Temporal Trends in Unhealthy Lifestyle Behaviors Among Adults With Diabetes in Iran: Steps Surveys, 2007–2021 Publisher



Khadem Z ; Cheraghloo N ; Farsi F ; Ebrahimpur M ; Azizpour Y ; Akbarpour S ; Payab M ; Bioky A A ; Nikoo M K ; Tavasoli N ; Ejtahed H ; Larijani B ; Mohajeritehrani M
Source: Journal of Diabetes and Metabolic Disorders Published:2026

Abstract

Purpose: Unhealthy lifestyle behaviors (ULBs) contribute substantially to poor outcomes among individuals with diabetes. This study examined temporal trends in ULBs among Iranian adults with diabetes between 2007 and 2021. Methods: Data were obtained from four nationally representative STEPwise approach to noncommunicable disease risk factor surveillance (STEPS) surveys conducted in 2007, 2011, 2016, and 2021. Adults aged ≥ 25 years with diabetes were included. ULBs comprised current smoking, insufficient physical activity, inadequate fruit and vegetable intake, and obesity. Each participant received a ULB score ranging from 0 to 4, and temporal trends were evaluated across the thresholds of ≥ 1, ≥2, and ≥ 3 ULBs, with ≥ 2 ULBs as the primary outcome. Age-standardized prevalence estimates were calculated overall and by sex, residence, and diabetes treatment status. Results: A total of 7,674 adults with diabetes were included. The prevalence of ≥ 2 ULBs increased from 55.57% in 2007 to 65.39% in 2021 (annual percent change [APC] = 1.17%), while the prevalence of ≥ 3 ULBs increased from 13.02% to 19.29% (APC = 2.86%). Obesity and inadequate fruit and vegetable intake remained highly prevalent throughout the study period. Smoking prevalence declined from 18.6% to 10.5%, whereas insufficient physical activity increased from 59.6% to 70.4%. ULBs were consistently more prevalent among females than males and remained common among individuals receiving diabetes treatment. Conclusion: Unhealthy lifestyle behaviors increased among Iranian adults with diabetes from 2007 to 2021. These findings highlight the need for sustained lifestyle interventions, particularly for women and other high-risk groups, to improve diabetes management and reduce future complications. © The Author(s), under exclusive licence to Tehran University of Medical Sciences 2026.