Iranian Journal of

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Background: Diabetes can disrupt the balance of cell death through different cell pathways, and exercise or consumption supplements can be effective in maintaining the balance of cell death types; Therefore, the purpose of this research is the effect of magnesium supplementation and exercise training on the content of CREB2 and C/EBP homologous protein (CHOP) in the left ventricle of the heart of type 2 diabetic rats.
Methods: In this experimental study, 24 2-month-old male Sprague-Dawley rats with an average weight of 280±20 grams were selected. Type 2 diabetes was induced by injecting nicotinamide and streptozotocin solutions. The rats were randomly divided into four groups, 1) control, 2) supplement, 3) training and 4) training+supplement; Resistance training consisted of 8 weeks and 3 weekly sessions of climbing a ladder. Magnesium supplement was given to rats once a day. To analyze the data, one-way ANOVA and Tukey's post hoc tests were used in SPSS version 29.
Results: Eight weeks of magnesium supplementation and resistance training led to a significant change in the content of CREB2 and CHOP proteins between groups in the left ventricle of the heart (P= 0.001). A significant decrease was observed in the groups of resistance training + magnesium supplement and magnesium supplement compared to the control group (P≥ 0.05); But the resistance training group had increased compared to the control group (P≥ 0.05).
Conclusion: The increase and decrease of CREB2 and CHOP proteins in the left ventricle of the heart can lead to improvement and physiological adaptation, like a bilateral mechanism.

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Background: There is a two-way relationship between diabetes. The purpose of the current research was to compare health control beliefs, emotion regulation strategies, and marital conflicts between diabetic and non-diabetic women.
Methods: The present study is a comparative causal research type. The statistical population of the present study is all diabetic and non-diabetic women in the city of Tehran who visited the Tehran clinic in the first half of 2022, out of which 43 were diabetic women which were selected by screening and available sampling method. The control group consists of 43 non-diabetic women were selected by matching demographic variables. The multidimensional health locus of control (MHLC) scales, emotional regulation strategies and marital conflicts scale quaternaries were used to collect data. Data were analyzed using descriptive statistics and inferential statistics including multivariate analysis of variance.
Results: The results showed that compared to non-diabetic women, women with diabetes had a higher level of emotional suppression regulation, the source of control of effective people, the source of control of chance and marital conflict. Also, they had a lower level of reappraisal emotion regulation and internal locus of control, and all these differences were significant.
Conclusion: The research results showed ineffective emotion regulation, faulty control source beliefs and marital conflict in women with diabetes, which reveals the need to pay attention to the above factors in the form of providing treatment and educational programs to diabetic women, families and centers related to diabetic women.

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Background: With the increasing prevalence of diabetes in children and the resulting mental pressures, attention to these patients has become a health priority in the world. Psychological distress is one of the problems of these patients that affects different aspects of their lives. It seems that enduring psychological distress can affect the psychological problems of these patients. Therefore, the present study was conducted with the aim of determining the relationship between psychological distress and tolerance of psychological distress in children with diabetes in Zahedan city.
Methods: This was a cross-sectional study. The samples included 200 children with pediatric diabetes referred to the diabetes clinic of Ali Ibn Abi Talib (AS) hospital in Zahedan and met the inclusion criteria. The data collection tool included the demographic information form and Kessler's psychological distress and Gaher's distress tolerance questionnaires, which were completed by interviewing the child. Descriptive and analytical data analysis was done using spss27 software.
Results: 52.6% of all subjects studied were girls and the average duration of infection was 22.6 months. A significant relationship was found between psychological distress and tolerance of psychological distress (r = -0.65 p < 0.001).
Conclusion: The findings showed that there is a significant and inverse correlation between psychological distress and distress tolerance. In other words, the higher the psychological distress tolerance, the less distress a person experiences. Therefore, it seems that in order to enjoy higher mental health in these patients, attention should be paid to improving their distress tolerance.

 

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Background: Vitamin D (vitD) deficiency is common in Iran. Although there are several studies on therapeutic doses of vitD, the optimal dose is to be evolved. we compared the effects of high dose supplemental vitamin D versus its recommended dose on the serum level of 25(OH)D.
Methods: This clinical trial was performed at Endocrine & Metabolism Research Institute in Shariati Hospital, Tehran, Iran within 2008-2009. The subjects were osteopenic women older than 50 years who had been referred to Bone Densitometry laboratory. They were received either (group P) 50000u vitD3 weekly for 3 months then monthly for another 9 months, or (group M) 800u vitD3 daily for one year. 1000 mg calcium carbonate was given to both groups. Serum 25(OH)D, calcium, phosphorus, and PTH was checked at base, 3rd, 6th and 12th month. 24h Urine for calcium was collected before and at the end of trial.
Result: Serum 25(OH)D level was significantly higher in group P at 3rd month (P< 0.05), but it gradually declined and there was not statistically difference to group M. PTH decreased in both groups. Urine calcium to creatinine ratio did not rise in both groups.
Conclusion: vitD supplement at doses of 50000u weekly for 3 months then monthly for another 9 months as compare to 800u vitD3 daily for one year increases serum 25(OH)D at higher level without causing hypercalcemia and hypercalciuria, but it seems that more frequent doses in monthly period would be required to maintain the optimal 25(OH)D level.
 

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Background: Obesity is a multifactorial disease whose incidence and burden on societies around the world is increasing. Sexual performance in these patients is an important aspect that is often ignored. Therefore, the aim of the present study was to investigate the effect of a period of endurance training along with electrical stimulation on the gene expression of some sex markers in testicular tissue of fasted obese rats.
Methods: In this experimental study, with a control group of 40 male Wistar rats (8 weeks old, weighing 200±19 grams), after induction of obesity and weight gain, randomly divided into 5 groups of 8: control, fasting-obese, fasting-endurance exercise, fasting-electrical stimulation and Fasting-endurance training-electrical stimulation were divided. Intervention groups for a period of 4 weeks under endurance sports activity (with a speed of 10 to 20 m/min and duration of 20 to 40 minutes), electrical stimulation (foot shock device for 0.5 mA and 20 minutes) and fasting (8 to 16 hours) were placed. After exercise and anesthesia, tissue sampling was done and after molecular processes, gene expression was measured using Real time-PCR machine. For data analysis, two-way analysis of variance test was used at a significance level of P< 0.05 and GraphPad software.
Results: The results showed that endurance training led to a significant increase in the expression of 5αR and aromatase genes in fasting obese rats compared to the obese group (P= 0.0001). Also, electrical stimulation and its combination with endurance training led to a significant increase in the expression of 5αR gene (P= 0.0001), but this increase was not significant in Aromatase gene (P= 0.377).
Conclusion: It seems that endurance training and electrical stimulation during fasting by increasing the expression of 5-alpha reductase and aromatase genes in obese samples is effective in their sexual health and leads to its improvement. Also, a combination of electrical stimulation and exercise can have positive effects on this process, but more studies are needed.

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Background: This study aimed to compare the effects of high-intensity interval games and high intensity interval training on body composition indicators, aerobic capacity and lipid profiles of obese and overweight girls aged 10 to 12 years.
Methods: In this semi-experimental research, 30 girls (average height 149.26 ± 5.32 m, weight 67.41 ± 7.65 kg, and body mass index 30.14 ± 2.3 kg/m2) with overweight and obesity participated and were randomly divided into the groups of high intensity interval training (10), high intensity interval game (10) and the control (10). Training programs for eight weeks(3d/w), (90-85% of maximum heart rate) and 3-minute recovery (65-75% of maximum heart rate) with 4 times Repetition was done, which was done in the form of running in high intensity interval training and in the form of playing in high intensity interval game. Blood samples were taken to measure the serum levels of lipid profiles (48 hours before and after the intervention period).
Results: The two training groups compared to the control group, increased aerobic capacity and High-density lipoprotein (HDL) and body fat percentage, Triglyceride (TG), Total Cholesterol (TC) and Low-density lipoprotein (LDL) (P< 0.010) showed a significant decrease and between the two training groups in TG, LDL and HDL (P< 0.01) was a significant difference, with a greater increase in HDL and a greater decrease in TG and LDL was accompanied in the high intensity game group.
Conclusion: High intensity interval games can be suggested as a more suitable solution to improve the lipid profile of obese and overweight girls.

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Background: Inflammatory protein C3 and IL-1β are significantly involved in the pathophysiology of type 2 diabetes (T2D) and Alzheimer's disease. Moreover, examining the importance of aerobic exercise timing (light vs. dark phase) can provide a better understanding of how exercise timing affects inflammatory markers associated with neurological diseases in older adult women with T2D. Therefore, this study aimed to investigate the effect of aerobic exercise timing on C3 and IL-1β levels in older adults’ women with T2D.
Methods: In this semi-experimental study, 45 women with T2D with an average age of 60 ± 5.07 years were divided into training groups (light and dark phase) and control (15 people in each group). Aerobic exercise was performed for 12 weeks at a moderate intensity (60-70% of heart rate reserve). Protein levels (C3 and IL-1β) were measured before and after the intervention using the ELISA method. Data were analyzed using SPSS27 software and ANOVA with a significance level of 0.05.
Results: Complement C3 was significantly lower in the dark phase exercise group compared to the control group (P= 0.0083). Additionally, the results showed that dark phase aerobic exercise significantly decreased C3 (P= 0.0028) and IL-1β (P= 0.0045) levels compared to baseline.
Conclusion: Aerobic exercise performed during the dark phase effectively reduced inflammatory protein levels of C3 and IL-1β in older adult women with T2D, suggesting it could be considered as a crucial strategy in managing this disease.

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Background: Insulin resistance plays a fundamental role in disorders such as obesity, diabetes, cardiovascular diseases, and metabolic syndrome. Regular physical activity and the use of medicinal plants are important strategies for its reduction and management. Ginger has attracted research attention due to its phytochemical compounds that influence insulin signaling pathways. Despite numerous studies, a bibliometric analysis examining the effects of exercise and ginger supplementation on insulin resistance has not yet been conducted. Therefore, the present study aimed to analyze the trends in Iranian research in this field.
Methods: In a bibliometric review, the keywords “training,” “ginger supplementation,” and “insulin resistance” were searched in the Magiran database. According to the entry criteria, 13 eligible articles were selected and data extracted from them, including writing pattern, collaboration, prolific authors and institutions, selected journals and study trends, and common keywords were extracted from the database of recipients and analyzed using VOSviewer software.
Results: The results indicated that 36 authors had an average of 3.23 ± 0.89 cooperation in writing articles. Fifty-four percent of the articles were published by public university faculty and 46% by independent universities. The most frequent keywords included "ginger", "insulin resistance", "obesity", "diabetes mellitus", "irisin" and "lipid peroxidation".
Conclusion: The results of this bibliometric study showed that exercise with ginger supplement reduced insulin resistance. In particular, 84% of the articles showed the positive effect of combined exercises (resistance and aerobic exercises) along with ginger supplements on the reduction of insulin resistance. Compared to other types of exercise, these exercises have had the greatest effect on improving the glycemic profile and body composition. In addition, high intensity interval training (HIIT) has also shown positive effects on reducing insulin resistance, but is not as effective as combined training. Also, due to the relationship between insulin resistance and various diseases, it is felt to conduct more studies on diverse statistical populations and people suffering from various diseases.

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Background: The increasing trend of diabetes patients requires lifestyle interventions to improve the self-management ability of these patients, and achieving this requires the use of valid tools in this field. This study aimed to determine the psychometric properties of the Comprehensive Diabetes Self-Management Scale (CDSMS) in patients with type 2 diabetes.
Methods: The present study was methodological research that was conducted in 2023. At the beginning of the work, the CDSMS questionnaire was translated into Persian using the standard translation-back translation method. Then, face validity, content validity, convergent validity, internal consistency, and instrument stability were determined. Data analysis was performed using descriptive statistics, Cronbach's alpha calculation, Kappa index, Pearson correlation coefficient, and intra-cluster correlation coefficient in SPSS software version 24.
Results: Based on the results, all the items of the instrument were retained. The total content validity index score of the Persian version of this questionnaire was 0.987. Also, the Kuder-Richardson and Kappa indices were 0.704 and 0.730, respectively. The level of agreement at two measurement times, two weeks apart, ranged from 0.503 to 0.990. The intra-cluster correlation index was also observed to be in the range of 0.625 to 0.952 and was significant (P < 0.001). The Cronbach's alpha coefficient of the instrument was also 0.83.
Conclusion: The results of the present study showed that the Persian version of the CDSMS questionnaire with 14 items has good validity and reliability and can be used to evaluate the self-management status of patients with type 2 diabetes in Iran.

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Background: In recent years, the prevalence of diabetes has increased significantly. Parents of children with diabetes suffer from many physical and psychological problems; Therefore, various interventions have been designed to improve their quality of life and well-being. These interventions have benefited from a wide range of approaches and methodologies. The present study was conducted with the aim of identifying and reviewing various psychological interventions for parents of children under 6 years old with diabetes and examining their strengths and weaknesses.
Methods: The search for interventional protocols was done through various databases such as Google Scholar, PubMed, Science Direct and Scopus. after checking the data entry criteria, 11 articles were selected and studied.
Results: The interventions used different approaches such as cognitive-behavioral, social learning, family therapy, and positive parenting. The intervention methods were mostly remote and had different consequences for the parent and the child, which has been highlighted. Also, the sample size in these studies was between 30 and 200 parents, and the satisfaction level of the main interventions was reported to be high.
Conclusion: In general, limited interventions have been conducted. Given that interventions focusing on the psychological state of parents can lead to increased social support and improved mental health in parents and children with diabetes, it is hoped that this article will pave the way for examining different approaches.
 

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Background: Recurrent diabetic ketoacidosis is one of the serious and life-threatening complications of diabetes that can lead to repeated hospitalizations and significant complications. This study was conducted with the aim of investigating the prevalence, risk factors, and clinical outcomes of recurrent diabetic ketoacidosis in southeast Iran.
Methods: In this retrospective descriptive-cross-sectional study, the medical records of 560 patients with diabetic ketoacidosis during the years 2017-2020 at Afzalipour Hospital in Kerman were reviewed. Patients with at least two admissions due to diabetic ketoacidosis were included in the study. Demographic, clinical, and laboratory data were collected and analyzed using a checklist. The collected data were analyzed using SPSS software version 25 with chi-square and independent t-tests at a significance level of 0.05.
Results: Of 560 patients, 40 patients (7.16%) had recurrent diabetic ketoacidosis. The mean age of patients was 28.36 ± 15.04 years, and 60% were women. 70% of patients had type 1 diabetes. The most common underlying causes included irregular consumption or discontinuation of insulin (72.5%) and presence of infection (55%). Substance abuse was reported in 25% of patients. The mean serum levels of urea, creatinine, and potassium were 55.23 ± 37.73 mg/dL, 0.98 ± 0.67 mg/dL, and 4.38 ± 0.64 mEq/L, respectively.
Conclusion: This study showed that patients with type 1 diabetes are at higher risk of recurrent diabetic ketoacidosis. Non-adherence to insulin therapy and infections were the most important identified risk factors. These findings emphasize the importance of patient education regarding regular insulin consumption and prevention of infections.
 

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Background: Type 1 diabetes is the most common type of diabetes affecting children and adolescents. Nursing interventions for children with type 1 diabetes include recognizing the adolescent's problems and providing technical care and emotional support. Nurses play an important role in helping adolescents and their families manage emotions, adjust treatment regimens, and integrate new routines into daily life. The aim of this systematic review is to identify and analyze effective nursing interventions in the management of type 1 diabetes in children and support their families. This study, by reviewing the available evidence, attempts to explain the role of nurses in improving clinical, psychological, and behavioral outcomes in children and promoting awareness, self-care skills, and quality of life in families.
Methods: A systematic search was conducted in the scientific databases PubMed, Scopus, Web of Science, CINAHL, SID and Magiran between 2010 and 2025. The search strategy was created using the PubMed keywords (Nursing Interventions) [title/abstract], (Type 1 Diabetes), (Child) and (Family). Systematic search with English keywords: ((Nursing Interventions[title/abstract]) AND (Type 1 Diabetes [title/abstract])) AND (Child[title/abstract])) AND (Family[title/abstract]). Out of 500 studies on nursing interventions in pediatric type 1 diabetes with more detailed review, a total of 10 studies met the inclusion criteria and were included in the final analysis.
Results: The findings showed that nursing interventions can have a significant impact on diabetes management by children and families, leading to improved adherence to treatment regimens, better blood sugar control, and increased quality of life for children and families.
Conclusion: Nursing interventions play a significant role in improving blood sugar control, increasing awareness and self-care of children with type 1 diabetes, and supporting their families. Interventions such as patient and family education, psychological counseling, regular follow-up, use of educational and care-oriented technologies, and team collaboration have been able to provide favorable results in reducing disease complications, improving quality of life, and increasing psychosocial adjustment. Accordingly, the development and implementation of evidence-based intervention programs, taking into account the individual, cultural, and social characteristics of families, is recommended to improve nursing care in children with diabetes.
 

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Background: The impact of psychological factors on physical diseases has highlighted the need to recognize these factors in the process of preventive and therapeutic interventions. In this regard, the aim of the present study was to compare personality traits, resilience, and coping strategies in diabetic patients and healthy individuals.
Methods: A causal-comparative method was used in a sample of 75 diabetic patients and 75 healthy individuals, who were selected by convenience sampling. Data collection was carried out using resilience, five-factor personality, and coping strategies questionnaires. Independent t-test and multivariate analysis of variance in SPSS 62 software were used to examine the hypotheses.
Results: The mean scores of resilience and the personality traits of extraversion and conscientiousness were higher in healthy individuals, and the mean score of neuroticism was higher in diabetic individuals. No significant difference was observed in the personality traits of agreeableness and openness between these two groups. The findings showed that the average scores of healthy individuals in using problem-oriented strategies and the average scores of diabetic individuals in using emotion-oriented strategies were higher than the other group.
Conclusion: The findings indicate that psychological factors play a significant role in the emergence and intensification of problems in diabetic patients. Addressing these factors and incorporating appropriate psychological strategies may therefore contribute to more effective prevention and treatment of diabetes.
 

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Blood glucose variability, defined as variations in blood glucose levels over time, is increasingly recognized as a significant factor in the pathology of diabetes complications. While chronic hyperglycemia has been linked to microvascular complications (retinopathy, nephropathy, and neuropathy) and macrovascular complications (coronary artery disease, stroke, and peripheral artery disease), emerging evidence suggests that glucose variability is an independent risk factor for these conditions. This review examined the relationship between blood glucose variability and the development of microvascular and macrovascular complications in diabetes, highlighting the underlying mechanisms, clinical implications, and therapeutic approaches.

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Background: Type 2 diabetes is rapidly increasing, particularly in the Middle East where central obesity is a major contributor to disease burden. Identifying high-risk individuals requires indices that assess visceral adiposity more effectively than body mass index (BMI). This study compared nine anthropometric indices in relation to diabetes and determined their predictive capacity and optimal cut-off values.
Methods: This cross-sectional analysis included 10,103 adults aged 35–70 years from the FASA cohort. Diabetes was defined as fasting glucose ≥126 mg/dL or antidiabetic medication use. Measurements included BMI, waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body roundness index (BRI), body adiposity index (BAI), a body shape index (ABSI), abdominal volume index (AVI), and weight-adjusted waist index (WWI). Associations were examined using logistic regression (crude and adjusted models). Discriminatory accuracy was assessed using receiver operating characteristic (ROC) curves, area under the curve (AUC), and Youden's index. 
Results: Individuals with diabetes exhibited higher values across anthropometric indices (p< 0.05). In adjusted models, WC, WHR, WHtR, AVI, and WWI remained significant predictors (p< 0.05). WHR demonstrated the highest AUC (0.651, p< 0.001). Optimal cut-off values with high sensitivity and specificity included WHR= 0.91, WHtR= 0.53, and BRI= 4.1. 
Conclusion: Central obesity indices—particularly WHR, WHtR, and BRI—demonstrated superior discriminatory capacity for diabetes and support the use of simple waist-based indices for early screening.

 

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Background: Nonfunctioning pituitary adenomas (NFPAs) are among the most prevalent subtypes of pituitary adenomas, presenting no clinical hormone elevation. The lack of definitive biomarkers for prognosis and treatment, combined with a significant risk of recurrence, poses substantial challenges to management. This study aims to identify key genes and biological pathways involved in NFPAs tumorigenesis using a systems biology approach.
Methods: The dataset with accession number GSE26966 was analyzed to identify differentially expressed genes (DEGs) in NFPAs. Interactions between DEGs at the protein level were constructed using protein-protein interaction (PPI) data collected from the IntAct database. Cytoscape software, igraph, and MCL packages were used to construct the PPI network, analyze its topology, and cluster it.
Results: 1,135 differential genes were identified between NFPAs and normal pituitary samples based on |log2FC|>2 and FDR < 0.05. Of these, 323 were up-regulated and 812 were down-regulated. The constructed PPI network consisted of 6,960 nodes and 15,691 edges. According to network clustering, cell cycle regulation, chromatin organization and assembly regulation, transcription regulation, and actin cytoskeleton regulation were the most significant pathways. Using topological analysis, CDKN1A, BHLHE40, FHL2, H1-2, H2BC21, and FGFR3 were identified as central hub nodes in the PPI network. These genes were also involved in the biological pathways mentioned above.
Conclusion: This study demonstrated that a systems biology approach, integrating gene transcriptome data with protein interaction data, can effectively identify pathways and biomarkers in NFPAs tumorigenesis.
 

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Background: Biobanks are biological repositories that collect, process, store, and distribute human biological samples. Among them, tumor banks play a central role in biomedical research. The overall goal of a tumor bank is to collect cancerous and normal samples under standardized conditions for basic, clinical, or applied research.
Methods: Tumor samples from patients with endocrine neoplasms were collected from excess tissue samples not required for diagnostic purposes after surgery in the surgical department of Dr. Shariati Hospital, Tehran, Iran. In addition, relevant biological samples such as serum, plasma and DNA were collected in parallel. Prior to sampling, informed consent was obtained from the patients and a questionnaire was completed. After rapid freezing with isopentane, tissue samples were stored in a liquid nitrogen tank, while other biological materials, such as serum, were stored in a -80°C freezer.
Results: Tissue, plasma, serum, and DNA samples collected from patients with endocrine neoplasms were stored in separate barcoded storage boxes in the biobank and were made available to researchers.
Conclusion: The use of bioproducts in domestic research and international networks has strengthened research collaborations through supporting the collection and distribution of tissues, especially cancer tissues. This trend plays an important role in facilitating basic and applied research in various fields of cancer, including molecular biology, immunology, genetics and pharmacology, and will pave the way for scientific advances and therapeutic innovations.

 

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Background: Decision-making is a cognitive process with complex neural underpinnings, fundamental to all human behavior. This study reviewed existing research to present a comprehensive model of this process, integrating the functions of specific brain regions with cognitive and emotional factors to create a complete framework.
Methods: Using a qualitative approach, we conducted a literature review across reputable databases. Neurocognitive factors were extracted and validated through a series of expert panel sessions with eight specialists. The final conceptual model was designed, and its validity was confirmed through a multi-stage consensus process.
Results: The model provides a comprehensive framework for understanding the neurocognitive mechanisms of decision-making. It integrates cognitive, emotional, and motivational factors—such as intention, emotion, and cognitive reserve—to explain how choices are made and outcomes are evaluated. The model emphasizes the key roles of the prefrontal cortex and the limbic system, and demonstrates how external stimuli influence this process.
Conclusion: This validated model offers an integrated framework for the decision-making process, highlighting the interplay between key brain regions and cognitive and emotional factors. The model has important applications in education, psychotherapy, and designing interventions to improve decision-making skills.
 

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Background: National Document for the Prevention and Control of Non-Communicable Diseases (NCDs) and Related Risk Factors, developed in 2015, serves as Iran’s roadmap for guiding health policies to manage NCDs. After a decade, assessing its implementation and progress is essential. We aimed to review and synthesize existing evidence on the implementation status of the document’s interventions, and identify facilitators, barriers, and strategies to enhance its execution.
Methods: Following the PRISMA-ScR 2020 checklist, a systematic search was conducted in PubMed, Scopus, Web of Science, SID databases, Google Scholar, organizational repositories, and reference lists of related studies in Persian and English. Research or review studies that evaluated at least one objective or intervention of the national document—using health or health system indicators in Iran—were included. Three researchers independently performed screening and data extraction. Data were analyzed narratively and organized into thematic categories.
Results: Overall, 78 studies, reports, and national documents were included. Implemented actions encompassed establishing committees, developing action plans, integrating services into the health system, revising standards, producing educational materials, launching registries, and signing multisectoral cooperation agreements. Facilitators included legal support, intersectoral collaboration capacities, service delivery structures, and community capabilities. Major challenges were deficiencies in the national document, limited resources, weak coordination, and external disruptions such as COVID-19 and sanctions. Recommended strategies emphasized strengthening cost-effective interventions, continuous monitoring, securing sustainable resources, improving service delivery models, and enhancing multi-sectoral approaches.
Conclusion: Successful implementation of NCD prevention and control policies requires evidence-informed policymaking, prioritization of cost-effective interventions, ongoing evaluation, and sustained managerial support.
 

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Background: Since 1999, the International Working Group on the Diabetic Foot (IWGDF) has consistently provided evidence-based guidelines aimed at the prevention and management of diabetic foot (DF). The latest version of these guidelines was published in 2023. Despite similarities such as being compiled by a working group, based on systematic reviews, and using the GRADE methodology to grade recommendations, it has some differences from the 2019 version. Awareness of these similarities and differences facilitates the faster implementation of evidence into clinical practice. The aim was to compare the similarities and differences between the 2019 and 2023 versions of the IWGDF guidelines.
Methods: In this comparative review study, both guideline versions were reviewed as primary sources. Data were extracted in two domains: structural (methodology) and content (number of chapters and recommendations, and key points). A comparison was then conducted on the data both quantitatively and qualitatively, whereby the similarities and differences between the two versions were identified and analyzed by juxtaposing the extracted information.
Results: The 2019 version consists of six guidelines, while the 2023 version includes seven separate guidelines. Both versions contain individual guidelines for prevention of foot ulcers (14 recommendations in 2023 vs. 16 in 2019), classification of foot ulcers (5 recommendations in both versions), diagnosis and treatment of foot infections (26 recommendations in 2023 vs. 27 in 2019), diagnosis and treatment of peripheral artery disease (25 recommendations in 2023 vs. 17 in 2019), offloading interventions (12 recommendations in 2023 vs. 9 in 2019), and wound healing interventions (29 recommendations in 2023 vs. 9 in 2019). A significant difference in the 2023 version compared to 2019 is the addition of a guideline for the diagnosis and treatment of active Charcot neuro-osteoarthropathy, which includes 26 recommendations.
Conclusion: Despite content similarities, the 2023 version differs from the 2019 version in the number of recommendations, with the most notable difference being the inclusion of a guideline for the diagnosis and treatment of active Charcot neuro-osteoarthropathy.