My life and times with enzymes and mediators.

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.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-026-02053-9.