Research Institute for Endocrine Sciences

Self-care is one of the most critical factors in disease prevention. Adults with pre-diabetes are at 5 to 15 times higher risk of developing type 2 diabetes compared with others. Without self-care behaviours to promote health and prevention, more than 70% will ultimately develop type 2 diabetes during their lives. This study aimed to design and psychometrically evaluate the self-care of adults with pre-diabetes. This study was a sequential exploratory mixed-methods study. In the first phase of the mixed-methods study, a qualitative study was conducted with a directed content analysis approach according to Riegel etal.'s middle-range theory as a guide. This qualitative-directed content analysis was conducted on prediabetes from June 2023 to October 2023. The experiences of 39 adults with pre-diabetes and 6 healthcare workers were assessed through individual, face-to-face, semi-structured interviews. The data were analysed based on the Elo and Kyngäs's method. The psychometric properties of the primary tool were evaluated in the second phase. Face and content validity, item analysis, structural validity, internal consistency, relative and absolute reliability, interpretability, responsiveness, and feasibility were evaluated, and the scoring method was determined. The concept of self-care in prediabetes includes behaviours that are performed to return blood sugar to a normal state in a routine and usual way (self-maintenance) and behaviours in response (self-management) to the changes that have been detected following the follow-up and interpretation of symptoms, periodic examinations and tests (self-monitoring). The primary tool entered the psychometric evaluation phase with 57 items (blueprint). After performing face and content validity and item analysis, the number of items was reduced to 29 items. Exploratory factor analysis was performed with 29 items and 207 people with prediabetes, and finally, three subscales with 19 items were formed, which explain 38% of the total extracted variance. The results of confirmatory factor analysis with 200 samples indicated the acceptable fit of the model. The Cronbach's alpha of all subscales was higher than 0.7, and the intraclass correlation coefficient of the scale was higher than 0.90. The standard error of measurement was 1.340, the minimum detectable change was 6.57, and the minimal important change was 3.71. The total score of the questionnaire had no ceiling and floor effect; the percentage of unanswered items was within the acceptable range. The results show that the self-care questionnaire for prediabetes has good psychometric properties and can measure self-care in adults with pre-diabetes.

Type 2 diabetes (T2DM) is often accompanied by comorbidities such as hypertension (HTN), cardiovascular disease (CVD), and chronic kidney disease (CKD), which increase the disease burden and complicate its management. In Iran, where diabetes prevalence is growing, understanding the extent and determinants of these comorbidities is crucial for improving clinical care and informing national public health strategies. We used data from the WHO STEPwise approach to non-communicable diseases risk factor surveillance (STEPS) 2021 to assess the prevalence of comorbidities among Iranian patients with T2DM. Comorbidity was defined as ≥ 2 of: HTN, CKD, history of CVD, or cancer. Multivariable logistic regression was done to identify the potential socio-demographic factors associated with comorbidities. Of a total of 2,900 participants aged 25-70 years with T2DM (56.24% women), 27.00% (95% confidence interval (CI): 24.74-29.40) had no comorbidity, 39.82% (95% CI: 37.26-42.43) had one comorbidity (HTN: 79.62%, CKD: 10.66%, CVD: 8.64%, cancer: 1.09%), and 33.18% (95% CI: 30.58-35.89) had ≥ 2 comorbidities. The prevalence of comorbidity was significantly associated with male gender, age ≥ 60 years, living in a rural area, body mass index >30 kg/m2 (all p-values < 0.05). However, higher years of schooling, being employed, and physical activity ≥ 150 min/week were associated with lower odds of comorbidities. Over 70% of Iranian adults have additional health conditions alongside diabetes, which significantly impact public health and underscore the need for personalized and multi-faceted preventive approaches.

The evidence considering the potential protective impact of statins on the mortality rate caused by colorectal cancer (CRC) is controversial. This study aimed to systematically assess the effect of statins on the survival rate of CRC patients. A comprehensive search was conducted in Scopus, PubMed, and Web of Science to assess the relationship between statin consumption and cancer-specific mortality (CSM), all-cause mortality (ACM), disease-free survival (DFS), and recurrence-free survival (RFS). Subgroup analyses were performed to assess data stratified by country, study design, disease stage, time to use, CRC, and treatment type due to high heterogeneity. Thirty-two studies were included; the data of 24 articles composed the meta-analysis. Statins improved prognosis of CRC, particularly in lower ACM (HR: 0.80; 95% CI: 0.74-0.87) with I²=90%, P-value < 0.01, and lower CSM (HR: 0.74; 95% CI: 0.67-0.82) with I²=88%, P-value < 0.01 when compared to non-users. Both pre- and post-diagnostic statin use were linked to lower ACM and CSM, though high heterogeneity was observed across studies. However, the results for statin use on RFS indicated an HR of 1.01 with 95% CI of 0.94 to 1.09 (I² = 0% and P-value = 0.93). Additionally, for DFS, the HR was 0.93 (95% CI: 0.85-1.01) with I² = 47%, suggesting no meaningful effect of statin use on DFS. No significant publication bias was found. Statin use was associated with a reduction in ACM and CSM in CRC patients. However, the variances in RFS and DFS were not statistically significant. However, these findings should be interpreted cautiously due to substantial heterogeneity among some included studies.

Whether high remnant cholesterol (RC) is associated with an increased risk of incident hypertension, independent of its well-known risk factors, in the general population remains unclear. We followed 5264 participants (3312 women; mean age 39.1 years) from Tehran Lipid and Glucose Study. RC was calculated as total cholesterol minus the sum of the high- and low-density lipoprotein-cholesterol. Hypertension was defined as systolic blood pressure (SBP) ≥ 140 mmHg, or diastolic blood pressure (DBP) ≥ 90 mmHg, or using anti-hypertensive medications. Multivariable Cox proportional hazards regression models were applied to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). In a random-effects meta-analysis we combined our results with six previous studies. In our cohort study, during a median follow-up of 12.4 years, 2189 events of hypertension occurred. Accordingly, in multivariable analyses, the association between RC and hypertension reached non-significant after adjusting for baseline SBP and DBP as covariates in both continuous (per 1-SD increase: 1.00 (0.91-1.10)) and categorical analyses (Q4 vs. Q1: 1.02 (0.85-1.22) (P for trend = 0.343)). However, in the meta-analysis, elevated RC was significantly associated with hypertension (pooled 11 effect-sizes, 1.30 (1.14-1.48); I2 = 99.80; N = 7 studies (6 studies used calculated RC); 2,559,478 participants). In subgroup analyses of meta-analysis, this association was generally more pronounced among individuals with lower baseline risk. In conclusion, in our cohort study, elevated RC was not significantly associated with higher risk of incident hypertension in the presence of large set of confounders, including baseline SBP and DBP levels. We investigated the association between remnant cholesterol and risk of hypertension through a prospective study and meta-analysis. In our cohort study, the association between RC and hypertension was not independent of baseline SBP and DBP levels among Iranian adults. However, the meta-analysis revealed a significant association, albeit with substantial heterogeneity.

Glycosylated hemoglobin (HbA1c) is a crucial biomarker in the diagnosis and management of dysglycemia. However, its diagnostic accuracy, especially considering its variations by age and sex, remains unclear. This study utilized data from Iran’s 2016 Stepwise Approach to Surveillance Survey. A total of 18,729 individuals aged ≥ 25 years old without diabetes were analyzed. The validity of HbA1c for detecting prediabetes and diabetes was assessed using measures of concordance, the Kappa statistic, and the area under the curve (AUC), with fasting plasma glucose (FPG) as the reference. Additionally, optimal HbA1c thresholds for prediabetes and diabetes were determined. The AUCs of HbA1c for detecting diabetes were 0.96 (95% CI 0.95–0.97) in women and 0.94 (95% CI 0.92–0.96) in men. For prediabetes, the AUCs were 0.81 (95% CI 0.79–0.83) in women and 0.76 (95% CI 0.74–0.79) in men. Moreover, an HbA1c threshold of 6.0% was optimal in young (sensitivity: 79.1, specifity: 97.6%) and middle-aged adults (sensitivity: 89.4%, specifity: 88.5%) for detection of diabetes, while an HbA1c of 6.5% was optimal in old adults (sensitivity: 78.2%, specificity: 94.8%). In young women (aged < 40 years old), the HbA1c of 5.7% was optimal for the detection of diabetes (sensitivity = 92.9%, specificity: 91.2%). The clinical performance of HbA1c in the detection of prediabetes was higher when defining prediabetes within the FPG range of 110–125 mg/dL (sensitivity: 71.3%, specifity: 75.8%) instead of 100–125 mg/dL (sensitivity: 52.9%, specifity: 79.3%). The study highlights a higher concordance of HbA1c with FPG in women than in men. We showed that lower HbA1c thresholds are needed in the young and middle-aged adult population, especially in young women.Supplementary InformationThe online version contains supplementary material available at 10.1038/s41598-025-00792-y.

Abstract Background Clinical guidelines for Inflammatory Bowel Disease (IBD) are essential for standardizing care, but their length, technical language, and inconsistent recommendations make them difficult for busy clinicians to use at the point of care. Manually comparing and reconciling multiple guidelines is labor-intensive and often impractical in real-world clinical practice. We aimed to develop and evaluate a proof-of-concept tool using large language models (LLMs) with retrieval-augmented generation (RAG) to improve guideline readability by harmonizing recommendations, highlighting consensus and controversy, and generating concise, actionable statements. Methods We designed an LLM-RAG pipeline (GPT-4o) to automatically segment guideline documents into manageable units, enrich them with metadata and summaries, and retrieve relevant content in response to clinical queries. The system synthesizes recommendations across guidelines, presenting areas of consensus and disagreement in a structured format. Four major international IBD guidelines (ACG, ECCO, BSG, ACPGBI) were analyzed across eight common clinical questions spanning Crohn’s disease and ulcerative colitis. Tool-generated outputs were benchmarked against expert summaries and evaluated by four independent reviewers using 5-point Likert scales for completeness, accuracy, relevance, coherence, and conciseness. Results The tool consistently improved guideline readability by distilling complex text into shorter, structured responses. It achieved mean scores of 4.34 (95% CI, 4.20–4.48) for consensus recognition and 4.61 (95% CI, 4.46–4.77) for disagreement detection. Completeness, accuracy, and relevance all scored &amp;gt;4.0. Although conciseness was lower (3.84, 95% CI, 3.50–4.19), reviewers noted that outputs captured essential information while substantially reducing textual burden. Outline generation performance was moderate (3.25, 95% CI, 2.85–3.65), reflecting challenges in extracting all relevant subtopics. In 7 of 8 clinical scenarios (87.5%), the tool’s recommendations aligned with expert conclusions. Conclusion This proof-of-concept study demonstrates that an LLM-RAG framework can systematically reconcile international IBD guidelines and present them in a more readable, clinically usable format. By reducing complexity and making consensus and controversy explicit, such tools can help clinicians access key evidence more efficiently, support faster decision-making at the bedside, and reduce practice variation. With further refinement, this approach could contribute to “living guidelines” that are continuously updated and more accessible to end-users, ultimately enhancing patient care.

Background and Objectives:Coronavirus disease 2019 (COVID-19), due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has expanded rapidly to all over the world. Interleukin-17 is one of the inflammatory cytokines which is highly expressed in the blood of individuals with COVID-19. Our aim in the present survey was to assess the mRNA expression levels of cytokine IL-17A, IL-17F and TNF-α in the blood of COVID-19 patients compared with healthy control individuals.Materials and Methods:A total of 69 patients including 32 mild patients, 20 severe and 17 asymptomatic patients in comparison with 25 healthy controls were evaluated. To measure the expression profile of IL-17A and IL-17F in whole blood, quantitative PCR was used.Results:Asymptomatic, mild, and severe SARS-CoV-2 infections were found to have significantly higher levels of IL-17A and IL-17F mRNAs than the healthy group (fold change IL-17A: 3.778; p= 0.002, 4.003; p= 0.001, 2.608; p= 0.0001 respectively, fold change IL-17F: 2.967; p= 0.003, 3.819; p= 0.001, 2.617; p= 0.0012 respectively). TNF-α mRNA expression was also measured, which shows an approximately similar increase compared to IL-17 (fold change: 2.726; p= 0.002, 2.383; P= 0.001, 2.631; p= 0.001, respectively).Conclusion:SARS-CoV-2 infection severity was associated with blood levels of IL-17A and IL-17F mRNA.