مجله دیابت و متابولیسم ایران
سال پنجم شماره 1 (پیاپی 14، پاییز 1384)

Concept of dietary patterns is new in the filed of nutritional epidemiology. However, it has not been focused to the extent that foods or nutrients have been considered. Although, identifying the association between nutrients and foods intake with chronic diseases is valuable yet, recent evidences have shown that the clinical trials that have used nutrients are not too successful to indicate the effects of that nutrient on the disease risk. On the other hand, the studies used dietary patterns have shown the significant effects on disease risk. Therefore, using dietary patterns analysis is an efficient method to identify diet-disease relations. However, it should be kept in the mind that dietary patterns are different across gender, ethnics, cultures and regions. It is, therefore, recommended that investigators in different countries need to assess their own community dietary patterns and emphasize on these patterns when trying to reduce chronic disease risk. The current study has been conducted to review the studies that have assessed the association of dietary patterns and chronic disease risk.

The determination of insulin receptors on RBC membrane is a suitable tool for the study of these receptors in diabetes and its related complications. The common methods for the study is the biopsy of fat or muscular tissues, cell culture or a preparation of certain amount of monocytes which is associated with some difficulties. Present study utilizes RBC's for this purpose. Certain amount of RBCs were exposed to a known amount of labeled Insulin and varying concentration of unlabelled Insulin. The competitive effect of Insulin replacement was determined by the measurement of residual receptor radioactivity. This study was carried out in three groups of healthy, poor controlled and good controlled diabetics. There were significant differences between the normal and poor controlled diabetics (P=0.017). In addition differences in receptor binding was obtained between good controlled diabetics and normal which were not significant (P=0.09). All changes were inversely proportional to the HbA1C of specimen. Using Scat chard plots the number of receptors in each group, normal, poor controlled and good controlled were determined to be 1820 (± 72.8), 1026 (±40.4) and 1230 (± 49.2) respectively. Considering the above results, it could be seen that the evaluation of the number of receptors in RBC could be a suitable tool for studying the state of insulin receptor in both physiological and pathological conditions.

Type 2 diabetic patients have 2 or 4 fold risk of coronary heart diseases. According to researches, all types of dyslipidemia independently have atherogenic properties; so it seems small dense LDL has the most effects in this case. To investigate whether glycemic control, which is assessed by concurrent HbAlc, has any favorable impact on LDL size we determined the relation between LDL size and HbAlc in diabetics. In this study, LDL size was determined by non-denaturing polyacrylamide gel electrophoresis in 81 type 2 diabetics 50 to 70 aged. BMI was calculated in all participants as weight (Kg) divided by height (m2). TG and HDL-C were measured using enzymatic kits. HbAlc was determined using immunoturbidometric method. Based on results obtained LDL size in diabetics was significantly correlated with TG (r=-0.281, P<0.05), sex (r=-0.276, P<0.05), HbAlc (r=-0.232, P<0.05) and HDL-C (r=0.215, P<0.01). In linear regression analysis TG (standardized =-0.192 p<0.054), HDL-C (standardized =0.214 p<0.05) and female sex (standardized =0.196 p<0.056) were the independent determinants of LDL size (although they showed borderline significance). HbAlc showed high co linearity with HDL-C and was excluded from the model. HbAlc is inversely correlated with LDL size in diabetics. However it is not an independent predictor of LDL size. It is likely that decrease in HDL-C levels due to poor glycemic control results in decrease in LDL size.

Lipoprotein abnormalities have been identified among the several risk factors that could account for increases the risk of CVD in diabetes. Abnormal status of B-group and antioxidant vitamins in diabetes may illustrate the benefits of these vitamins supplementation on modification of lipid profiles. As a randomized double blind placebo controlled clinical trial, 110 type 2 diabetic patients were randomly assigned to one of the five treatment groups and received one of the following supplements per day for a period of 2 months: 1) B-group vitamins including B2 (10 mg), B6 (10mg), B12 (200µg) and Folate (1000µg); 2) B-group vitamins and vitamin E (100mg); 3) B-group vitamins and vitamin C (200mg); 4) B-group vitamins, vitamins E (100mg) and C (200mg) and 5) placebo. Fasting blood samples at the beginning and at the end of 2 months trial were collected and analyzed for cholesterol, triglyceride, apolipoproteins A1 and B (apo A1 & B), vitamin E, folate, vitamin B12 in serum and vitamin C in whole blood. Differences in baselines models. Covariates and changes in variables during study were adjusted by analysis of covariance using general linear. No significant changes were found in mean serum apolipoproteins levels after 2 months of supplementation. Vitamin E variation showed significant positive correlation with variation in apo A1 (P=0.003) and apo B (P<0.001). In multiple regression analysis, serum vitamin E levels were an independent and important predictor of serum apoA1 and B levels (P=0.002 and P<0.001, respectively). Serum vitamin B12 variation was important predictor of serum apo B levels (P<0.05). Serum vitamin E level is a good predictor of serum apo A1 and B levels. Further increases in dose of vitamin supplements and intervention period are recommended for obtaining the desirable modifications.

Since by considering increases worldwide prevalence of diabetes mellitus, and its management in the short and long–term requires significant expenditure on the part of patients and healthcare providers alike, and on the other hand existing resources fall short of the country's needs in this domain, diabetes has become one of the major health priorities in our country, as it has across the globe. Assessment of injuries due to diabetes mellitus and complications are divided to two sections: 1– economic cost of diabetes mellitus and 2 – burden of diabetes mellitus. In this study we assessed burden of diabetes mellitus and complications in Iran in year 2000. We used ten years ago studies about prevalence of diabetes and complications in Iran, associated DALYs index by helping computer model (DisMod) for assessment of burden of diabetes and complications in Iran in year 2000. Burden of diabetes in Iran was 306440 years in year 2000. Burden of diabetic retinopathy, nephropathy, neuropathy, diabetic foot and lower limb amputation were 20532, 20532, 33286, 5848 and 1573 years, respectively. Pay attention to this study, we will need to reduce diabetes's burden by setting serious programs about prevention and treatment of diabetes mellitus and complications. Thus, we suggest, other studies are planning for assessment of burden of other diseases. Then after comparing burden of diabetes to other diseases, government politicians are performance priorities setting for using of our country resource.

Metformin is usually using for glycemic control in type 2 diabetes mellitus. The drug is the first line for obese patients without renal or liver failure. Different pharmaceutical types of Metformin are available. As a clinical trial, we compared effects of Aria Metformin (product of Aria pharmaceutical company, Iran) with Merck Metformin or Glucophage (product of Merck pharmaceutical company, France), in diabetic patients. This double blind randomized clinical trial study performed with 60 non- pregnant diabetic patients, in order to comparison of therapeutic effects of combination therapy (Glibenclamide + Metformin "Aria or Merck") in a 12 weeks period. We evaluated FBS, BS 2hpp, HbA1c, lipid profile, liver function tests, weight, BMI and common or uncommon side effects. Not only each of two pharmaceutical types of Metformin had the same therapeutic effects for controlling of glycemia, lipid profile and weight, but also there were not difference between them in side effects. Distention was the most common side effects of two types products (33%). There is not significant difference between them in common side effects. 70% of patients were satisfied with each two kinds of Metformin. It seems, in view of beneficial therapeutic effects of Aria Metformin, low rate of side effects, and finally low cost, Aria Metformin is a good choice.

The aim of this study was to compare time action profile of regular human Insulin produced by Exir pharmaceutical Co. and Actrapid® HM produced by Novo Nordisk with euglycemic clamp technique for the first time in Iran. Euglycemic glucose clamps were performed with two Insulin brands in a single-center, randomized, double-blind, and crossover study on 6 healthy male volunteers. Glucose disposal kinetics including metabolic clearance rate of glucose (MCRg) and metabolic clearance rate of insulin (MCRi) were determined during a 2-h predetermined intravenous Insulin infusion while blood glucose levels were maintained steady using variable continues intravenous glucose infusions based on method of De Fronzo. There were no differences in glucose kinetics or time action profile with respect to glucose infusion rates (688.4 vs. 664.6 mg/kg per 120min), MCRg (0.63±0.19 vs. 0.62±0.25 ml/kg), and MCRi(110 % vs110%) between Exir and Novo Nordisk regular human Insulin preparations. Serum insulin levels increased and serum C-peptide levels decreased with both exogenous Insulin infusions which were statistically the same for both preparations. Time action profile and bioavailability of regular human insulin produced by Exir Pharmaceutical Corporation is comparable with commonly used Novo Nordisk preparation demonstrated by 2 hour euglycemic clamp study.

Obese patients are usually thought to have an increased risk for complications in coronary artery bypass grafting surgery (CABG). Several studies have been unclear about the relationship between obesity and the risk of adverse outcomes. The aim of this study was to assess the relationship between Body Mass Index (BMI) and in-hospital mortality following CABG. Between December 2003 and February 2005, 1258 patients who underwent isolated CABG at Tehran Heart Center were included in this study. Patients were divided into three groups according to their BMI. Patients in group I had BMI<30 (non obese patients). In group II patients had (obese patients). Patients in group III had (very obese patients). Patients in each group were followed for in-hospital death and variables were compared to find any statistically meaningful relationship. No significant difference was found between non obese and obese patients (group I & II), but hypertension was more prominent in very obese patients (group III) and female sex was more prevalent in this group comparing two other groups. Mortality was more in the 3rd group as well. In non obese diabetic patients, the rate of mortality was higher than other patients. Logistic regression showed that BMI can not be considered as an independent factor to predict the risk of death in post CABG in-hospital mortality. It seems, in coronary artery bypass grafting, BMI is not an independent factor for predicting in-hospital mortality.

It is well recognized that an increased body weight is often associated with increased blood pressure. Moreover, leptin an adipocyte-derived hormone is strongly suggested to have an important role in pathogenesis of the obesity. We aimed to evaluate the levels of serum leptin in association with obesity and hypertension in a sample of Iranian obese children. Children from all the primary schools of a distinct of Tehran were screened for obesity. Children with a waist circumference equal to or above 90th percentile for their age and height were invited for the study. Anthropometric measurements were done and blood samples for fasting serum leptin levels were collected from 563 enrolled obese children. Multivariate linear regression analysis was used to evaluate relationship of various factors with obesity. Mean Serum leptin levels were 8.65 ±2.18 (ng/ml). Serum Leptin levels were higher in girls than boys (P=0.009). There were significant correlations between body mass index (BMI) and serum Leptin levels, child age, systolic and diastolic blood pressure. Systolic blood pressure and diastolic blood pressure lost their association with serum Leptin level in multivariate linear regression analysis. BMI is independently associated with Leptin levels among obese children. This may affirm a role for this hormone in the pathogenesis of childhood obesity. It seems unlikely that plasma Leptin be a major mediator of association between obesity and hypertension. However, severe hyperleptinemia may act as a risk factor for increased blood pressure.

Sirenomelia is a very rare anomaly with incidence rate of one in every 100000 births. With fused legs and other different anomalies that cant be alive more than few days after birth. Etiology of Sirenomelia is unknown, Maternal diabetes mellitus and embryonic exposure with teratogenic agents have been proposed as possible causative factors. We report a case of sirenomelia was born from a diabetic mother.