Parent Experiences During Child Hospitalization in an International Cohort: A Qualitative Descriptive Study Guided by Family-Centered Care Principles and the Socio-Ecological Model.

Diabetes mellitus remains one of the most pressing public health challenges of our time. It is a chronic metabolic disorder marked by persistent hyperglycaemia resulting from defects in insulin secretion, insulin action, or both. Type 2 diabetes (T2DM) accounts for over 90% of cases and continues to drive an escalating global burden. According to the most recent International Diabetes Federation Diabetes Atlas (11th edition, 2025), approximately 589 million adults aged 20–79 years were living with diabetes in 2024 an 11.1% prevalence that equates to one in nine adults worldwide. Projections indicate this figure will climb to 853 million by 2050, with the Middle East and North Africa (MENA) region experiencing the steepest rise: from 84.7 million in 2024 to an estimated 162.6 million by 2050. In Iraq specifically, the adult prevalence stands at 13.4%, affecting roughly 2.67 million people. Yet community-based data from Erbil City reveal that more than 90% of individuals with T2DM have uncontrolled glycaemia, largely because of poor medication adherence and limited health literacy. These statistics are not merely numbers; they represent millions of lives at risk of devastating complications in a region already strained by healthcare resource limitations. Among these complications, diabetic retinopathy (DR) stands out as the leading cause of preventable blindness in working-age adults. A comprehensive systematic review and meta-analysis by Teo and colleagues, drawing on 59 population-based studies, estimated the global prevalence of DR at 22.27% (95% CI 19.73–25.03%) among people with diabetes in 2020, corresponding to 103.12 million affected adults, with projections reaching 160.50 million by 2045. Vision-threatening DR and clinically significant macular oedema were estimated at 6.17% and 4.07%, respectively. Individuals of Middle Eastern origin face markedly elevated risk compared with Asians (OR 2.44; 95% CI 1.51–3.94), and pooled data from the Eastern Mediterranean Region show a prevalence as high as 31%. In Iraq, the picture is both concerning and incomplete. Hospital-based studies in Baghdad have identified DR as the second most common cause of certifiable blindness, while regional surveys report prevalence rates of 30.5% in Basrah and approximately 8.6% in Sulaimani Governorate (Kurdistan Region), where disease duration beyond 10 years emerges as the strongest predictor. Notably, Iraq was excluded from the most recent large-scale Eastern Mediterranean meta-analysis because nationally representative prevalence data were unavailable, highlighting an important evidence gap rather than a reflection of disease burden. The biological pathway is well understood sustained hyperglycaemia triggers pericyte loss, vascular endothelial growth factor upregulation, oxidative stress, and inflammation, culminating in capillary occlusion, neovascularization, and eventual vision loss. DR progresses silently through mild, moderate, and severe non-proliferative stages before reaching proliferative disease, often remaining asymptomatic until irreversible damage has occurred. Landmark trials the Diabetes Control and Complications Trial and the UK Prospective Diabetes Study demonstrated unequivocally that intensive glycemic control can reduce DR incidence by up to 76% and that each 1% absolute reduction in HbA1c lowers microvascular risk by approximately 25%. HbA1c therefore remains the single most modifiable therapeutic target in DR prevention and management.