Warning signals of elevated prediabetes prevalence in the modern Iranian urban population

•The estimated overall prevalence of DM and pre-DM were 14.1% and 32%, respectively.•Incremental pre-DM among the Iranian urban population compared to earlier studies.•It highlights the importance of improving DM awareness and screening strategies. We sought to estimate the prevalence of diabetes mellitus (DM) and pre-DM and their associated factors among a sample of the Iranian urban population between 2017 and 2019. The present investigation is a sub-study on the HAMRAH cohort study, a longitudinal population-based cohort study to assess the 10-year risk of cardiovascular diseases and their related risk factors in the adult population of the Iranian capital, Tehran. Via a multistage cluster randomized sampling method, 2123 adults aged between 30 and 75 years who had no history of cardiovascular diseases were selected for the study. With the aid of the 2010 American Diabetes Association criteria for the definition of DM and pre-DM, age and sex-specific prevalence rates were estimated. The estimated overall prevalence of DM was 14.3% (95% CI: 13.1%–15.8%): 10.4% known DM (95% CI: 9.1%–11.8%) and 4% newly diagnosed DM (95% CI: 3.1%–5.1%). Pre-DM was detected in about 29.2% of the study participants (95% CI: 22.9–36.3%). Our logistic regression analysis revealed that increasing age, higher systolic blood pressure, higher levels of triglycerides, and lower levels of high-density lipoprotein were significantly associated with DM. DM and pre-DM follow a notable incremental pattern among the Iranian urban population. This finding underscores the significance of the need to improve prevention and screening strategies in the Iranian urban population.