and health houses by the Information and Applied Research Center of the Ministry of Health and Medical Education.

In the next step, the data were integrated with the Ministry of Health and Medical Education. In this study, the mortality rate of different types of diabetes was categorized based on the International Coding of Diseases (ICD-10, code E10-E14) in Iran (all provinces) from 2006 to 2010.

• The number and rate of deaths from diabetes, male to female sex ratio, and death rates in age and sex groups and their residence were calculated and reported using Excel 2016 software.
• Also, for data analysis, the Chi-square test was performed in SPSS V.24.
• P values less than 0.05 were considered statistically significant.

Finally, a picture of the changes in diabetes mortality in Iran over five years was obtained.3. Results In this study, the mortality of different types of diabetes from all age groups has been collected from 2006 to 2010. During the study period, 27418 deaths occurred due to various types of diabetes, of whom 54.9% were females and 45.1% males.

The lowest death rate of both sexes was 9.42 per 100000 in 2006, and the highest was 10.6 per 100000 in 2010. However, in the whole study period, females’ death rate was higher than males, and the sex ratio of males to females varied from 0.74 in 2008 to 0.88 in 2006. In terms of residence, the death rate from various types of diabetes was much higher in urban areas than in rural areas in all years.

The average age of the deceased varied from 66.6 years in 2010 to 69.3 years in 2007 and was 68.1 years in total for five years study period. The mortality rate due to diabetes was significantly different between men and women in all years. Diabetes mortality was significantly higher in women (P‌ Table 1 and Figure 1 ). Table 2 presents that the lowest death rate from various types of diabetes belongs to the 5-14 years age group (from 0.14 in 2007 to 0.24 per 100000 population in 2010). In comparison, the highest rate belonged to the age group of over 70 years (from 150.69 in 2006 to 181.31 per 100000 population in 2010). The trend of diabetes mortality from 2006 to 2010 by age groups shows that after the age group under 5 years, a relative decrease in death rate was observed in the age group of 5 to 14 and then the trend of diabetes death increased with age and in the age group of 70 years and above has had a vertical ascent ( Figure 2 ). Regarding the mortality from diabetes by type, the highest cause of death belonged to non-insulin-dependent diabetes (E11), with 40% of the total number of deaths, followed by other disorders related to diabetes (E12-E14) with 30.8%. The lowest number belonged to insulin-dependent diabetes (E10), with 29.2% of all deaths. Mortality is higher in women in all types of death causes ( Table 3 ). 4. Discussion The present study results in a five-year period show that the death rate due to diabetes increases significantly during the study years. This finding is consistent with the results of previous studies on the increase in deaths due to diabetes in all countries, especially developing countries,

• The mortality rate due to diabetes in Europe varies from 7.9 per 100,000 people in Greece to 32.2 in Italy.
• The mortality rate in Iran is higher than in Greece and lower than in Italy.
• While a declining trend is reported for some non-communicable diseases globally, diabetes is an exception.
• The mortality rate from diabetes is increasing in Europe, which is associated with the population’s aging process,

A 29% increase in deaths from diabetes in North America, a 12% increase in East Asia, and an 11% increase in West Asia indicate a growing trend of deaths from diabetes, which is consistent with the results of the present study. Death from diabetes is mainly due to its complications such as cardiovascular diseases, kidney problems, and the like,

• In this study, the number of deaths due to diabetes was significantly different between men and women, so that in all study years, deaths due to diabetes in women were significantly higher than in men.
• This finding is consistent with the findings of Ruiz-Ramos et al.
• In Spain and Roglic,
• The higher prevalence of diabetes in women can be one of the causes of high mortality due to diabetes in women,

In the study of Farahmand et al., obesity has been reported as a risk factor for diabetes in women more than men, which is considered a risk factor in diabetes, Another cause of obesity in women is related to childbirth, Gharipour study states that people with a BMI above 30 are 9.98 times more likely to develop diabetes, which all justifies the causes of more deaths in women, according to the present study results.

• The present study showed that the mortality rate from various types of diabetes in all years in urban areas was much higher than that in rural areas.
• This finding was inconsistent with the results of a study by Bragg et al.
• In China, which showed that despite the higher prevalence of diabetes in urban areas, more deaths occur in rural areas.

They blamed the lack of diabetes management and its complications in rural areas, Increased urbanization, change in lifestyle pattern, a tendency to western life, and dietary style and tendency to consume ready-to-eat, fast foods and sedentary during the last two decades, especially in developing countries, are some of the reasons for the higher prevalence of diabetes and consequent death from diabetes in urban areas.

• Behaviors and lifestyles strongly influence non-communicable diseases.
• The victims of these diseases share an unhealthy diet with high saturated fat and sugar, low physical activity, and smoking.
• The high prevalence of diabetes in cities can also be due to low physical activity and high consumption of sugar and fatty foods that are risk factors for diabetes.

These foods become synonymous with the urban lifestyle. On the contrary, its prevalence in rural areas has remained low due to limited exposure to risk factors and rural life preservation, and traditional physical activity, In the present study, the lowest death rate from diabetes belonged to the age group of 5-14 years, and the highest rate was seen in people over 70 years.

• After the age group of under 5 years, a relative decrease in the death rate is observed in the age group 5 to 14 years.
• Then, the death rate of diabetes has increased with age and has risen vertically in 70 years and above.
• Bragg et al.
• Reported that the prevalence of diabetes also increased with age,

In 2010, nearly 4 million people were estimated to die of diabetes, about 6.5% of the total number of deaths at all ages, and 10% of all deaths between the ages of 20-79 years, This study showed that the highest cause of death was non-insulin-dependent diabetes, with 40% of all deaths.

The prevalence of diabetes in Iran is high and is expected to increase in the future, along with increasing life expectancy, urban development, and increasing obesity. Preventive activities in controlling diabetes and thus reducing its mortality can be done in different ways. Before employing any prevention policies, much benefit can be obtained from the effects of increasing awareness about diabetes in the general population.

Many studies have reported a lack of knowledge about diabetes and its risk factors in South Asia and even in patients with diabetes, Diabetes has many risk factors that can be changed with lifestyle and by promoting knowledge in this field, adopt a healthy lifestyle.

1. Mohan et al.
2. Reported that in an Indian community, creating a public park at one’s own expense significantly increased the physical activity of local residents.
3. Leaving the traditional food patterns and consuming diets high in saturated fat and refined carbohydrates are essential factors in increasing obesity and diabetes.

Consumption of low amounts of fiber and unsaturated fats, as well as high intake of refined carbohydrates, saturated fats, and trans fats, are among the diets that lead to insulin resistance and diabetes, Therefore, policies should focus on informing and educating on these unhealthy eating patterns.

1. Other successful policies in this area include efforts to improve food labels and to train to reduce the incidence of diabetes and obesity.
2. Today, the aging of the population is observed in developing countries, and especially in these countries, geographical transmission occurs on a larger scale without improving living conditions, social provision, and access to health care.

It is predicted that with unhealthy aging due to lack of progress in nutritional status and socio-economic conditions, the disease’s burden will increase in the elderly population. Thus, it is essential to consider both prevention and treatment policy options.

Also, in non-communicable diseases, the underlying causes should be considered, and the health system’s capacities to deal with the increasing burden of the disease should be examined.5. Conclusion From 2006 to 2010, deaths due to diabetes have increased in Iran, and it was higher in women and urban communities.

Because of the increase in the elderly population, the growing trend of urbanization, changing diet and lifestyle in Iran, it is necessary to plan, educate, and perform interventions to prevent, diagnose, and early treatment of diabetes. Ethical Considerations Compliance with ethical guidelines In this study, the data published by the Ministry of Health and Medical Education of Iran has been used and publishers have maintained the confidentiality of the data.

1. Funding This research did not receive any grant from funding agencies in the public, commercial, or non-profit sectors.
2. Authors’ contributions Investigation, writing – original draft, and writing – review & editing: All Authors; Methodology, data collection and data analysis: Amin Ataey.
3. Conflicts of interest The authors declared no conflict of interest.

Acknowledgements We would like to thank all the people who helped us in compiling this article. Also, we used the information published by the Deputy Minister of Health of the Ministry of Health. So we appreciate the efforts of these colleagues. References

International Diabetes Federation. IDF Diabetes Atlas,2019, Available from: https://www.diabetesatlas.org/en/resources/ Maracy MR, Kheirabadi GR, Fakhari N, Zonnari R., Iranian Journal of Endocrinology and Metabolism.2011; 13(2):165-72. http://ijem.sbmu.ac.ir/article-1-1099-en.html. Azizi F, Hatami H, Janghorbani M.,1 th ed. Tehran: Eshtiagh Publicatio; 2007, Boyle JP, Thompson TJ, Gregg EW, Barker LE, Williamson DF. Projection of the year 2050 burden of diabetes in the US adult population: d ynamic modeling of incidence, mortality, and prediabetes prevalence. Population Health Metrics 2010; 8:29. Roglic G, Unwin N, Bennett PH, Mathers C, Tuomilehto J, Nag S, et al. The burden of mortality attributable to diabetes. D iabetes c are.2005; 28(9):2130-5. Joshi SK, Shrestha S. Diabetes mellitus: a review of its associations with different environmental factors. Kathmandu University Medical Journal.2010; 8(29):109-15 Heron MP. Deaths: leading causes for 2012. National v ital s tatistics r eports.2015; 64(10):1-93. m alaki Moghadam H, Askarishahi M., Iranian Journal of Endocrinology and Metabolism.2017; 18(6):412-9. http://ijem.sbmu.ac.ir/article-1-2111-fa.html Naghavi M, Jafari N., Tehran: A rvij; 2007. http://opac.nlai.ir/opac-prod/bibliographic/1028108 Dortag E, Bahrampour A, Haghdost A, Zendedel K, Jaberipour M, Marzeban M., Journal of North Khorasan University of Medical Sciences.2011; 3(5):33-44. Khosravi A, Aghamohamadi S, Kazemi E, Pour Malek F, Shariati M. Mortality profile in Iran (29 provinces) over the years 2006 to 2010, Tehran: Ministry of Heal th and Medical Education; 2013. Hajer GR, van Haeften TW, Visseren FL. Adipose tissue dysfunction in obesity, diabetes, and vascular diseases. European Heart Journal.2008; 29(24):2959-71. Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P. Contribution of trends in survival and coronar y-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA Project populations. Lancet (London, England).1999; 353(9164): 1547-57. World Diabetes Foundation. Diabetes Atlas, 3 rd edition WDF04-084,2006, Available from: https://www.worlddiabetesfoundation.org/projects/belgium-wdf04-084 Garcia BF, Godoy C, Perez S, B olumar F. Multiple codification of the causes of death: f rom dying” of” to dying” from”. Gaceta Sanitaria.1992; 6(29):53-7. Goldacre MJ. Cause-specific mortality: u nderstanding uncertain tips of the disease iceberg. Journal of Epidemiology and Community Health.1993; 47(6):491-6. Ruiz-Ramos M, Escolar-Pujolar A, Mayoral-Sanchez E, Corral-San Laureano F, Fernandez-Fernandez I. Diabetes mellitus in Spain: Death rates, prevalence, impact, costs and inequalities. Gaceta Sanitaria.2006; 20(S1):15-24. Roglic G, Unwin N. Mortality attributable to diabetes: e stimates for the year 2010. Diabetes Research and Clinical Practice.2010; 87(1):15-9. Farahmand M, Hejazi N, Akbarzade M, Almasi-Hashiani A., Zahedan Journal of Research in Medical Sciences.2012; 13(S1):49. https://sites.kowsarpub.com/zjrms/articles/95265.html Hajian K, Hiedari B., Iranian Journal of Endocrinology and Metabolism.2006; 8(2):147-56. http://ijem.sbmu.ac.ir/article-1-282-en.html Sarshar N, Khajavi AJ., The Horizon of Medical Sciences.2006; 12(3):38-43. http://hms.gmu.ac.ir/article-1-65-en.html Gharipour M, Mohammadifard N, Asgsri S, Naderi G., Jou rnal of Inflammatory Disease.2003; 7(2):53-64. http://journal.qums.ac.ir/article-1-242-en.html Bragg F HM, Iona A, Guo Y, Du H, Chen Y, Bian Z, et al. Association between diabetes and cause-specific mortality in rural and urban areas of China. Jama,2017; 317(3):280-9. Okosun IS, Chandra KD, Boev A, Boltri JM, Choi ST, Parish DC, et al. Abdominal adiposity in U.S. adults: p revalence and trends, 1960-2000. Preventive Medicine.2004; 39(1):197-206. Ghassemi H, Harrison G, Mohammad K. An accelerated nutrition transition in Iran. Public Health Nutrition.2002; 5(1a):149-55. Kelishadi R, Ardalan G, Gheiratmand R, Gouya MM, Razaghi EM, Delavari A, et al. Association of physical activity and dietary behaviours in relation to the body mass index in a national sample of Iranian children and adolescents: CASPIAN Study. Bulletin of the World Health Organization.2007; 85:19-26. Cheema A, Adeloye D, Sidhu S, Sridhar D, Chan KY. Urbanization and prevalence of type 2 diabetes in Southern Asia: A systematic analysis. Journal of Global Health.2014; 4(1):010404. Rafique G, Azam S, White F. Diabetes knowledge, beliefs and practices among people with diabetes attending a university hospital in Karachi, Pakistan. Eastern Mediterranean Health Journal.2006; 12(5):590-8. Ulvi OS, Chaudhary RY, Ali T, Alvi RA, Kh an M, Khan M, et al. Investigating the awareness level about diabetes mellitus and associated factors in Tarlai (rural Islamabad). Journal of Pakistan Medical Association.2009; 59(11):798-801. Murugesan N, Snehalatha C, Shobhana R, Roglic G, Ramach andran A. Awareness about diabetes and its complications in the general and diabetic population in a city in southern India. Diabetes Research and Clinical Practice.2007; 77(3):433-7. Gul N. Knowledge, attitudes and practices of type 2 diabetic patients. Journal of Ayub Medical College Abbottabad.2010; 22(3):128-31. Mohan V, Shanthirani C, Deepa M, Datta M, Williams O, Deepa R. Community Empowerment-a successful model for prevention of non-communicable dis eases in India-the Chennai urban population study, Journal of the Association of Physicians of India.2006; 54:858-62. Misra A, Khurana L, Isharwal S, Bhardwaj S. South Asian diets and insulin resistance. British Journal of Nutrition.200 8; 101(4):465-73.

Why is diabetes so common in Middle East?

The factors associated with T2DM seem more pronounced in the Arab world. Although genetic risk factors can’t be ruled out in the context of T2DM in the Arab world, factors such as obesity, rapid urbanization and lack of exercise are key determinants of the rapid increase of the rate of T2DM among the Arab world.

Why is diabetes so high in Asia?

Asians have a strong ethnic and genetic predisposition for diabetes and have lower thresholds for the environmental risk factors. As a result, they develop diabetes at a younger age and at a lower body mass index and waist circumference when compared with the Western population.