Iranian Journal of Diabetes and Obesity
Volume:5 Issue: 4, Winter 2013

Thyroid dysfunction complicates the metabolic derangement observed in Diabetes Mellitus (DM). It is necessary to recognize and treat it, when present, in order to achieve stability of metabolic control in these patients. The aim of this study was to investigate the effect of DM on thyroid hormone levels and other biochemical variables. To determine the incidence ofabnormal thyroid hormone levels in diabetics in Nepalgunj medical college and Hospital (Nepal), blood samples from 100 diabetic subjects and 100 non-diabetic controls were taken between 1st February, 2012 to 31st January, 2013 for investigation of free triidothyronine (FT3), free thyroxine (FT4), thyroid stimulating hormone (TSH), fasting plasma glucose (FPG), serum cholesterol, serum triglycerides, high density lipoprotein (HDL), low density lipoprotein (LDL), very low density lipoprotein (VLDL), blood urea, serum creatinine, total protein, albumin, serum glutamate oxaloacetate transaminase (SGOT) and serum glutamate pyruvate transaminase (SGPT). Our findings showed that the level of FT3 and FT4 were significantly lower while the level of TSH was significantly higher in type 2 diabetics as compared to non-diabetics. From the 100 diabetic subjects that were studied, 29% showed abnormal thyroid hormone levels (24% hypothyroidism and 5% hyperthyroidism).The incidence of hypothyroidism was more in females (16%) as compared to males (8%) in type 2 diabetes. Failure to recognize the presence of these abnormal thyroid hormone levels in diabetics may be a primary cause of poor management often encountered in some treated diabetics.

Interruption of rennin-angiotensin-aldosterone system has become a leading therapeutic strategy in the treatment of diabetic nephropathy; however, ACEIs and ARBs do not uniformly suppress the rennin-angiotensin-aldosterone system. Plasma aldosterone levels are elevated in a group of patients despite therapy and this phenomenon known as aldosterone escape or aldosterone break through. Forty-two type 2 diabetic patients with overt proteinuria were randomized into two groups and according to double-blind case-control study, one group was treated with spironolactone and others were treated with placebo for 4 months. Twenty-four hours urine protein, glomerular filtration rate (GFR) and blood pressure were measured at baseline and after 4 months of treatment. Serum potassium was checked at baseline and one month of treatment. Urine protein decreased in case group by 26.5% at the end of 4 months, but increased in control group by 17.9% (P=0.003). GFR did not have any significant change in case group (P<0.354), but decreased in case group significantly (P<0.001). Our study showed that spironolactone 12.5 mg/day is safe (without hyperkalemia and gynecomastia) and effective to decrease proteinuria in diabetic patient with CKD1-2.

Globally, 3-5.2 percent of people suffer from diabetes which is one of the most serious metabolic disorders resulting in an increase in inflammatory biomarkers e.g. interleukin-6, tumor necrosis factor-alpha, and C-reactive protein. The aim of this study was to investigate the relationship between inflammation, oxidative stress and fasting blood glucose, lipid profile and anthropometric parameters in patients with type 2 diabetes. This study was conducted as a crosssectional study in Tehran through 2009-2010 on 45 men and women aged 35-65 years old with type 2 diabetes. Blood glucose, lipid profile, C-reactive protein, and malonedialdehyde were measured. Independent sample T-test and linear regression analysis were used. Fasting blood glucose, malonedialdehyde, total cholesterol and body mass index were higher in women than in men; but there was no difference between two sexes in other factors. Malonedialdehyde, neither directly nor after adjustment for sex was not related to fasting blood glucose, total cholesterol, triglycerides and anthropometric indices (weight, body mass index, and body fat mass). This study showed that oxidative stress had not any relationship with blood glucose, lipid profile, and anthropometric index, but inflammation was related to glycemia, body mass index, and fat mass. Control of inflammation and oxidative stress is necessary for accelerating treatment process and preventing complications due to them.

It is well known that diabetes is one of the main health challenges. According to the evidence presented in recent years by investigators, serum uric acid has emerged as a possible risk factorfor diabetes mellitus. The aim of the present study was to compare the mean serum uric acid and the antioxidant activity of glutathione levels in patients with diabetes and the control group. This cross-sectional study carried out on 30 diabetic patients (51.3 ±13.8 years, 15 males and 15 females) as well as 30 non-diabetic controls (54.2 ±13.4 years, 15 males and 15 females). The uric acid and glutathione levels were measured by Uricase-PAP method and glutathione the butler (DTNB) methods, respectively. Analysis was performed using SPSS version 20. Statistical significance was defined as P<0.05. Mean serum uric acid levels in diabetic patients (2.87±0.63 mg/dl) was lower than the control group (3.76±0.7 mg/dl). Also, mean total glutathione in diabetic group (181.64±38.7 μmol/l) was lower than the control group (273.6±39.28μmol/l).Differences in uric acid and glutathione levels between the two groups were significant (P<0.05). This study indicated that serum uric acid and glutathione levels changed in diabetic patients compared to healthy control subjects. It may be related to the biochemical interaction between serum glucose and purine metabolism, with increased excretion of uric acid during hyperglycemia and glycosuria. The present study revealed that evaluation of the levels of biochemical factors in diabetic patients at different stages of the disease, can be helpful in their condition.

Insulin resistance and hyperinsulinemia are common among the women with polycystic ovarian syndrome (PCOS). Familial aggregation of PCOS has implications on the role of heredity in this disease. The aim of this study was to evaluate insulin resistance among the fathers, mothers, and siblings of the women with PCOS referring to the clinics affiliated to Shiraz University of Medical Sciences. The present case-control study was conducted on 107 individuals as the case group and 107 individuals as the control group. After recording their height and weight, blood samples were obtained from all the participants in order to assay their serum insulin and blood sugar. Then, the participants were supposed to drink 75 gr glucose solutions and after lapsing 2 hours, blood samples were again taken from all the participants. Finally, the data were analyzed using independent t-test, Fisher's exact test, and chi-square test. P-values less than 0.05 were considered asstatically significant. All the statistical analyses were performed through the SPSS statistical software (ver. 11.5). A significant difference was found between the two groups regarding glucose intolerance, obesity, and insulin resistance according to Homeostasis Model Assessment Index (HOMA) and Quantitative Insulin Sensitivity Check Index (QUICKI), and fasting insulin indexes (P<0.05). Moreover, a significant association was observed between android obesity and glucose intolerance (P<0.05), body mass index (≥ 30 Kg/m2), and type II diabetes in the two groups. The first-degree relatives of the women suffering from polycystic ovarian syndrome constitute a risk group and early identification of insulin resistance may prevent the onset and progression of the disease.

Patients with type 2 diabetes mellitus (DM) have a markedly increased risk of cardiovascular morbidity and mortality. There are some recommendations for prescription of aspirin in these patients. Our purpose was to determine aspirin usage rate in diabetic patients and to compare it in different ages and based upon cardiovascular disease (CVD) risk factors. In this study we collected data from 1256 self-reported diabetes mellitus patients referred to Yazd Diabetes Research Center during 2010-2011. This data included age, sex, history of diabetes mellitus, drug history, antiplatelet therapy duration, smoking, hypertension, dyslipidemia, family history of premature CVD and albuminuria. 48.5% of patients were male (609 patients) and 51.5% were female (647 patients). From female patients ≤60 years old, 52.7% used antiplatelet drug; however, this percent for patients over 60 years was 58.9% and for male patients ≤50 and >50 was 47.7% and 81%, respectively. From antiplatelet drug users, 43.1% of males aged ≤50 and 29.2% of females aged ≤60 years old had no or one risk factor that is unnecessary to take it. Physician must encourage diabetic patients to use aspirin when the potential benefit of a reduction in cardiovascular disease outweighs the potential harms. So, clinical judgment is required for prescription of aspirin in men aged ≤ 50 years and women aged ≤ 60 years without multiple risk factors.

In this presentation, a case of bilateral choroidal folds in patient with diabetic retinopathy was reported. By our knowledge, this case presentation is the first report of choroidal folds in diabetic retinopathy, which bilateral symmetric and horizontal folds arranged in macula. The thick choroid that is developed in diabetics may be a cause of these folds but the source of difference in patterns is unknown.