Leveraging nationwide epidemiological big data for diabetes modeling and disease surveillance: an innovative approach for advancing public health policy in developing countries

Across 84 million prescriptions (2013-2023), metformin dominated treatment, but novel agents such as DPP-4 and SGLT2 inhibitors surged after 2017, reshaping the therapeutic landscape. Stark contrasts emerged: first-line metformin initiation ranged from 58.3% in underserved Sistan & Baluchestan to 91.7% in resource-advantaged Tehran; inappropriate early adoption of new agents and premature insulinisation persisted in several regions. These patterns mirror global fault lines-where innovation coexists with inequity-and underscore the urgency for adaptive, data-led policy. Our proposed multi-tier model-combining real-time digital surveillance, prescriber upskilling, and patient empowerment-offers a novel, globally relevant pathway for transforming big data into equitable, future-ready diabetes strategies in resource-limited health systems.