Journal of Diabetes and Metabolic Disorders
Volume:9 Issue: 1, 2010

Probiotics has recently been considered as an alternative biological method for chemical agents in reduction of plasma cholesterol. However, the results of human and animal studies showed various results and sometimes strain dependency and host specify of probiotic strains have explained as the possible reasons for such variations. Therefore, it seems necessary to find new probiotic agents among the native strains through in-vivo experiments.
Lactobacillus bacteria isolated from fecal samples of infants and Lactobacillus plantarum A7 was selected due to its potent resistance to biliary secretions for evaluation of its effects on cholesterol reduction in mice. Sixteen male rats were fed with a high cholesterol regimen for 14 days (pre-intervention period), and their serum blood samples analyzed for cholesterol, triglyceride, LDL and HDL. Then they randomly divided into two groups (control and treated groups). Treated group received 108 CFU/ml of Lactobacillus plantarum A7 with the diet formulation which was used in pre-intervention period for 14 days; while, the control group continued to receive the same formula and did not receive any bacteria (intervention period). Serum samples were analyzed for lipid parameters. Blood, spleen and liver samples of both groups were evaluated for translocation.
In pre-intervention period, mean values of cholesterol, triglyceride, HDL and LDL in treated group were 101.3, 105.1, 40.9 and 35.6 mg/dl, respectively and no significance difference was observed between treated and control groups. During intervention period, the mean values of cholesterol, triglyceride, HDL and LDL in treated group were 92, 97.7, 46 and 30.4 mg/dl, respectively and total cholesterol, triglyceride and LDL reduced significantly in treated group but for HDL this difference was not significant. All the translocation tests were negative for either the strain tested.
L. plantarum A7 is effective in lowering serum lipid levels in rats. Furthermore, daily usage of 108 cells of this strain could be considered safe, regarding its translocation from intestinal lumen to other organs, although more studies on safety must be done in the future.

The prevalence of diabetes is rising in tandem with the increase in the population growth rate and urbanization all over the world. Learning how to deal with the disease and keeping the blood glucose within suitable levels have become the greatest challenge for diabetics, pointing out the importance of patient education as a self-empowerment treatment modality necessary for improving the quality of life in these patients. The vast majority of diabetics believe their physicians are exclusively responsible for educating them in this regard; the role of non-physician health-care providers, however, has gained increasing acceptance in different parts of the world during the past 25 years. Many believe nurses should fulfil a leading role in diabetes treatment and care education as existing clinical and observational clinical trials have shown nurses to be capable of providing an effective quality care at lower costs. Drawing upon the expertise of nurses in providing care for diseases such as diabetes in different clinical, social and educational units, benefiting from nurses in the education programs can reduce not only the number of unnecessary referrals to specialists but also the heavy burden of such visits impose to the society. Policy makers, therefore, are urged to focus more attention on the referral system in different levels of health-care system.

The study aimed to investigate the prevalence of hypertension and type2 diabetes in Iranian elderly residents of Kahrizak Charity Foundation.
We recruited 266 volunteers among a total of 985 elderly residents of Kahrizak Charity Foundation who were ≥60 years based on stratified ward randomized sampling during 2006-2007.
Crude prevalence of hypertension was 55% in men and 67% in women. Diabetes prevalence was 21% in men and 16% in women.
diabetes and hypertension are worryingly prevalent in elderly and necessitates further studies and influential health policy decisions.

We investigated the association between three adipocytokines: resistin, adiponectinl, visfatin, and gestational diabetes mellitus (GDM) and early postpartum metabolic syndrome.
In a case-control study, 70 GDM patients and 76 healthy pregnant women were recruited from Endocrinology and Metabolism Research Center GDM Clinic, Tehran, Iran. Circulatory resistin, adiponectin and visfatin were measured in week 24-28th of pregnancy. All the participants followed until 6-12 weeks after delivery.
The concentrations of all three adipocytokines were significantly different between GDM patients and healthy pregnant women. Visfatin concentration was higher in GDM patients (10.62±8.12 vs. 4.30±4.00 ng/ml, P Our results indicate that adipocytokines may associate with GDM and postpartum metabolic syndrome. However, the efficacy of their measurement during pregnancy as a predictor of postpartum metabolic syndrome is controversial.

The aim of the study was to compare the bone turnover in healthy pregnant women and patients with Gestational Diabetes Mellitus (GDM).
A cross-sectional study was conducted on 695 pregnant women referred to five teaching hospital clinics. Universal screening was performed with Glucose Challenge Test (GCT)-50 g. Those with plasma glucose levels ≥7.2 mmol/L were diagnosed as GDM if they had an impaired GTT-100 g based on Carpenter and Coustan criteria. The levels of insulin and C-peptide were measured during OGTT-100 g test. The homeostasis model assessment index (HOMA) equation was used as the insulin resistance index. The concentrations of Osteocalcin, cross laps, and calcium were also measured.
There was a significant difference in Osteocalcin and Crosslaps levels between GDM and normal groups. Concerning bone markers and insulin resistance, after adjusting for BMI and age, in regression model the HOMA index revealed significant relation with serum levels of Crosslaps (P= 0.03, β = 0.16).
Our study showed a higher bone turnover in GDM patients during pregnancy. Specially increased bone resorption which was independently correlated with GDM may propose common defective pathways may contribute to GDM and bone loss pathogenesis.

Today, obesity is a major health problem in both developing and developed countries and investigations discovering its mechanisms are ongoing. Obesity is considered as a state of low-grade inflammation and it is believed that inflammation could be regarded as cause or consequence of obesity. Among all studied factors involved in obesity, leptin has been subject of extensive research. Leptin is a product of the ob gene and is regulated dynamically in the body. Leptin, which is mostly produced by adipocytes, has a role in satiety and is elevated in obesity. It can affect many cells in the immune system and is a target in immunological approaches. Other energy-regulating molecules are also under investigation and research in this field can help to discover new treatments for inflammatory diseases and also to reverse obesity and prevent its disastrous complications.

Much effort regarding practices for promoting health is underway nowadays. Health professions, previously being therapy-oriented, are now focused on prevention and providing health via improving lifestyles and eliminating factors that have adverse effects on public health. The aim of study is determining the effect of education on nutrition style and body mass index in employed women in Iran University of Medical Sciences (IUMS).
As a semi-experimental and interventional study, 200 volunteers were with recruited. The data collecting tool was the life style questionnaire. To analyze the inputs using SPSS software, we were used difference means, Chi-Square test and the paired t-test for forward method.
The results showed that more than 51.4% of women were obese and overweight before the educational intervention that decreased to 48.5% after education. Education improved nutrition style in 72% of women.
The results showed education had a beneficial effect on nutrition style. Regarding the fact that education entails a national intention and a detailed program that could only be implemented by the contribution and the support of the ministry's administrators, we draw the attention of the administrators and planners of IUMS towards planning and policy making in this direction.

Despite the high worldwide prevalence of diabetes, there is not accurate information of knowledge, attitude and practice of physicians in this case in our country. This pilot study was designed to answer this question.
This study was performed in collaboration with 69 physicians with various specialties. Research instrument was a questionnaire that consist some questions on four discrete areas: demographic information, knowledge, attitude and practice in the field of diabetes and its complications. Statistical method was descriptive analyzing test.
In 29 percent of all physicians, the knowledge of diabetes was enough. A negative linear relationship was found between total score on knowledge and specialized degree or increased years of practice; while relation was significant only for increasing years of practice. A negative linear relationship was also found between attitude and becoming more specialized degree and increasing years of practice, without statistically significant difference. About 36.2 percent of all physicians had a good clinical practice and majority of them (50 percent) were general physicians. A negative significant linear relationship was found between practice scores and specialized professional degree or increasing years of practice. Also, a positive significant linear relationship was observed between knowledge score and attitude (r = 0.54), knowledge score and practice (r = 0.47), and attitude score and practice (r = 0.48).
The knowledge, attitude, and practice of our physicians were not suitable in the field of treatment and control of diabetes and its complications. Holding continuing education programs with continuous surveillance is essential to improve knowledge, attitude and practice of physicians.

Leptin, an adipokine, is considered to have a role in obesity and associated metabolic dysfunction. Serum leptin has generally been reported as lower in Caucasian subjects with diabetes. In non-caucasian groups, however, the data on leptin in subjects with diabetes is more controversial being reported as lower, similar or higher than controls. We report on serum leptin concentrations in obese Pakistani subjects with type 2 diabetes mellitus and their age and weight matched controls.
We compared fasting serum leptin concentrations in 71 (11 males & 60 females) obese Pakistani subjects with type 2 diabetes attending diabetic clinic and 73 (12 male & 61 females) age and weight matched controls, from hypertensive clinic of Shaikh Zayed Hospital, Lahore, Pakistan.
The median ages of study cases and controls were 45.8 yrs and 40.3 yrs respectively. The median BMIs of study cases and controls were 32.4 and 33.4 kg/m2 respectively. Serum leptin concentrations in females and males with diabetes [median inter quartile range, 21.5 (14.1-28.7) and 11.7 (4.7-18.5) µg/L, respectively] were lower (P We report lower serum leptin concentrations in obese Pakistani subjects with type 2 diabetes mellitus. We suggest that this may be due either to altered fat distribution or to relative insulin deficiency in type 2 diabetes or both.

In this study, the effects of various degrees of maternal glucose intolerance and Fasting Plasma Glucose (FPG) during pregnancy on the prevalence of macrosomia were addressed.
In this cohort study, we recruited 1801 pregnant women who referred to perinatal clinic between July 2004 and September 2005. Gestational Diabetes Mellitus (GDM) was diagnosed by oral glucose tolerance test (OGTT) and glucose challenge test (GCT). According to the results of GCT and OGTT, patients were assigned in four groups: 1-normal GCT ( The prevalence of macrosomia in patients with GDM, IGT, only abnormal GCT and normal GCT was 15.8% , 6%, 3.6% and 1.1%, respectively; and the differences between the groups were significant (RR: 2.5; CI95%:1.99-3.12); also, macrosomia positively correlated with obesity before pregnancy (RR: 1.92; CI95%:1.36-2.73). Mean FPG in the third trimester in each group had statistically significant difference regarding to increase prevalence of macrosomia with increase in FPG values.
The lower degrees of glucose intolerance (IGT and Only abnormal GCT) rather than the Carpenter-Coustan criteria could be related with increase in the prevalence of macrosomia, and FPG itself has independent relationship with macrosomia.

Recent studies have demonstrated that resistin, an inflammatory adipokine, plays a key role in the pathogenesis of coronary artery disease (CAD). It is also known that the resistin gene (RETN) polymorphism, particularly in promoter region, is correlated with serum resistin levels and consequently an increased risk of CAD. This study investigates potential correlation between resistin gene polymorphism at -420C/G (rs1862513) and diabetes, as well as severity of CAD, in an Iranian cohort.
As a cross-sectional study, we recruited 113 subjects who were candidate for diagnostic coronary angiography. Laboratory measurements were FBS, OGTT, HbA1C, hsCRP, and lipid profile. Genotyping for Single Nucleotide Polymorphism (SNP) was performed using the PCR-RFLP method.
Our findings showed that CAD patients with diabetes had significantly higher FBS, HbA1C and cholesterol levels and more severe coronary artery stenosis compared to non-diabetic subjects. Besides, the frequencies of the RETN -420C/G genotype in the diabetic group were significantly higher as compared to those in non-diabetic group (P=0.009). Moreover, the CC genotype carriers had more than twofold increased risk of Type 2 diabetes mellitus (T2DM) compared with the GG carriers. Although, there was no statistically significant correlation between RETN -420C/G polymorphism and severity of CAD (P=0.3), when we reanalyzed data with entering both the patients with one and two involved coronary arteries as one group, it was observed that patients with CC genotype more severely suffered from the coronary artery disease than the other genotypes (P=0.04). The Odds Ratio (OR) and relative risk for CAD patients with CC genotype were 4.33 (95%CI=1.02-18.38) and 2.25 (95%CI=0.97-5.19, P= 0.04), respectively.
The results indicate that polymorphism in promoter region of RETN gene plays a role in the pathogenesis of coronary artery disease (probably due to its inflammatory characteristics) and the CC genotype is associated with an increased risk of diabetes and CAD compared to GG and CG.

Diabetes Mellitus (DM) is the most common metabolic disease in the world. About 15% of diabetic patients experience diabetic foot ulcer (DFU). Despite all the efforts in treating DFUs, the incidence of lower extremity amputations remains rather high. There are different modalities for treating this complication of DM. AngiparsTM is a novel safe herbal formulation, recently presented for treating the condition. This study presents a trial which has been designed to evaluate the efficacy and safety of AngiparsTM in treatment of DFUs in larger scale. In this randomized double-blind placebo controlled trial, a total of 300 participants (150 in each of the two arms) will be recruited from a tertiary clinic in Tehran. The patients aged between 18 and 75 years and are diagnosed with grade II or III of foot ulcer based on the Wagner's wound classification. The closure of the wound surface area is determined as the primary outcome, whereas the secondary outcome consists of ankle brachial index, toe pressure, wound bed temperature, overall clinical and patient impression of change, and the adverse effects of AngiparsTM. These factors will be measured at baseline as well as 2, 4, 6, 10 and 18 weeks after the six weeks treatment period by an individual unaware of the participant's baseline characteristics and their treatment allocation. We will also collect data and analyze intention-to-treat of our intervention. The results of this study will provide valuable new information regarding AngiparsTM, a novel herbal drug hypothesized to be effective in treating DFUs.

Diet adherence, as one of the cornerstones of diabetes self-management, is important to improve glycemic control and preventing diabetes complications. Health Belief Model (HBM) is one of the most helpful models used in health education programs. Aim of this study was to determine the effects of education based on HBM on diet obedience in type 2 diabetic patients.
In this quasi-experimental study, 128 diabetic patients referred to Fatemeh Zahra hospital of Najafabad, a city located in central region of Iran, were randomly allocated into 2 groups. The experiment group participated in four 40-minutes educational classes which were designed based on HBM. Data were gathered both before and 3 months after intervention and then were analyzed.
After the intervention, significant differences were found between groups about perceived susceptibility (P≤0.001), perceived severity (P≤0.001), perceived barriers (P=0.004) and practice (diet obedience) (P The results showed that using HBM in diabetes education program is effective in diet obedience among type 2 diabetic patients.

Specific syndromes and single-gene defects are rare causes of obesity, accounting for less than one percent of childhood obesity. Most endocrine and genetic causes of obesity are associated with short stature. The purpose of this paper was clinically and biochemically describe a toddler with insulin mediated pseudoacromegaly and in addition, to examine the response to pharmacologic therapy. The patient was a 3-year-old boy with severe obesity, pseudoacromegaly, Blount disease and acanthosis nigricans diagnosed as insulin resistance syndrome according to clinical and biochemical findings. A trial for measuring the effect of OrlistatTM on weight gain and body mass index was done.

Insulin resistance is the central defect in obesity and type 2 diabetes. In Lipid accumulation and increased Protein Tyrosine Phosphatase-1B (PTP-1B) gene expression have been reported in muscle insulin resistance. The aim of this study was to investigate the effect of PTP-1B knockdown on glucose uptake and triglyceride levels in C2C12 cells.
Reducing the expression of PTP-1B in C2C12 myoblasts was performed using the plasmids containing the shRNA against PTP-1B gene. PTP-1B protein level was assessed by western blot. The rate of glucose uptake and the intracellular triglyceride levels were evaluated in the PTP-1B knockdown and normal cells.
PTP-1B protein level in PTP-1B knockdown C2C12 cells decreased by 58% compared to the normal cells. Insulin-stimulated glucose uptake was decreased by palmitate in both the control and knockdown cells, whereas PTP1B knockdown cells treated with 0.5 and 0.75mM palmitate remained sensitive to the insulin with about 2.5 and 3-fold, respectively as well as increase in glucose uptake compared to the control cells. Treatment of the cells with 0.5 and 0.75mM palmitate resulted in 1.25 and 1.42 fold increase in triglyceride levels, respectively in the knockdown cells compared to the control cells.
The results of this study suggest that increased insulin sensitivity in PTP-1B knockdown cells can be partly attributed to increased triglyceride levels within the muscle cells. Thus, reduced PTP-1B gene expression can be a potential therapeutic target for treating insulin resistance, type 2diabetes and metabolic syndrome.

To determine efficacy and side effects of oral insulin spray (Oral-Lyn) in comparison to subcutaneously injected regular human insulin.
Fifteen patients with type 1 diabetes entered in this open-label single arm study with historical control of the same patients for 8 weeks conducted at the Endocrine and Metabolism Research Institute (EMRI). Some biochemical and hormonal lab tests were taken before and at the end of the study. All patients used Oral-Lyn spray instead of regular insulin in dinner time and peripheral glucose measurements were self-monitored by them via similar type glucometer in four different times included fasting, two hours after breakfast, before dinner and two hours post dinner time blood glucose measures.
This study demonstrated that buccal spray had not serious complications and had the same effects on blood glucose control in comparison with regular insulin injections. Also, the rate of hypoglycemia was decreased to 33.3% at the end of the study from 50% at the beginning. Hemoglobin A1C (HbA1c) values did not show any significant changes throughout the study.
Oral-Lyn provides similar postprandial glucose control and caused lower hypoglycemic episodes when compared to regular insulin injections.

Recently, immunomodulatory effect of vitamin D was documented. It was proposed that serum level of vitamin D in some populations including patients with asthma, cystic fibrosis, chronic obstructive pulmonary disease (COPD), tuberculosis and respiratory infections is lower than normal. We have evaluated serum vitamin D concentration in H1N1 infected patients.
Fifty-two patients with documented H1N1 influenza were enrolled the study during pandemic 2009 flu. Patient's demographic data was recorded and one venous blood sample (3 ml) was collected from each patient at same time a day (at morning). Serum 25 (OH) D concentrations was measured by Chemiluminescence method.
Median (interquartiles 25-75) serum 25 (OH) D concentrations in the studied population was 26.62 (13.85-45.86) nmol/l. In men and women enrolled in the study, medians (interquartiles 25-75) of serum 25(OH) D were 28.95 (21.10-44.55) and 16.72 (10.48-98.34), respectively. Serum vitamin D concentration was higher in women than men, but it was not statistically significant.
Based on vitamin D deficiency definition [serum 25(OH) D levels less than 35 nmol/l], 60.8% of the Iranian H1N1 infected patients had vitamin D deficiency.

The main goal of this study was to evaluate the possible effects of whole-body electromagnetic field (EMF) exposure on the lipid profile (total cholesterol, triglycerides, VLDL and HDL) in 16 adult male white New Zealand rabbits.
In two separate experiments, sham exposed group (control group) male rabbits were exposed to sham stimulated (without electromagnetic stimulation) for 5 days, 2 hours per day and the rabbits of treatment group were treated with triangular form 10 Hz of electromagnetic field for 5 days, 2 hours per day.
At the end of the study, after 12 hours fasting period, blood samples were isolated and levels of total cholesterol (TC), triglycerides (TG), VLDL and HDL were measured by Auto analyzer. We found significant decrease in the plasma triglyceride, total cholesterol, VLDL and significant increase in HDL levels in rabbits that were exposed to 10 Hz extremely low frequency electromagnetic field (ELF-EMF). P-values in all cases were equal to 0.001.
Our results indicated the effects of whole body EMF exposure on levels of plasma lipids. We conclude that 10 Hz pulsed electromagnetic field favorably alters metabolism of lipoproteins, TG and TC which are associated with the risk of atherosclerosis and coronary heart diseases.

Recent studies revealed that smoking causes metabolic syndrome and insulin resistance which are characterized by increased postprandial triglyceride in smokers compared with nonsmoker people. This study aimed to evaluate the effects of smoking on postprandial triglyceride in healthy smokers.
In a case-control study 78 participants aged 30-60 years (35 female and 43 male) who referred to the clinics of Khatam-Al-Anbia Hospital, Zahedan and had normal lipid levels and fasting blood sugar were recruited. Of 78 total subjects 39 were smokers and the remaining were non-smokers. Their body mass indices were between 19 to 29.9 kg/m2. Each of these patients consumed 60 g butter (containing 716 kcal energy per 100 grams and 81.06% fat). Then blood triglyceride levels were evaluated one and six hours after consumption. The results were statistically analyzed using T- test and ANOVA.
Triglyceride levels among men and women showed no significant differences (P = 0.403). In both smokers and non-smokers, fasting triglyceride levels were not significantly different, but was significantly different one and six hours after butter consumption (P In this study it was shown that in smokers postprandial triglyceride levels increased more than non-smokers, triglycerides after a meal remained longer in blood and triglyceride clearance delayed as well. The increase in triglyceride levels after a meal and smoking may consider as an important factor in the development of cardiovascular diseases.

An elevated homocysteine concentration is associated with increased risk of hypertension. Although both low- and high-dose folate reduce blood homocysteine levels significantly, the relative effects of different doses of folate on blood pressure is not well established yet. In this study we investigated the effects of administrating high-dose folic acid on homocysteine and blood pressure of hyperhomocysteinemic persons.
Forty-two individuals with hypertension and moderate/intermediate hyperhomocysteinemia received either 5 mg/day folic acid or placebo for six weeks. Baseline and 6th week blood pressures, homocysteine, folate and Vitamin B12 levels were measured.
Systolic blood pressure reduced significantly while decrease in diastolic blood pressure was not significant in folic acid compared to the placebo group (P=0.001 and P=0.17, respectively; ANOVA). Homocysteine decreased while folate increased significantly in folic acid relative to placebo group (P=0.04 and P=0.002, respectively; ANOVA]. Changes in folic acid concentrations were significantly and negatively correlated with changes in systolic blood pressure (P=0.02, r = -0.51, Pearson's correlation coefficient).
Short-term high-dose supplementation with folic acid is effective in reduction of systolic blood pressure in hypertensive hyperhomocysteinemic subjects.

Several studies have shown the beneficial effects of n-3 long-chain polyunsaturated fatty acids (n-3 LCPUFA) on autoimmune, allergic and inflammatory diseases. This study was aimed to determine the effects of low dose n-3 LCPUFA from fish oil supplement on some hematologic indexes which at the same time are non-specific markers of immunity and inflammation in a group of Iranian elderly subjects.
We investigated 114 elderly residents of Kahrizak Charity Foundation aged ≥ 65 years in this randomized, double-blind placebo-controlled clinical trial. During 6 months of this study, the placebo group received 1g capsule/day containing medium chain triglycerides, while the intervention group took 1g fish oil capsule/day containing 300 mg n-3 LCPUFA. Blood samples were collected before and after the intervention to determine hematologic indices, including white blood cell, platelet and red blood cell counts and hemoglobin and hematocrit values.
After 6 months, there were no significant alterations in the studied variables in placebo group. In intervention group, only there was a significant elevation in hemoglobin levels compared with baseline (P=0.004). By univariate analysis after some adjustment, fish oil containing low dose n-3 LCPUFA did not show any significant overall effects on the values of red blood cells, white blood cells, platelets; also hemoglobin and hematocrit.
Six months low-dose supplementation with n-3 LCPUFA derived from fish oil had no effects on the hematologic markers such as leukocyte, granulocyte, lymphocyte and platelet count in this group of Iranian elderly people.