Journal of Diabetes and Metabolic Disorders
Volume:3 Issue: 2, 2004

Insulin dependant Diabetes Mellitus (IDDM) is associated with a reduction in production or secretion of insulin from pancreatic Islets. On the other hand increase in insulin secretion will result in destruction of islets that will lead to Diabetes .Therefore the factors that could regulate secretion will prevent the onset of diabetes . Glucose metabolism that commences with the glucokinase action is closely related to insulin secretion.
The aim of this study is to survey the effect of eat ions Zn2, V5 and W5 on insulin secretion and on the key enzyme, glucokinase, which is known to play an important role in insulin secretion.
20 single islets were seprated from pancreatic tissues of each normal and diabetic rats and placed in tubes containing perfusion medium . Method ions with different concentrations/ and controls were provided with each set of experiment . Insulin secretion were determined using IDMA method. Glucokinaes activity in homogenate supernatant of normal and diabetic rats was assayed by spectropho to metric methods.
the level of insulin concernlyation was shown to increase with vandate and tungsten treatment in normal and diabetic rats / and decreased by zinc .The effect of zinc on glucokinase activity was similarly reducing . Tungsten caused an increase in glucokinase activity (p The inhibitory effect of zinc on insulin secretion and the enhancing effect of tungsten correlate closely with their effect on glucokinase activity. There for the effect in insulin secretion could be assumed to be via glucokinase activation or inhibition . The effect of vandate on insulin secretion my be through other mechanisms which is not yet clarified.

Type 1A Diabetes Mellitus (T1DM) is a chronic and progressive auto- immune disorder resulting from immune mediated destruction of Langerhans islet beta cells. The etiology of T1DM like the other autoimmune diseases is unknown and many factors are involved, Both humoral and cell-mediated immunity have a critical role in T1DM pathogenesis. The cytokines, the immunomodulatory peptides, are responsible for the immune cell recruitment and producing auto-antibodies by the immune effector cells. To evaluate the role of cytokines in sensitivity or resistance to T1DM, we have employed IFN gamma to determine their gene polymorphisms and their association with T1DM.
30 patient suffering from T1DM and 40 normal control were studied simultaneously .PCR technique was used to characterize the polymorphisms of cytokine. Salting out method was performed for DNA isolation .The polymorphosime of IFN gamma gene was determined on position UTR`5.The PCR products were evaluated by Gel Electerophoresis Technique.
There was a significant difference between patient and control group in TT allele IFN gamma gene: p In this study, we found a negative association between IFN gamma gene at position 5`UTR and T1DM in study group that means this allele may be a protective factor against T1DM.

Although dietary guidelines recommend increased intake of grain products to prevent chronic diseases, epidemiologic data regarding whole-grain intake associated with metabolic syndrome is sparse. This study was undertaken to evaluate the relationship between whole-grain intake, metabolic syndrome and metabolic risk factors in Tehran adults population.
In this cross-sectional study, 827 subjects aged 18-74 were randomly selected from participants of the Tehran Lipid and Glucose Study. Usual dietary intake was assessed using a semi-quantitative food frequency questionnaire and two 24-hour dietary recalls. BMI, FBS, blood pressure, hypertriglyceridemia, hypercholesterolemia, high LDL, low LDL, metabolic syndrome (according to ATP III guidelines) and hypertension (based on JNC VI) were assessed subjects were categorized on quartile cut-points of whole and refined grain intake.
Mean (±SD) consumptions of whole- and refined grains were 93±29 and 201±57 g/d, respectively. Compared with subjects in the lower quartile category, those in the upper category of whole-grain intake had lower prevalence of metabolic risks. Conversely, those in the higher category of refined grain intake had higher prevalence of metabolic risk factors, except for diabetes. After controlling for confounders, a significant decreasing trend was observed for the risk of having hypertriglyceridemia [odds ratios among quartiles: 1.00,0.89, 0.74, 0.61, respectively], hypertension and metabolic syndrome. Higher consumption of refined grains were associated with higher risk of having hypercholestrolemia [1.00, 1.07, 1.19, 1.23), hypertriglyceridemia [1.00, 1.17, 1.49, 2.01), hypertension and metabolic syndrome.
Whole grain intake is inversely and refined grain intake is positively associated with the risk of developing metabolic syndrome. Recommendations to increase whole-grain intake may reduce the risk of developing metabolic syndrome.

Chronic complications of diabetes causes substantial mortality and morbidity. The incidence and rate of progression of these complications depends on ethnic factors. The aim of this study was to investigate the incidence of late complications of diabetes and its relation to blood glucose control in a group of diabetic patients from South of Iran.
In this retrospective study, medical records of all diabetic patients who were followed regularly during a 12 year period at outpatient clinics of Shiraz University of Medical Sciences were investigated. Information regarding age, sex, type of diabetes, duration of disease , mean fasting and postprandial blood sugar, complications (eye, kidneys, peripheral nerves, foot, cardiovascular, cerebrovascular), and timing of complications with regard to duration of disease were collected.
The study population included 392 patients (205 males and 186 females), 300 patients had type 2 and 92 had type 1 diabetes. The mean age at diagnosis was 20.4±12.8 years for type 1 and 47.5±10.4 years for type 2 patients. 95% of patients developed at least one chronic complication during the follow-up period. The incidence rates of eye , renal, and peripheral nerve complications were 51.5, 44.7, and 68.8 percent respectively. Diabetic foot problems occurred in 16.8 percent of cases and it led to amputation in 8.4 percent (33 cases) of patients. The incidence rates of cardiovascular and cerebrovascular complications were 49.7 and 15.3 percent respectively. The development of eye, renal, and peripheral nerve complications was related to blood sugar control.
Our diabetic patients developed chronic complications early and at a higher than expected rates. Future studies and more emphasis on prevention methods are recommended.

Diabetic Neuropathy is the most common and troublesome complication of Diabetes Mellitus, leading to the greatest morbidity and mortality and resulting in a huge economic burden for diabetes care. Early diagnosis of distal symmetric sensorimotor polyneuropathy, a common complication of diabetes, may decrease morbidity by allowing potential therapeutic interventions.
In 68 diabetic patients after neuropathy screening by U.K and Michigan scores, Bilateral sural nerve conduction parameters as nerve conduction velocity, latency and amplitude were determined and analysed.
54.4% of patients had Rt sural abnormal response, 50% had abnormality in left side and 39.7% had bilateral abnormality. There was significant statistical correlation between Michigan physical score and electrophysiologic finding (P-value 0.3). The most prevalent abnormal electrophysiologic finding was amplitude decrement of sural response.
Sural nerve response is one of the simplest and most sensitive peripheral sensory nerves for electrophysiologic study of diabetic neuropathy and its evaluation is recommended in all diabetic patients in spite of normal physical examination and history for detection of subclinical neuropathic cases. For increment of sensitivity, amplitude measurement of sensory response is highly recommended.

Polycystic ovary syndrome (PCOS) which is characterized by menstrual irregularities (due to chronic anovulation) and hyperandrogenism is one of the most common endocrine disorders of women at reproductive age. The precise cause of PCOS is unknown, but it seems that several factors may have role in its pathogenesis. Insulin resistance and impaired insulin secretion are common findings in PCOS patients. Approximately 30 - 40 % of women with PCOS have impaired glucose tolerance or type 2 DM. According to my knowledge, there is no published study about prevalence of IGT and type 2 Diabetes Mellitus (type 2 DM) in Iranian women with PCOS. The aim of this prospective, controlled study was to determine the prevalence of abnormal glucose metabolism in women from north west part of the country.
302 PCOS women and 116 normal women as a control group were prospectively studied. The diagnosis of PCOS was made based upon the presence of chronic anovulation and hyperandrogenemia. Other causes of hyperandrogenism were excluded by appropriate clinical and laboratory evaluations. None of the patients were known diabetics prior to study. In all patients with PCOS and control women appropriate medical history was taken and physical examination was done. Blood pressure, body weight, height, BMI, waist / hip ratio, score of hirsutism and other signs of androgen excess were determined. Serum concentrations of total testosterone and DHEA-S were measured by RIA methods in both patients and control group. Standard Oral Glucose Tolerance Test (OGTT) with 75 grams oral glucose was performed between 8 -9 AM after an overnight fast of 10 - 12 hours. Fasting and 2 - hour post - glucose plasma sugars were measured by glucose oxidase method.
Results of OGTT were interpreted according to WHO criteria. Mean age and mean BMI were similar in both patients and controls. Serum levels of total testosterone and DHEA - S were significantly higher in PCOS women in comparison with controls. 65% of patients and 68% of controls had BMI of ≥ 25 kg / m2. 55% of PCOS women and 51.6% of control women were obese (BMI ≥ 27kg/m2). 96 (31.7%) of PCOS women had impaired glucose tolerance (IGT) and 27 (8.9%) were diabetics. The prevalence of IGT and diabetes in controls were 14.6% and 5.1% respectively. In non-obese PCOS women the prevalence of IGT and DM were 17.2% and 3.6% respectively, while only 8.9% of control women had IGT and 1.7% were diabetics. Finally, 44.1% of obese PCOS women were glucose intolerant and 13.5% had diabetes mellitus in comparison with 20% and 10% of controls.
It is concluded that the prevalence of IGT and DM in both obese and non-obese PCOS women were significantly higher than in control women. Screening of all PCOS women for IGT and DM is highly recommended.

Coronary heart disease is the leading cause of death in many nations. .Hyperlipidemia with elevated serum total cholesterol, LDL cholesterol and triglyceride are known as cardiovascular risk factors. HDL cholesterol is considered to be a protective factor. Any effort for management of dyslipidemia directly reduces cardiovascular mortality and morbidity and cause increasing public health .The ignorance of the extent and impact of hyperlipidemia prompted us to determine the prevalence of hyperlipidemia in Rafsanjan urban population over than 20 years old.
In this study 247 men and 244 women were evaluated for serum total cholesterol , LDL cholesterol , HDLcholesterol and triglyceride levels.Blood samples were obtained at morning, after 14 hours fasting and for data analysis SPSS-11 soft ware was used.
Mean age of subjects was 38.35±13.14 years.High cholesterol level was present in 20.6%, LDL levels were high in 10.8% , 5.7% had elevated level of triglyceride and 8.4% of participants had low HDL cholesterol. Total cholesterol , LDL cholesterol and triglyceride levels were significantly increased by age and HDL levels were also decreased by age.
According to our finding about 29% of studied population had at least one lipid abnormality and this important finding showed very high prevalence of dyslipidemia and requires specific attention and planning.

This study was designed to compare the effects of fluoxetine and imipramine on fasting blood glucose (FBG) in patients with major depressive disorder.
Non-diabetic patients, with major depressive disorder (based on DSM-IV criteria) entered this randomized, double - blind study. Patients did not receive any medication affecting serum FBG levels at least for 2 weeks prior to the initiation of the study. Patients were assigned to receive 20 to 40 mg/day of fluoxetine or 75 to 200 mg/day of imipramine for 8 weeks. Benzodiazepines were allowed when needed for anxiety, agitation or sleep. Pregnant women, and patients with diabetes mellitus, and history of major heart diseases were excluded from this study. Additionally, none of the patients should have received electroconvulsive therapy (ECT) within 6 months prior to initiation of the antidepressants. FBG levels were measured at the initiation of study as well as 4 and 8 weeks after starting antidepressants.
Nineteen patients in the fluoxetine and 24 patients in the imipramine groups completed the study. In the fluoxetine group, FBG level was decreased from 88.5 mg/dL (baseline) to 85.0 mg/dL at week 4 (P=0.73), and to 79.8mg/dL at week 8 (P This 8-weeks study showed that FBG levels may decrease in depressive patients receiving fluoxetine and may increase in those patients treated with imipramine. Therefore, it is suggested to measure and monitor FBG before initiation and during treatment with fluoxetine and imipramine.

Increased echogenicity of pancreas, due to hemosiderosis, is a frequent finding in b - thalassemic paitents. Hemosiderosis also leads to b - cell dysfunction. So diabetes and glucose intolerance are common consequences of hemosiderosis. The aim of this study was to investigate the association of increased pancreas echogenicity (IPE) with insulin sensitivity in b - thalassemic children aged 10-20 years.
After exclusion of thalassemic paitents with diabetes or familial history of diabetes, pancreas ultrasonography was performed in 42 b-thalassemic children and they were divided into 2 groups with normal (21) and increased (21) pancreas echogenicity. Serum ferritin was measured, as well as serum insulin and glucose values, during an OGTT, at 0, 30, 60 and 120 minutes. A control group was selected randomly (n= 23). Insulin Sensitivity Index and Fasting Glucose/Insulin Ratio were calculated and the data were analysed using t-test and ANOVA statistical methods.
Serum feritin differed significantly between 2 groups of thalassemic paitents (P0.05). Serum feritin was inversely correllated with ISI in patients IPE and 28.6% of them had IFG, as compared to patients with normal echogenicity (P

Previous in vitro and animal studies have supported a role for growth hormone in development of diabetic nephropathy. The purpose of this study was to investigate the relation between basal and stimulated growth hormone and proteinuria in type 2 diabetic patients.
21 type 2 diabetic patients with macroalbuminuria were selected. Fasting insulin, basal and levodopa stimulated growth hormone levels were measured. The control group consisted of 21 type 2 diabetic patients with 24 hr urine protein of less than 50 mg. The two groups were matched according to sex, age, duration of diabetes, body mass index, creatinine clearance, fasting blood sugar, glycosylated hemoglobin, and blood pressure.
The patients with macroalbuminuria had higher basal growth hormone (3.1 ± 2.6 vs 1.25 ± 0.7 ng/ml, P = 0.024). Stimulated growth hormone and fasting insulin levels were not significantly different.
There is direct relation between basal growth hormone and development of diabetic nephropathy and this relation suggests a role for growth hormone in human diabetic nephropathy.

Obesity is a serious public health problem in developing countries due to its association with the cardiovascular risk factors. Childhood obesity is responsible for a number of different complications both during childhood and adulthood. The aim of the present study was to determine the cardiovascular risk factors in overweight and obese Iranian children.
We screened 13086 children aged 7-12 years by measuring waist circumference. Those with a waist circumference ≥61 cm were selected for further evaluation. Anthropometric measurements were done and blood samples were taken from 563 enrolled overweight/obese children (284 boys and 279 girls). We determined cardiovascular risk factors (including fasting total cholesterol, LDL-C, HDL-C, triglycerides, blood pressure). In addition we measured the fasting blood sugar, insulin, apo-A , apo-B and leptin levels.
Only 2.7% of overweight or obese children had no risk factors. While, 20.6% had one and 70.85% had two or more risk factors. The prevalence of high total Cholestrol levels was 42.6%. HDL-C showed an acceptable level in 92.4%of children .There were strong correlations between BMI and serum apoB and leptin levels (p The high prevalence of cardiovascular risk factors in overweight and obese Iranian children emphasizes the need for prevention and control of childhood obesity from early childhood in our country.

Diabetes Mellitus is a common chronic disease with severe of complications. Proper glycaemic control can prevent these complications considerably. Evaluation of effectiveness of community based and patient centered interventions on glycaemic control, quality of life, patient satisfaction, patient knowledge and reported symptoms were the main aims of this research.
In a clinical trial, patients referring to Iranian Diabetes Association, who were more than 18 years old, divided to intervention and control group randomly. After three months of general interventions in both groups, including diabetes education and specific interventions including telephone calls, continuous corresponding and sending educational issues in intervention group, changes in variables were studied.
Among 52 patients in each group, 17 were male and 42 had type 2 diabetes. The average age was 49 in intervention and 51 in control group. Two groups had no significant difference in age, sex, type of diabetes, treatment method and duration of diabetes, other diseases and education. Both groups showed significant improvement in glycaemic control. The mean reduction in HbA1c was 1.45 in intervention and 0.86 percent in control group; the difference is statistically significant (P= 0.02). Patient satisfaction increased in both groups. The satisfaction is significantly higher in intervention group (P=0.000). Knowledge has increased significantly in both groups; the difference in groups is not significant. The improvement in Quality of Life was just significant in intervention group. The reported sign and symptoms have not changed in both groups.
Community based and patient centered interventions with emphasis on continuous education and support can improve glycemic control, quality of life, patient satisfaction and patient knowledge in diabetes mellitus.

The precise mechanisms of vascular diseases in insulin dependent diabetes mellitus (IDDM) are not clearly understood. There are evidences of alteration in mechanisms involved in regulating vascular tone including increased ACE activity in some tissues. To investigate the effect of insulin treatment on these changes this study was performed.
Three groups of 8 male Sprauge Dawely rats including control (C) and two diabetic groups (D, IT) were used in this study. Diabetes was induced by injection of 60 mg/kg STZ ip. After induction of diabetes IT group were treated with insulin (10 units/kg/day s.c.) for four weeks. The control group and the untreated diabetic group were treated with the same amount of Saline and for the same time. ACE activity was determined by HPLC method.
4 weeks after induction of diabetes, SBP and ACE activity in serum, lung, heart and aorta increased in D group compared to control rats. Insulin treatment reversed these changes to normal values in IT group.
It is concluded that increased ACE activity could contribute to the development of diabetic vasculopathy and ACE reducing activity of insulin may be partially involved in decrease of cardiovascular complications in diabetes.

Previous clinical and experimental studies suggest the valuable effect of antioxidants on lipids status. The present study was designed to investigate the efficacy of silymarin treatment as an antioxidants on lipids profile in type II diabetic hyperlipidemic patients.
A 4-month randomized double blind clinical trial was conducted in 54 non-insulin dependent diabetic hyperlipidemic patients in a two well - matched groups. First group (n=29) received 200mg silymarin tablet 3 times a day plus standard therapy, while the control group (n=25) received placebo tablet 3 times a day plus standard therapy. The patients were visited monthly and fasting blood glucose, total cholesterol, LDL, HDL cholesterol, triglyceride, SGOT and SGPT were determined at the beginning and at the end of the study after four months.
Results revealed that in silymarin treated patients, fasting blood glucose, LDL and total cholesterol, triglycerid, SGOT, SGPT and glucose level at the end of the study were significantly decreased as compared to beginning of the study. In placebo treated patients fasting blood glucose level at the end of the study were significantly increased as compared to beginning of the study.
In conclusion, the silymarin as an herbal antioxidant have beneficial effects on reducing glucose and lipids profile in type II diabetic patients.