Iranian Journal of

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Diabetes mellitus is a common disease and its incidence and prevalence are increasing in most populations. The trend is particularly worrying in developing countries. The number of diabetic patients in Iran is estimated at 1.5 million. The distribution of diabetes in Iran has been the subject of several surveys. Disease prevalence rates, for all forms of diabetes, of 7–17% have been variously reported in several adult urban populations. Geographical prevalence is not uniform, however, and the prevalence of type 2 diabetes mellitus has been reported at 3-5% in rural communities. A screening program conducted at different locations of Iran revealed that nearly 50% of people with type 2 diabetes were unaware of their condition. Not surprisingly, therefore, that the incidence of complications for diabetes is high in Iran. A battle is being waged on all fronts at present to control the socio-economic scourge that is diabetes mellitus. A national program has been designed for the primary, secondary, and tertiary prevention of diabetes. The major strategies that it puts forwards are screening, the identification of high-risk groups, public education, and the training of specialist care providers. This article reviews the epidemiological features of diabetes in Iran.

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Diabetes during pregnancy is either concurrent diabetes, diagnosed before pregnancy, or ‘gestational diabetes mellitus’ (GDM), first diagnosed in pregnancy. GDM is the commonest metabolic disorder of pregnancy, with a prevalence of one to 14 percent, depending on the reporting team. The prevalence of GDM in Tehran is 4.7%. Diabetes concurrent with pregnancy is diagnosed according to the recently revised criteria of the National Diabetes Data Group (NDDG). GDM is diagnosed with a 100-gram 3-hour glucose tolerance test (3hGTT100), with at least two abnormally high readings being required for a definite diagnosis. Screening for GDM is still a matter of dispute. Universal or selective screening? Each has its supporters. The American Diabetes Association (ADA) recommended universal screening until 1997, and this is still recommended for areas with a high prevalence of GDM. Diabetes during pregnancy has multiple potential consequences for mother and fetus fetal macrosomia being the commonest. The children of diabetic mothers are also more likely to become overweight and develop impaired glucose tolerance. ADA recommendations for glycemic control in diabetic mothers-to-be include maintaining their fasting blood glucose between 60 and 95mg/dl, and their postprandial blood glucose between 80 and 120mg/dl. Measurement of urinary ketones is recommended when the patient is on a calorie-restricted diet. Lifestyle changes are an integral part of management. Insulin requirements and calorie intake must be adjusted in line with weight gain as pregnancy progresses.