Journal of Diabetes and Metabolic Disorders
Volume:8 Issue: 1, 2009

Obesity is a known risk factor for type 2 diabetes and its prevalence is increasing. The aim of this study was to examine the association between changes in body weight and body fat distribution and the subsequent risk of pre-diabetes and/or diabetes over a 3-year period among a population of Tehran Citizinery.
A total of 3957 subjects aged 20 years and over, participants of the Tehran Lipid and Glucose Study, were included in this study. Demographic characteristics, plasma glucose in both the fasting state and two hours after 75gr oral glucose were measured at baseline (1998-1999) and after 3 years (2001-2002). Subjects were divided according to their baseline body mass index (BMI), weight changes (loss > 4%, loss or gain 10% weight gain), quintile of changes in waist circumference (WC) and waist to hip ratio (WHR) over the study period. The relative risk of developing pre-diabetes and/or diabetes was measured after adjustment for age, sex and family history of diabetes.
After three years of follow-up, 3.7% developed diabetes. Weight gain and baseline BMI were related to risk of developing pre-diabetes or diabetes in subjects with normal plasma glucose. Compared with subjects with stable weight, those who gained weight by 4-10% and >10% had 1.2 (1.01-1.53) and 1.3 (1.04-1.86) times the risk of pre-diabetes or diabetes, respectively after controlling for age, sex, family history of diabetes and BMI. In contrast, participants who lost >4% in weight, the relative risk decreased significantly [RR: 0.4 (0.27-0.65)]. These effects of weight changes were seen mostly in female subjects. Also, according to the baseline BMI, the risk increased in overweight and obese subjects by 1.7 (1.36-2.40) and 2.0 (1.55-2.63) times, respectively. Individuals with pre-diabetes at baseline, only BMI ≥ 30 kg/m2 was associated with the increased risk of diabetes [ RR: 2.7 (1.49-4.78) ]. There was no relation between changes in WC or WHR and risk of developing abnormal glucose homeostasis after controlling for BMI and weight gain.
Weight gain and BMI were independent risk factors in the development of abnormal glucose homeostasis. The data support public health recommendations to reduce the risk of diabetes by preventing weight gain and encouraging weight loss in overweight and obese People.

Diabetes mellitus is the most prevalent endocrine disease that increases blood glucose and lipids. This disease affects cardiovascular system, kidneys, nervous system and eyes. Studies have indicated some herbal extracts have anti-diabetic effects, and can be used in diabetic patients for reducing blood glucose. Hence, in the present study, we decided to induce diabetes, which was similar to human type1 diabetes, in experimental rats and, after diabetes verification, we evaluated hypoglycemic effect of hydro-alcoholic extract of Ziziphus Jujuba leaves and blood lipoproteins (LDL, HDL, and VLDL), triglyceride and total cholesterol changes.
In the present study, 30 adult male rats were assigned to 3 groups as follows: Group 1 was treated by saline (2 ml /kg, i.p.)
Group 2 was treated by alloxan monohydrate (120 mg/kg, i.p) for 3 days alternately. Then, blood glucose was evaluated, and diabetes verified.
Group 3 was treated by alloxan monohydrate for 3 days alternately and, after blood glucose evaluation and diabetes verification, animals received hydro-alcoholic extract of Z. Jujuba (100mg /kg, i.p.) for 5 days alternately.
After 48 hours, the animals were anesthetized and the blood was collected into a tube, then, levels of serum glucose, lipoproteins (HDL, LDL, and VLDL), triglycerides, and total cholesterol were evaluated by enzymatic kits.
The analysis variance results indicated significant reduction (P = 0.001) of glucose- triglyceride- cholesterol and VLDL levels in group 3 in comparison with group 2. Z. Jujuba also increased HDL levels significantly (P=0.001) in comparison with group 2. Also, the extract reduced diabetic rats LDL level, but it wasnt significant (P=0.12) in comparison with group 2.
According to the results obtained, it was concluded that, Z. Jujuba leaves can be used in diabetics for the purpose of glucose and lipid reduction.

Stress hyperglycemia is associated with increased mortality in critically ill patients. The aim of this study was to determine the prevalence of stress hyperglycemia and its association with mortality among patients admitted to emergency department.
As a prospective study in a period of 6 months, 1031 patients admitted to emergency department, were evaluated. At baseline blood sample was taken for BS, urea, creatinine and hematocrit. At least two blood samples for FBS were taken. Patients with malignancy and those with less than 24 hours admission were excluded. Patients were classified into five groups according to FBS: 1) Stress hyperglycemia: FBS≥126 mg/dl at two times without history of diabetes mellitus; 2) Diabetics; 3) Impaired fasting glucose (110 Eight hundred Sixty six patients (480 male and 386 female) aged 54±18.1 years entered the study. The prevalence of stress hyperglycemia was 14%, Known diabetes 15.6%, IFG was 6.1%, patients on corticosteroid 7% and normal blood glucose 57.3%. Mortality was higher in stress hyperglycemic group (19.8%) compared with diabetics (3.7%), normoglycemic patients (1.4%), IFG patients (1.9%) and patients on glucocorticoid treatment (4.9%) (P=0.0001). Duration of hospitalization was longer in stress hyperglycemia compared with normoglycemic group (P=0.002) but not with other groups. Patients with stress hyperglycemia had higher ICU admission (P=0.001). Eight percent of stress hyperglycemic patients had HbA1c higher than 6%. Mortality and duration of hospital stay in this group was the same as normal HbA1c.
Stress hyperglycemia is common among emergency admissions and these patients have significantly higher mortality rate compared to other patients (P=0.001).

Over the past century, most nutrition research and policy concerning the developing world focused on poverty and under-nutrition. Now, there is a growing evidence of a major shift toward overweight and obesity in these societies. The aim of this study was to assess changes in prevalence of obesity among 14-18 years old adolescent girls in Ahvaz between years 1997 and 2006.
Two cross-sectional studies were separately carried out. In 1997, 398 adolescent girls aged 14-18 year, and in 2006, 420 girls were selected from Ahvaz senior high schools, by stratified sampling. Socio-economic questionnaires were completed, weight and height were measured, and then BMI was calculated.
We observed a statistical significant difference in BMI and weight when participants of two studies were compared, revealed a tremendous trend toward over-weight and obesity. Results reveal a 3-fold increase in the prevalence of obesity and over-weight between 1997 and 2006 (OR= 2.87, 95%CI: 1.83-4.49; P Results of this study are eloquent of the fact that prevalence of obesity is increasing among adolescent girl students in Ahvaz. Regarding the harmful ramifications of obesity, it is critical to encourage healthy eating patterns and increase physical activity among adolescent girls.

The aim of the study was to compare albumin to creatinine ratio (ACR) in the morning urine sample with the 24-hour urinary albumin excretion in diabetic patients by using facilities available in Iran, also determining correlation between them and day to day variation of ACR.
In this 8-month long cross-sectional study conducted in the year ending on 20 March 2006 in Zanjan, a 24-hour collected urine sample and 2 single morning samples were evaluated for measuring albumin by use of immune-turbidometry in 201 outpatients afflicted with diabetes mellitus type 2. The correlation coefficient of ACR in single samples and 24-hour urinary albumin excretion samples were assessed by use of Pearson correlation statistical test, and the regression analysis and its diagnostic function in diagnosing of micro-albuminuria.
Fifty one out of 201 patients (25.40%) had micro-albuminuria and 8 (4%) were afflicted with macro-albuminuria. The correlation coefficient of ACR was maximally 81% (P Until more assessment of other available laboratory kits is made, the morning urine albumin/creatinine ratio test will not be an acceptable alternative for measuring 24-hour urine albumin in diagnosis of micro-albuminuria in diabetic patients in Iran.

The association of MTHFR and metabolic syndrome (MS) has been shown in special groups of diabetic and schizophrenic subjects, but no single study has investigated this relation in metabolic syndrome subjects. Our aim was to examine the association of MTHFR gene polymorphism with metabolic syndrome, type II diabetes mellitus and hypertension in an Iranian population.
As a cross-sectional study, the relevance of metabolic syndrome, hypertension and type II diabetes was investigated. Subjects were recruited from Tehran Homocysteine survey. Fasting serum levels of blood sugar, triglyceride (TG), total cholesterol (TC), HDL-Cholesterol (HDL-C) and LDL-Cholesterol (LDL-C), homocysteine, folic acid, and B12 were measured. MTHFR polymorphism was determined using PCR-RFLP.
Of participants, 150, 191, 160 subjects met the criteria for metabolic syndrome, hypertension and diabetes, respectively. Compared to control group, frequency of CC, CT, and TT genotypes were not significantly different. In control and hypertensive groups, serum homocysteine levels were significantly higher in TT than CC and CT genotypes (P We found no significant association between MTHFR polymorphism and metabolic syndrome, hypertension, and diabetes in this Iranian population. Results of present the study should be confirmed in larger population-based studies.

According to the importance of the screening and treatment of gestational diabetes mellitus (GDM) in preventing adverse maternal and fetal complications, awareness of GDM prevalence in different parts of Iran seems to be necessary.
We reviewed studies which have been assessed the prevalence of gestational diabetes mellitus in different regions of Iran. For collecting data, online resources and local databases were searched and researchers in this field were questioned.
The information was available in 11 out of 30 provinces of Iran. Collectively 18 surveys were assessed from 1992 to 2007. The prevalence of GDM ranged between 1.3% and 10%.
A wide range of GDM prevalence was reported in different regions of Iran. For enhancement the accuracy of evaluations of the GDM prevalence, also to facilitate the comparison of data, it is suggested to apply similar protocols for definition and screening of GDM in local researches of different regions of the country.

There are some metabolic similarities between women with history of gestational diabetes mellitus (GDM) and women with polycystic ovary syndrome (PCOS); so, it has been postulated that there may be shared etiopathological factors between to conditions. The present study was designed to determine the prevalence of PCOS in women with a history of GDM.
Twenty women with and 24 without GDM were followed for two years after delivery. Clinical features, blood biochemistry, and hormonal profile were compared between two groups. Ovarian morphology was studied via abdominal ultrasonography. The National Institute of Health (NIH) and the Rotterdam criteria were used for diagnosis.
The prevalence of PCOS was higher in the GDM group than that in the non-GDM group (45% vs. 25%, P= 0.16); however, the difference was not statistically significant. The GDM group had a higher prevalence of overweight, central obesity, hirsutism, irregular menses, and PCOS than did the women in the non-GDM group. The serum levels of fasting blood sugar, hemoglobin A1C, lipid profiles, and insulin were also higher in the GDM group. Testosterone levels tended to be higher in the GDM group; significantly, free testosterone index.
There was a high prevalence of PCOS and metabolic syndrome in our sample of Iranian women with GDM which suggests a correlation between PCOS and GDM. Therefore, we recommend that all women with a history of PCOS be screened for GDM.

Oxidative stress is implicated as a final common pathway in the development of diabetic neuropathy and pharmacological interventions targeted at inhibiting free radical production have shown beneficial effects. Since Silybum Marianum (SM) is a plant rich in phenolics which their role against oxidative stress and inflammation have been shown in prior studies, we tried to determine the protective effect of aqueous extract of SM in streptozotocin (STZ)-induced diabetic neuropathy in rats.
Male wistar rats (n =40) were randomly divided into 4 groups, i.e. Vehicle-treated control (VC), Extract-treated control (EC), Vehicle-treated diabetic (VD), and Extract-treated diabetic(ED) groups. Animals in VC, EC, VD and ED groups received sterile saline or saline plus SM extract (200mg/kg) orally for 8 weeks. Diabetes was induced by a single intraperitoneal injection of STZ (60 mg/kg).
We found significant reduction in motor nerve conduction velocity, tail flick latency in hot immersion test and hyperalgesia in both phases of formalin test of diabetic rats compared to age matched non-diabetic rats. SM treatment significantly improved the nerve conduction velocity and nociception in diabetic rats. The changes in lipid peroxidation status and anti-oxidant enzyme (Superoxide dismutase) levels observed in diabetic rats were significantly restored by SM treatment.
This study provides experimental evidence for protective effect of SM extract on nerve function and oxidative stress in animal model of diabetic neuropathy.

There are conflicting data about bone density alterations in type 2 diabetic patients. Regarding the role of adipokines in glucose metabolism, they may have metabolic effects on bone mineral density (BMD) changes. The aim of this study was to determine the relationship between circulating visfatin, adiponectin and the visfatin genotype with BMD in type 2 diabetes (T2DM).
Thirty-two patients with T2DM participated in this cross-sectional study. Laboratory measurements were included FBS, HbA1C, lipid Profile, fasting serum visfatin and adiponectin. Hip and spine BMD were measured using DEXA. Genotyping for visfatin gene SNP (rs2110385) was performed by using the PCR- RFLP method.
Genotype distributions of GG, GT and TT were 37.5%, 43.8% and 18.8%, respectively. Prevalence of osteoporosis in patients with GG genotype was 33.3%; whereas, not observed in other two genotypes. Hip BMD and Z-score were significantly lower in GG genotype. We found significant correlation between circulating visfatin and hip BMD (r=-0.31). Circulating adiponectin and visfatin levels had significant correlation with hip BMD independent of BMI and age.
Our results suggest that adipokines may contribute to BMD changes in type 2 diabetes mellitus patients. Genotype variations may explain inconsistent BMD changes among these patients.

Treatment of diabetes with oral antidiabetic agents is accompanied by considerable variability in pharmacokinetics and clinical efficacy. Genetic factors may contribute to individual differences in bioavailability, drug transport, metabolism and drug action. We investigated the role of visfatin gene polymorphism (rs2110385) on required dosage of oral antidiabetic agents in type2 diabetic patient.
As a cross-sectional study, we recruited 94 patients with type 2 diabetes. Laboratory measurements were FBS, OGTT, HbA1C, fasting serum visfatin and Insulin. HOMA-IR and QUICKI indices were calculated. Genotyping for SNP was performed using the PCR-RFLP method. We recorded the amount of antidiabetic agents in the last 8 weeks before the survey according to drug dose (metformin 500mg and glibenclamide 5 mg).
We found no significant difference in FBS, G2h, HbA1C levels, Fasting insulin concentration, and HOMA and QUICKI indices between various genotypes. The required dose of glibenclamide for adjustment of glucose homeostasis was lower in genotype GG compared to others, but there was no difference in required dose of metformin between various genotypes.
It seems that visfatin gene variation modifies the insulin secretion by glibenclamide treatment.

Women with history of gestational diabetes mellitus (GDM) have higher risk for developing diabetes in the future life. The aim of the current study was to examine the association between GDM and susceptibility to type 2 diabetes and Impaired Glucose Tolerance (IGT) after pregnancy.
As a cohort study, 2416 women who had consecutively referred to five university educational hospitals in Tehran, Iran for antenatal care, were recruited. The universal screening was performed with a GCT-50g and those with plasma glucose level ≥ 130mg/dl were diagnosed as GDM if they had an impaired GTT-100g based on Carpenter and Coustan criteria. All participants followed by 6-12 weeks after delivery for OGTT-75g. Concerning American Diabetes Association criteria was diagnosed post-partum diabetes mellitus and IGT.
The prevalence of overt postpartum diabetes mellitus and IGT were 8.1% (CI 95%: 3.5-15.4) and 21.4% (CI 95%: 13.7-30.8), respectively. We found a significant difference in the prevalence of hyperglycemia (FBG>105 mg/dl during pregnancy), necessity to use insulin during pregnancy and BMI≥27 kg/m2 before pregnancy in patients who developed diabetes after delivery as compared with normal controls. Results of multivariate analysis suggested that gestational necessity for insulin prescribing and BMI≥27 kg/m2 were the two best predictors for developing postpartum diabetes. As well our findings demonstrated that the best predictors for postpartum IGT were history of abortion, gestational insulin therapy and BMI≥27 kg/m2. This correlation was present after adjusting for the age.
It seems that high glucose levels during pregnancy, necessity for insulin therapy during pregnancy, history of abortion and BMI≥27 kg/m2 are the best predictors for postpartum development of diabetes and IGT.

In traditional medicine, leaves of eucalyptus (Eucalyptus globulus Labill.) possess interesting biological properties such as antioxidant, antibacterial and antiviral effects. The aim of this study was to evaluate the hypolipidemic effects of eucalyptus ethanolic extract in non-diabetic and streptozotocin-induced diabetic rats.
In the present study, oral administration of 0.05, 0.1, 0.2 and 0.4 g/kg of eucalyptus leaves alcoholic extract for 21 days on the level of triglyceride and cholesterol in non-diabetic and streptozotocin-induced diabetic rats were evaluated. Six rats were arranged in each experimental group. A comparison was made between the effects of the alcoholic extract and a known antidiabetic agent, glibenclamide (600 mg/kg). Statistical analysis was carried out using one-way ANOVA followed by Tukey's post hoc test.
The results showed that oral administration of the eucalyptus alcoholic extract caused a significant reduction of serum triglyceride and cholesterol in diabetic rats (P It can be suggested to using leaves of eucalyptus as an adjuvant in the treatment of diabetes, however, further biochemical and pharmacological investigations are warranted to precisely elucidate the possible mechanism of action of this plant.

The elderly population is usually defined as those at least 60 or 65 years of age. In tandem with the rest of the world, Iran has seen a dramatic increase in this age group in recent decades. It is estimated that the percentage of men and women over 65 years old in 2020 will be 9.4% and 9.1%, respectively. The old are liable to suffer from coincidental diseases; decisions as to the most appropriate treatment modality should, therefore, be made on an individual basis in harmony with the physical and mental status of the patients as well as possible drug interactions. Diabetes, together with its complications such as hypoglycemia, is one of the most prevalent chronic diseases and its prevalence rises considerably by aging. Educating patients and their families empowers them to maintain their independence in the management and treatment of their medical condition. In addition, regular ophthalmologic, cardiovascular, and other laboratory examinations can reduce treatment costs and burdens and confers a better overall quality of life. Given the increase in the aged population around the globe and in Iran and the relative paucity of data on diabetes in this age group, it seems advisable that more attention be paid to raising awareness of the problems of diabetes in this age group.

Fetal macrosomia is associated with increased maternal and fetal complications. Various factors may predispose a fetus to macrosomia. The aim of the present study was to evaluate the association between serum and amniotic fluid (AF) insulin, C-peptide, and glucose and macrosomia.
Thirty-eight neonates were enrolled in this case-control study. Ten macrosomic neonates were considered as the case group, and 28 normal weight neonates were designated as the control group. AF C-peptide, insulin, and glucose were measured in both groups; also maternal and neonatal serum C-peptide, insulin, and glucose were simultaneously measured during delivery.
There was a significant correlation between neonatal (P=0.01) and maternal (P=0.006) serum C-peptide levels and macrosomia. The serum glucose levels of the mothers in the macrosomic group were also significantly higher than those of the control group. The AF insulin and C-peptide levels in the macrosomic group were higher than those of the control group; however, the difference was not significant. There was no significant correlation between macrosomia and the other factors such as placental weight, gender, neonatal Apgar score, and gestational age.
The results demonstrated that AF C-peptide and also maternal and neonatal serum C-peptide were factors that could influence fetal weight and predict macrosomia.

Aloe Vera has been introduced as a traditional anti-diabetic agent. The aim of this survey was to evaluate the effect of aqueous extract of Aloe Vera on blood glucose, serum insulin and lipids profiles in fructose-fed male rats.
The experiment was performed on 45 Wistar-Albino adult male rats that randomly divided into control (A) and four test groups (B, C, D, and E). Control group was fed with water, but test groups took fructose-enriched water (10%, w/v) and received 0, 100, 150 and 200mg/Kg of Aloe Vera aqueous extract, respectively for 4 weeks. At the end of study, animals were anesthetized, sacrificed and blood samples were collected. Serum glucose, insulin and lipid levels were measured. Obtained data were analyzed by SPSS software, via ANOVA, Tukey and Chi-square statistical tests. Results were expressed as mean±SE. Statistical difference were recognized significant by P Results revealed that serum glucose and insulin levels were significantly decreased in group E but HDL value in groups D and E were significantly increased, compared with those of the group B. In addition, water consumption in groups D and E were significantly decreased but food intake was significantly increased just in group E in comparison with those of group B.
The results obtained from this survey showed that Aloe Vera aqueous extract affects serum blood sugar, insulin and lipids profile in fructose-fed male rats. Further studies are warranted to elucidate precise involved mechanisms.

Recently, it has been suggested that resistin, as an adipokine, links obesity with insulin resistance; moreover, the resistin gene polymorphisms, particularly in promoter region, is associated with serum resistin level and susceptibility to diabetes. This study investigates the association between resistin polymorphism at -420C/G and type2 diabetes (T2DM) in Iran.
This cross-sectional study was conducted on 47 type 2 diabetic patients and 66 non-diabetic controls. Blood sample was obtained from the subjects and after DNA extraction, the SNP analysis was performed via PCR-RFLP method. Then, the association between polymorphism in -420C/G and several clinical and biochemical characteristics including age of onset, fasting glucose and HbA1c were investigated.
The frequency of CC genotype among diabetic patients (48.9%) as compared with healthy subjects (24.2%) was twofold. The relative risk for -420 CC diabetic patients were 2.99(95% CI: 1.34-6.68, P= 0.009). The C allele frequency was higher among the diabetic patients compared with healthy controls, although this difference was not significant (P=0.13). Also, diabetic patients with CC genotype had the lowest age of onset and the highest fasting glucose and HbA1c among all studied patients (P≥0.05).
The results show that polymorphisms of promoter resistin gene are associated with type2 diabetes; nonetheless, CC genotype compared to GG and CG increases susceptibility to T2DM.

It has been reported that vitamin D deficiency may predispose individuals to glucose intolerance and type 2 diabetes mellitus. Since FokI variant of Vitamin D Receptor (VDR) associates with alteration of receptor function which affects the bioactivity of vitamin D, we aimed to evaluate the association of FokI variant of VDR with various glucose metabolism indices among patients with diabetes mellitus type 2 (T2DM).
In a case series study, we recruited 105 patients with T2DM according to ADA criteria. Age at diagnosis, BMI, FBS, lipid profile, insulin levels and HbA1C were measured. HOMA-IR was calculated as index of insulin resistance. VDR genotyping was performed using PCR-RFLP method.
Of totally 105 diabetic patients (mean age 55±10 years), 79.4% were female. Frequency of FF, ff and Ff genotypes were 71.4, 5.7 and 22.8%, respectively. In patients with Ff and ff genotype, age at diabetes onset was lower, BMI>27 and poor-controlled conditions were more frequent compared with FF genotype. In patients with ff and Ff genotypes the prevalence of obesity was higher, age of onset was significantly lower, HbA1C was higher, HOMA-IR was higher and poor-control condition was more prevalent as compared to FF genotype (P=0.04). The odds ratio and relative risk for association of ff genotype with poor-controlled condition were 2.54 (CI 95%: 1.05 to 6.17) and 1.68 (CI 95%: 0.97 to 2.89), respectively.
Our findings showed that VDR polymorphism is associated with age at diagnosis and insulin resistance in patients with type 2 diabetes mellitus.