Iranian Journal of Diabetes and Obesity
Volume:5 Issue: 3, Autumn 2013

Homeostasis model assessment of insulin resistance (HOMA-IR) is a simple and practical method for estimation of insulin resistance (IR), but a reliable reference interval (RI) of HOMA-IR is needed to deduce the threshold level to define IR. This RI has been controversial in different populations and even more divergent when considering factors like age, gender and body mass index (BMI). This pilot study aimed to establish RI for HOMA-IR in Alexandria governorate, Egypt based on the EP28-A3c document from the Clinical and Laboratory Standards Institute (CLSI). The reference sample population included 308 healthy nondiabetic normotensive adult men aged 20-69 years with BMI 18.7-29.4 kg/m2. Serum glucose and insulin were measured by glucose oxidase method and by electrochemiluminescence immunoassay respectively, and then HOMA-IR was calculated. The data was analyzed by non-parametric statistical methods; the values were log transformed, then outliers were truncated, and finally the reference values were constructed using 2.5th and 97.5th percentiles as lower and upper reference limits. There was no significant difference in HOMA-IR according to age or BMI; thus, the RI was established from the whole participants and it was 0.4-3.5, and subsequently values above 3.5 can be suggestive of IR status. Although the reported RIs are based on recommended standards, larger scale studies including female subjects are warranted to enable the adoption of such values in laboratories in Alexandria.

Previous studies have indicated the hyperglycemia-induce cell death in various tissues such as brain, kidneys, liver and especially in the testis. Recent studies have reported that diabetes can trigger male infertility. In this study we report the histological analysis of the testis tissue after diabetes type 1 induction in wistar rats. At various time intervals after diabetes type 1 induction, testicular cell was assessed in the controls and in the diabetic rats. Hyperglycemia was induced in male wistar rats by intraperitoneal injection of drug streptozotocin (STZ). At different time points (4, 6, 8 and 20 weeks) post diabetes type 1 induction, rats were euthanized and testicular tissues were removed for histological analysis. Their testes were fixed in formaldehyde (37%), embedded in paraffin and then sectioned (4µm thick). They were further deparaffinized, stained with Hematoxylin-Eosin (H&E) and DAPI, and observed under light and fluorescence microscope, respectively. Histological results showed reduced cell density in testis, which indicates that diabetes type 1 and hyperglycemia conditions impair normal cell density in testis tissue. The changes in seminiferous tubules from 4 weeks to 20 weeks were also observed. The testicular histology of diabetic animals shows that the maximum reduction in cell density occurred after 20 weeks. The induced diabetic condition provides evidence that hyperglycemia plays an important role in pathogenesis of diabetes, and also indicated that chronic hyperglycemia eventually leads to cell death and male infertility. Probably, the consequent of inflammatory condition of hyperglycemia resulted in apoptotic-related gene products and testicular dysfunction which has an important implication for infertility, and offer new chances for therapeutic interventions.

Diabetic peripheral neuropathy is the main risk factor of diabetic foot ulcer and its early diagnosis is important to prevent limb amputation. We assessed the prevalence of peripheral neuropathy in diabetic patients. This cross-sectional study was performed on 352 randomly selected diabetic patients using a standardized questionnaire including age, gender, duration of diabetes, BMI, smoking status, HbA1c, fasting blood glucose, serum creatinine, triglyceride, cholesterol and uric acid as well as past medical history. Peripheral neuropathy was evaluated using United Kingdom Neuropathy Score screening test and 10 gram Semmes Weinstein monofilament tests. Ankle-Brachial Index was also used for detecting peripheral arterial disease. Forty-eight percent of patients were male and 52% were female; Mean age of the subjects was 57.0±10.3 with a median duration of diabetes of 12.6±7.5 years. The overall prevalence of neuropathy was 59.3%; 40.3% of patients failed to sense the monofilament. There was a statistically significant correlation between the results of United Kingdom Neuropathy Score screening test and 10-point monofilament testing (r=0.43, P<0.001). The prevalence increased with age, from 5.6% in the participants aged less than 40 years to 51.8% in patients more than 60 years. Neuropathy was associated with duration of diabetes, and was present in 14.1% and 34% of patients with diabetes duration less than 5 years and greater than 15 years, respectively. The prevalence of neuropathy was not significantly different between men and women. Our study showed significant correlation between neuropathy and history of cerebrovascular accident. Diabetic peripheral neuropathy is a common complication associated with diabetes. It increases with both age and duration of diabetes.

The aim of this study was to compare the body fat parameters in individuals with and without metabolic syndrome using an objective method. This case-control study was performed in Tehran and consisted of 105 individuals with age range of 20 to 55 years. All participants were overweight and obese. NCEP ATP III criteria were used for identifying subjects with metabolic syndrome. Waist circumference, weight and height were measured by an expert person and with non-elastic tape measure, balanced beam scale and standing stadiometer, respectively. Fat mass was measured using BIA (model: Tanita BC 418). Mean age of total participants, case group, and control group were 35±14, 35.85±6.9 and 34.98±8.1 years, respectively. Mean BMI in case group was higher than control group (P<0.01). There was no significant difference between case and control groups for total body fat, right hand fat, as well as right and left leg fats. But there was significant difference between the two groups for trunk and left right hand fats, before controlling of confounding factors. After controlling confounding factors this observed difference was disappeared. One unit increase in BMI raised the development odds of metabolic syndrome by 1.14% (95%CI: 1.02-1.27). We found that BMI is a more accurate predictor of MetS rather than body fat mass. However, other predisposing factors especially at molecular levels are needed to clarify underlying mechanisms of this syndrome.

There is some evidence that causal beliefs are related with adherence behaviors. The aim of the present study was to explore the relationship between illness causal beliefs, demographic factors and medication adherence among a group of patients with type 2 diabetes. Ninety-three patients with type 2 diabetes participated in this study using convenience sampling method. The participants completed the subscale of Cause of Illness Perception Questionnaire-Revised (IPQ) and Medication Adherence Rating Scale (MARS). To analyze the data, the statistical methods of Pearson correlation coefficient and simultaneous multiple regression analysis were conducted. Participants perceived that psychological factors such as stress and emotional state play an important role in their illness. They also perceived that immunity and accident have little part in their illness. Results showed a significant correlation between age and medication adherence (r=-.20, P<0.05). Furthermore, the findings indicated that the education was not related to adherence. The findings did not show any significant correlation between the component of illness causal beliefs (psychological attribution, risk factors, immunity and chance/accident) and medication adherence. However, medication adherence correlated positively and significantly with illness causal beliefs of God (r=0.24, P<0.05) and destination (r=0.28, P<0.01). According to the results of the multiple regression analysis, destination predicted medication adherence (β=34, P<0.05). This study highlights the importance of assessment of patients'' beliefs about their illness. Understanding patients'' illness causal beliefs can help practitioners improve medication adherence.

Adolescence is a period of life in which the individuals face many mental problems concerned with mental body image. Obesity could be the cause of dissatisfaction and makes adolescents’ self-esteem to decrease. This study aimed to examine the adolescents’ satisfaction of their body image correlated to their self-esteem. In this cross-sectional study all of the boy and girl students (N=8,510) aged 15-17 in Abadan high schools were examined for their body mass index (BMI). Students with BMI above 95% were selected as the research sample. Instruments of the study included: (1) the Multidimensional Body-Self Relations Questionnaire (MBSRQ) and (2) the Cooper Smith self-esteem Questionnaire. Individuals’ data also included age, gender, education, parents’ education and parents’ work. Data were analyzed using SPSS version 17. Descriptive and inferential statistics including Chi-Square (χ2), Pearson and Spearman correlation analyses were used. The prevalence of obesity among the adolescents aged 15-17 years was 5.99%. Obese adolescents could be divided into the categories of low (42.2%), moderate (43.9%) and high (13.9%). Low and high self-esteem was found in 63.3% and 36.7% of fat adolescents, respectively. There were significant relationships between the satisfaction of body image with self-esteem (P<0.001) and with BMI (r=-0.093, P=0.036) among fat adolescents. Obesity could be one of the main factors decreasing adolescents’ body image and consequently their self-esteem. Encouraging adolescents to do the exercises and healthy diet could prevent this problem. Further research may be done on this issue around Iran.

Abnormal values of the transient ischemic dilation (TID) ratio are associated with severe and extensive coronary artery disease (CAD). TID can be used as a diagnostic and prognostic marker of CAD in diabetic patients. The aim of current study was to determine the pooled estimate of TID ratio in single myocardial perfusion scan in diabetic patients by a systematic review and meta-analysis. The electronic databases of PubMed/MEDLINE, Scopus (EMBASE), Web of Science, and Cochrane Library up to December 30, 2013 were searched. The reference lists of all included studies were searched for further studies. The search strategy was according to PICO characteristics. The heterogeneity between the studies was accounted with P<0.1. The random/fixed effect model was used according to the heterogeneity. Point estimates were pooled estimate of TID ratio with 95% confidence interval (CI) by pooling available data. Egger’s test was used to assess publication bias. The primary search contained 423 studies. Totally, 17 studies met the inclusion criteria and the critical appraisal scores. The TID ratio in four single pharmacological stress studies with angiographic evidence of low risk or normal coronary artery disease was 1.079 (95% CI: 1.07-1.089). Our findings were achieved according to the purpose of the study and the pooled estimate of TID±SD was calculated. The pooled estimate of TID was so smaller than the TID calculated in individual studies and so precise.