{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T19:07:57Z","timestamp":1772219277236,"version":"3.50.1"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T00:00:00Z","timestamp":1772150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>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 \u2265 2 of: HTN, CKD, history of CVD, or cancer. Multivariable logistic regression was done to identify the potential socio-demographic factors associated with comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of a total of 2,900 participants aged 25-70 years with T2DM (56.24% women), 27.00% (95% confidence interval (CI): 24.74\u201329.40) had no comorbidity, 39.82% (95% CI: 37.26\u201342.43) had one comorbidity (HTN: 79.62%, CKD: 10.66%, CVD: 8.64%, cancer: 1.09%), and 33.18% (95% CI: 30.58\u201335.89) had \u2265 2 comorbidities. The prevalence of comorbidity was significantly associated with male gender, age \u2265 60 years, living in a rural area, body mass index &gt;30 kg\/m2 (all p-values &lt; 0.05). However, higher years of schooling, being employed, and physical activity \u2265 150 min\/week were associated with lower odds of comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0343690","type":"journal-article","created":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T18:21:21Z","timestamp":1772216481000},"page":"e0343690","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence and factors associated with comorbidities in Iranian patients with type 2 diabetes: A national study"],"prefix":"10.1371","volume":"21","author":[{"given":"Koushan","family":"Hajiuni","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarmad","family":"Salehi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zahra","family":"Rajabli","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sina","family":"Azadnajafabad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samaneh","family":"Akbarpour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Samaneh","family":"Asgari","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4241-1783","authenticated-orcid":true,"given":"Nazila","family":"Rezaei","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2026,2,27]]},"reference":[{"issue":"11","key":"pone.0343690.ref001","doi-asserted-by":"crossref","first-page":"1987","DOI":"10.2337\/dc16-0614","article-title":"Risk of Cause-Specific Death in Individuals With Diabetes: A Competing Risks Analysis","volume":"39","author":"JM Baena-D\u00edez","year":"2016","journal-title":"Diabetes Care"},{"key":"pone.0343690.ref002","volume-title":"IDF Diabetes Atlas","author":"I. D. Federation","year":"2025","edition":"11"},{"issue":"1","key":"pone.0343690.ref003","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1016\/j.diabres.2009.10.007","article-title":"Global estimates of the prevalence of diabetes for 2010 and 2030","volume":"87","author":"JE Shaw","year":"2010","journal-title":"Diabetes Res Clin Pract"},{"issue":"2","key":"pone.0343690.ref004","doi-asserted-by":"crossref","first-page":"1731","DOI":"10.1007\/s40200-023-01308-z","article-title":"The diabetes cascade of care through the 14 years in Iran: findings of nationwide STEPS surveys 2007\u20132021","volume":"22","author":"A Ameli","year":"2023","journal-title":"J Diabetes Metab Disord"},{"issue":"11","key":"pone.0343690.ref005","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2020-039625","article-title":"Associations between multimorbidity and glycaemia (HbA1c) in people with type 2 diabetes: cross-sectional study in Australian general practice","volume":"10","author":"JI Chiang","year":"2020","journal-title":"BMJ Open"},{"issue":"9","key":"pone.0343690.ref006","doi-asserted-by":"crossref","first-page":"634","DOI":"10.34172\/aim.2022.99","article-title":"Protocol Design for Surveillance of Risk Factors of Non-communicable Diseases During the COVID-19 Pandemic: An Experience from Iran STEPS Survey 2021","volume":"25","author":"S Djalalinia","year":"2022","journal-title":"Arch Iran Med"},{"key":"pone.0343690.ref007","author":"W. H. Organization"},{"issue":"7","key":"pone.0343690.ref008","doi-asserted-by":"crossref","first-page":"656","DOI":"10.1001\/jamapediatrics.2013.1329","article-title":"Missing data and multiple imputation","volume":"167","author":"P Cummings","year":"2013","journal-title":"JAMA Pediatr"},{"issue":"1","key":"pone.0343690.ref009","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1093\/aje\/kwh175","article-title":"Imputations of missing values in practice: results from imputations of serum cholesterol in 28 cohort studies","volume":"160","author":"F Barzi","year":"2004","journal-title":"Am J Epidemiol"},{"issue":"2","key":"pone.0343690.ref010","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s10389-006-0024-x","article-title":"Development of the World Health Organization Global Physical Activity Questionnaire (GPAQ)","volume":"14","author":"T Armstrong","year":"2006","journal-title":"J Public Health"},{"issue":"9","key":"pone.0343690.ref011","first-page":"608","article-title":"Protocol Design for Large-Scale Cross-Sectional Studies of Surveillance of Risk Factors of Non-Communicable Diseases in Iran: STEPs 2016","volume":"20","author":"S Djalalinia","year":"2017","journal-title":"Arch Iran Med"},{"issue":"9","key":"pone.0343690.ref012","article-title":"Protocol design for large\u2013scale cross\u2013sectional studies of surveillance of risk factors of non\u2013communicable diseases in Iran: STEPs 2016","volume":"20","author":"S Djalalinia","year":"2017","journal-title":"Archives of Iranian Medicine"},{"issue":"1","key":"pone.0343690.ref013","doi-asserted-by":"crossref","first-page":"10272","DOI":"10.1038\/s41598-023-37299-3","article-title":"Tobacco consumption patterns among Iranian adults: a national and sub-national update from the STEPS survey 2021","volume":"13","author":"M Abbasi-Kangevari","year":"2023","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0343690.ref014","doi-asserted-by":"crossref","first-page":"16819","DOI":"10.1038\/s41598-024-66257-w","article-title":"Alcohol consumption among Iranian population based on the findings of STEPS survey 2021","volume":"14","author":"A Hajebi","year":"2024","journal-title":"Sci Rep"},{"key":"pone.0343690.ref015","author":"W. H. Organization"},{"issue":"19","key":"pone.0343690.ref016","doi-asserted-by":"crossref","DOI":"10.1016\/j.jacc.2017.11.005","article-title":"2017 ACC\/AHA\/AAPA\/ABC\/ACPM\/AGS\/APhA\/ASH\/ASPC\/NMA\/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults","volume":"71","author":"PK Whelton","year":"2018","journal-title":"Journal of the American College of Cardiology"},{"key":"pone.0343690.ref017","article-title":"2. Classification and Diagnosis of Diabetes:Standards of Medical Care in Diabetes\u20142021","volume":"44","author":"A. D. Association","year":"2020","journal-title":"Diabetes Care"},{"key":"pone.0343690.ref018","article-title":"6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes\u20142025","volume":"48","author":"NA ElSayed","year":"2024","journal-title":"Diabetes Care"},{"issue":"9","key":"pone.0343690.ref019","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"AS Levey","year":"2009","journal-title":"Ann Intern Med"},{"key":"pone.0343690.ref020","article-title":"KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease","volume":"49","author":"KDOQI","year":"2007","journal-title":"Am J Kidney Dis"},{"key":"pone.0343690.ref021","volume-title":"Stata Statistical Software: Release 14.2","year":"2015"},{"key":"pone.0343690.ref022","volume-title":"Microsoft Excel computer software","year":"2016"},{"issue":"5","key":"pone.0343690.ref023","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.pcd.2019.12.006","article-title":"Prevalence of comorbidities in patients with type-2 diabetes mellitus","volume":"14","author":"S Ak\u0131n","year":"2020","journal-title":"Prim Care Diabetes"},{"key":"pone.0343690.ref024","doi-asserted-by":"crossref","first-page":"1307463","DOI":"10.3389\/fcdhc.2023.1307463","article-title":"Factors associated with diabetes concordant comorbidities among adult diabetic patients in Central Ethiopia: a cross-sectional study","volume":"4","author":"YM Negussie","year":"2023","journal-title":"Front Clin Diabetes Healthc"},{"issue":"7","key":"pone.0343690.ref025","doi-asserted-by":"crossref","first-page":"1175","DOI":"10.1007\/s13300-023-01421-5","article-title":"Multimorbidity, Polypharmacy, Severe Hypoglycemia, and Glycemic Control in Patients Using Glucose-Lowering Drugs for Type 2 Diabetes: A Retrospective Cohort Study Using Health Insurance Claims in Japan","volume":"14","author":"R Koto","year":"2023","journal-title":"Diabetes Therapy"},{"key":"pone.0343690.ref026","doi-asserted-by":"crossref","first-page":"101584","DOI":"10.1016\/j.eclinm.2022.101584","article-title":"Variations in comorbidity burden in people with type 2 diabetes over disease duration: A population-based analysis of real world evidence","volume":"52","author":"J Pearson-Stuttard","year":"2022","journal-title":"EClinicalMedicine"},{"issue":"9","key":"pone.0343690.ref027","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2023-076261","article-title":"Prevalence of comorbidities and its associated factors among type-2 diabetes patients: a hospital-based study in Jashore District, Bangladesh","volume":"13","author":"SD Shuvo","year":"2023","journal-title":"BMJ Open"},{"issue":"03","key":"pone.0343690.ref028","doi-asserted-by":"crossref","first-page":"84","DOI":"10.4236\/jdm.2018.83009","article-title":"Association between Comorbidities and Selected Sociodemographic Factors with Complications of Diabetes: Results from the National Diabetic Registry Malaysia","volume":"08","author":"NA Muhamad","year":"2018","journal-title":"Journal of Diabetes Mellitus"},{"issue":"7","key":"pone.0343690.ref029","doi-asserted-by":"crossref","first-page":"1243","DOI":"10.1185\/03007995.2016.1168291","article-title":"Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus","volume":"32","author":"K Iglay","year":"2016","journal-title":"Current Medical Research and Opinion"},{"issue":"8","key":"pone.0343690.ref030","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0181661","article-title":"Prevalence and pattern of co morbidity among type2 diabetics attending urban primary healthcare centers at Bhubaneswar (India)","volume":"12","author":"S Pati","year":"2017","journal-title":"PLoS One"},{"key":"pone.0343690.ref031","doi-asserted-by":"crossref","first-page":"586187","DOI":"10.3389\/fphar.2020.586187","article-title":"Comorbidity in an Older Population with Type-2 Diabetes Mellitus: Identification of the Characteristics and Healthcare Utilization of High-Cost Patients","volume":"11","author":"I Guerrero-Fern\u00e1ndez de Alba","year":"2020","journal-title":"Front Pharmacol"},{"issue":"1","key":"pone.0343690.ref032","article-title":"Prevalence of comorbidities and their associated factors in patients with type 2 diabetes at a tertiary care department in Ningbo, China: a cross-sectional study","volume":"11","author":"X Li","year":"2021","journal-title":"BMJ Open"},{"key":"pone.0343690.ref033","doi-asserted-by":"crossref","DOI":"10.2337\/db18-2395-PUB","article-title":"Age and Gender-Related Variations in Comorbidities among Diabetes Patients\u2014A Community-Based Cross-Sectional Study","volume":"67","author":"F Uddin","year":"2018","journal-title":"Diabetes"},{"issue":"1","key":"pone.0343690.ref034","doi-asserted-by":"crossref","first-page":"2346","DOI":"10.1038\/s41598-023-29276-7","article-title":"Obesity and risk for its comorbidities diabetes, hypertension, and dyslipidemia in Japanese individuals aged 65 years","volume":"13","author":"T Yamada","year":"2023","journal-title":"Sci Rep"},{"issue":"11","key":"pone.0343690.ref035","doi-asserted-by":"crossref","first-page":"2065","DOI":"10.2337\/dc16-1728","article-title":"Physical Activity\/Exercise and Diabetes: A Position Statement of the American Diabetes Association","volume":"39","author":"SR Colberg","year":"2016","journal-title":"Diabetes Care"},{"issue":"26","key":"pone.0343690.ref036","first-page":"470","article-title":"Body mass index, waist circumference, and the risk of type 2 diabetes mellitus: implications for routine clinical practice","volume":"107","author":"S Feller","year":"2010","journal-title":"Dtsch Arztebl Int"},{"key":"pone.0343690.ref037","article-title":"Independent association of waist circumference with hypertension and diabetes in African American women, South Carolina, 2007-2009","volume":"9","author":"TY Warren","year":"2012","journal-title":"Prev Chronic Dis"},{"key":"pone.0343690.ref038","doi-asserted-by":"crossref","first-page":"1485490","DOI":"10.3389\/fmed.2024.1485490","article-title":"Marital status and risk of type 2 diabetes among middle-aged and elderly population: a systematic review and meta-analysis","volume":"11","author":"MA Karimi","year":"2025","journal-title":"Front Med (Lausanne)"},{"key":"pone.0343690.ref039","doi-asserted-by":"crossref","first-page":"1881","DOI":"10.2147\/IJGM.S307436","article-title":"Diabetes Mellitus and Marital Status: Evidence from the National Longitudinal Mortality Study on the Effect of Marital Dissolution and the Death of a Spouse","volume":"14","author":"AJ Kposowa","year":"2021","journal-title":"Int J Gen Med"},{"issue":"1","key":"pone.0343690.ref040","doi-asserted-by":"crossref","first-page":"17","DOI":"10.3109\/13814788.2012.714768","article-title":"Multimorbidity in a cohort of patients with type 2 diabetes","volume":"19","author":"C Teljeur","year":"2013","journal-title":"European Journal of General Practice"},{"issue":"1","key":"pone.0343690.ref041","doi-asserted-by":"crossref","first-page":"11071","DOI":"10.1038\/s41598-021-90379-0","article-title":"Occurrence of comorbidities in newly diagnosed type 2 diabetes patients and their impact after 11 years\u2019 follow-up","volume":"11","author":"S Eilat-Tsanani","year":"2021","journal-title":"Scientific Reports"},{"issue":"7","key":"pone.0343690.ref042","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.3390\/medicina59071205","article-title":"Medication Adherence among Patients with Diabetes Mellitus and Its Related Factors-A Real-World Pilot Study in Bulgaria","volume":"59","author":"R Dinkova","year":"2023","journal-title":"Medicina (Kaunas)"},{"issue":"2","key":"pone.0343690.ref043","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1007\/s11892-023-01532-0","article-title":"Factors Influencing Medication Adherence Among Adults Living with Diabetes and Comorbidities: a Qualitative Systematic Review","volume":"24","author":"K Gow","year":"2024","journal-title":"Curr Diab Rep"},{"issue":"1","key":"pone.0343690.ref044","article-title":"Importance of medication adherence in treatment needed diabetic retinopathy","volume":"11","author":"C-C Kao","year":"2021","journal-title":"Sci Rep"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343690","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T18:21:36Z","timestamp":1772216496000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0343690"}},"subtitle":[],"editor":[{"given":"Patricia","family":"Khashayar","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2026,2,27]]},"references-count":44,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,27]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0343690","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,27]]}}}