Global, regional, and national burden of diabetes from 1990 to 2021, with projections of prevalence to 2050: a systematic analysis for the Global Burden of Disease Study 2021

This online publication has been corrected. The corrected version first appeared at thelancet.com on September 28, 2023BACKGROUND : Diabetes is one of the leading causes of death and disability worldwide, and affects people regardless of country, age group, or sex. Using the most recent evidentiary and analytical framework from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD), we produced location-specific, age-specific, and sex-specific estimates of diabetes prevalence and burden from 1990 to 2021, the proportion of type 1 and type 2 diabetes in 2021, the proportion of the type 2 diabetes burden attributable to selected risk factors, and projections of diabetes prevalence through 2050. METHODS : Estimates of diabetes prevalence and burden were computed in 204 countries and territories, across 25 age groups, for males and females separately and combined; these estimates comprised lost years of healthy life, measured in disability-adjusted life-years (DALYs; defined as the sum of years of life lost [YLLs] and years lived with disability [YLDs]). We used the Cause of Death Ensemble model (CODEm) approach to estimate deaths due to diabetes, incorporating 25 666 location-years of data from vital registration and verbal autopsy reports in separate total (including both type 1 and type 2 diabetes) and type-specific models. Other forms of diabetes, including gestational and monogenic diabetes, were not explicitly modelled. Total and type 1 diabetes prevalence was estimated by use of a Bayesian meta-regression modelling tool, DisMod-MR 2.1, to analyse 1527 location-years of data from the scientific literature, survey microdata, and insurance claims; type 2 diabetes estimates were computed by subtracting type 1 diabetes from total estimates. Mortality and prevalence estimates, along with standard life expectancy and disability weights, were used to calculate YLLs, YLDs, and DALYs. When appropriate, we extrapolated estimates to a hypothetical population with a standardised age structure to allow comparison in populations with different age structures. We used the comparative risk assessment framework to estimate the risk-attributable type 2 diabetes burden for 16 risk factors falling under risk categories including environmental and occupational factors, tobacco use, high alcohol use, high body-mass index (BMI), dietary factors, and low physical activity. Using a regression framework, we forecast type 1 and type 2 diabetes prevalence through 2050 with Socio-demographic Index (SDI) and high BMI as predictors, respectively. FINDINGS : In 2021, there were 529 million (95% uncertainty interval [UI] 500–564) people living with diabetes worldwide, and the global age-standardised total diabetes prevalence was 6·1% (5·8–6·5). At the super-region level, the highest age-standardised rates were observed in north Africa and the Middle East (9·3% [8·7–9·9]) and, at the regional level, in Oceania (12·3% [11·5–13·0]). Nationally, Qatar had the world’s highest age-specific prevalence of diabetes, at 76·1% (73·1–79·5) in individuals aged 75–79 years. Total diabetes prevalence—especially among older adults—primarily reflects type 2 diabetes, which in 2021 accounted for 96·0% (95·1–96·8) of diabetes cases and 95·4% (94·9–95·9) of diabetes DALYs worldwide. In 2021, 52·2% (25·5–71·8) of global type 2 diabetes DALYs were attributable to high BMI. The contribution of high BMI to type 2 diabetes DALYs rose by 24·3% (18·5–30·4) worldwide between 1990 and 2021. By 2050, more than 1·31 billion (1·22–1·39) people are projected to have diabetes, with expected age-standardised total diabetes prevalence rates greater than 10% in two super-regions: 16·8% (16·1–17·6) in north Africa and the Middle East and 11·3% (10·8–11·9) in Latin America and Caribbean. By 2050, 89 (43·6%) of 204 countries and territories will have an age-standardised rate greater than 10%. INTERPRETATION : Diabetes remains a substantial public health issue. Type 2 diabetes, which makes up the bulk of diabetes cases, is largely preventable and, in some cases, potentially reversible if identified and managed early in the disease course. However, all evidence indicates that diabetes prevalence is increasing worldwide, primarily due to a rise in obesity caused by multiple factors. Preventing and controlling type 2 diabetes remains an ongoing challenge. It is essential to better understand disparities in risk factor profiles and diabetes burden across populations, to inform strategies to successfully control diabetes risk factors within the context of multiple and complex drivers.Bill & Melinda Gates Foundation.http://www.thelancet.comam2024School of Health Systems and Public Health (SHSPH)SDG-03:Good heatlh and well-bein

The Internal and External Disequilibrium Relationship in Economy and Extending of Monetary Trilemma (The Case Study of Iran Economy)

The main purpose of this paper is to provide a framework for examining the relationship between internal and external imbalances and their trade-offs based on extending of monetary trilemma that analyzes monetary imbalances with real-sector economic imbalances.                 The empirical study of this paper examines the theoretical model presented in the context of the system of simultaneous equations for the Iranian economy (OLS and 2SLS). The results of the empirical studies and tests show the validity of the theory presented so that any kind of impulse on the variables of government spending policy, domestic interest rates (deposits and loans), exchange rates, domestic and foreign prices, and foreign interest rates, with other conditions remaining constant. The imbalance is created in the sector concerned, then equilibrium is provided by the transfer and compensation of the imbalance from the sector concerned to the other sectors and the general equilibrium in the economy is restored

The Dynamics of the Exchange Rate and Extension of Monetary Trilemma

Simultaneous making policy of interest rates, exchange rates and capital accounts can be extended to trilemma theory, contrary to its earlier theories, provided that the imbalances of the private sector, the government and the capital account adjusted through the policy variables such as the government expenditures, the interest rates on domestic deposits, the interest rates on domestic loans, effective exchange rates, foreign prices and foreign interest rates. On the other hand, the components of the extension of trilemma theory in the form of internal and external imbalances affect the exchange rate. In other words, if the real sector markets of the economy are not cleared through the aforementioned trilemma components, and policy variables, internal and external imbalances will be affected by opposite direction of net domestic assets (ΔNDA) and net foreign assets (ΔNFA) of the banking system. This is in accordance with the fundamental principles of the monetary approach balance of payments and exchange rate. Policy variables do not put pressure on the unofficial exchange rate as long as they have the same effect on the net changes in the domestic and foreign assets of the banking system. The purpose of this study is to consider the effect of internal and external imbalances on exchange rate through the simultaneous equations system, generating impulses in policy variables, and examining reactions in Iranian economy. In this paper, the monetary exchange rate determination model is analyzed and examined by using the extension of trilemma theory for macroeconomic data of Iran in the form of internal and external imbalances. The results of this study suggest that policy variables can stabilize the unofficial exchange rate (with other conditions being constant) through trading off internal and external imbalances. Thus, the economic policymaker can, while independently policing interest rates, capital accounts and government expenditures and other policy variables in this research, maintain exchange rate stability as a strategic variable and anchor the general level of prices.</jats:p

Breast Self-examination and its Effective Factors Based on the Theory of Planned Behavior among Women in Kerman, Iran

Background and Objectives: Breast cancer is the most common form of malignant diseases in women. Early diagnosis is effective on its successful treatment. The aim of this study was to evaluate breast self-examination and its effective factors based on the theory of planned behavior among women in Kerman, Iran. Materials and Methods: In this descriptive-analytical cross-sectional study, 300 women referred to the health centers in Kerman, Iran, were selected by the cluster and convenience sampling. Data were collected using questionnaires included demographic variables and questions about knowledge and constructs of the theory of planned behavior. Data analysis was done using descriptive statistics and Pearson’s correlation, Spearman, Chi-square, independent t-test, Mann-Whitney and logistic regression with the SPSS 21 software. Results: The mean age of the participants was 30.26 ± 8.18 years. Results showed that 12.7% of the women performed breast self-examination regularly every month. The most common reason for not doing breast self-examination was not knowing how to perform it. Knowledge was the most important predictor in breast self-examination (OR= 0.896, P <0.001). There was a significant difference in the average scores of knowledge, attitude, perceived behavioral control and behavioral intention between groups that did and did not perform breast self-examination (P <0.05). Conclusions: Education interventions based on the theory of planned behavior can be implemented for increasing women's knowledge and empowering them in timely diagnosis and treatment of breast cancer

Withdrawn: Rubenstein-Taybi Syndrome with bilateral absence of patella: a case report

Rubinstein-Taybi Syndrome (RTS) is a neuromuscular syndrome which is mainly characterized by a delay in growth, psychomotor retardation, duplication of the distal phalanx of the thumbs, typical facial dimorphism. Absence of patella that causes difficulties in walking is extremely rare and occurs usually with other signs of a syndrome. Bilateral absence of patella was seen during clinical examination of a case suffered to Rubinstein-Taybi Syndrome. The case was a six-year-old full term born boy, with deformed knees since birth admitted to Farabi Hospital, Kermanshah, Iran, at September 2015. The physical signs were similar to the previously reported cases, except the absence of patella.</jats:p