Journal of Diabetes and Metabolic Disorders
Volume:3 Issue: 1, 2003

Celiac disease and type1 diabetes mellitus have been linked to identical HLA markers and chromosomal loci, which may account for the co-occurrence of these two disorders in a significant subgroup of population. We designed a study to investigate the frequency of gliadin antibodies, a marker for coeliac disease, in diabetic patients.
In this study 182 diabetic patients (52 with type1 and 130 with type2 diabetes) were screened for anti-gliadin IgG by indirect immunofluorescence. Age range was 3-29.5 and 42-65 years for type 1 and type 2 diabetes groups.
Anti-gliadin IgG was positive in1.9% and 1.5% of patients with type 1and type 2 diabetes. The reported frequency of anti-gliadin seropositivity is 0.02% among healthy blood donors in Tehran.
The frequency of anti-gliadin seropositivity is 30 and 24 times higher in type 1 and type 2 diabetic patients, respectively, comparing with the general population of Tehran. This concurs with reports elsewhere of the higher prevalence of coeliac disease in diabetic populations. The relatively low sensitivity and specificity (both around 80%) of the gliadin antibody test makes it a less-than ideal- experimental diagnostic tool, but the IFI assay is quick and inexpensive and therefore suitable for population screening programs, which we recommend in all at-risk patients with diabetes.

Diabetes mellitus is the most common endocrine-metabolic disorder in childhood and adolescence. As many as one in five insulin-dependent diabetics may have thyroid antibodies in their serum; the prevalence is 2-20 times greater than that observed in general populations.
It this study we measured Tpo-ab, Tg-ab, TSH and HbA1C in 48 children and adolescents with diabetes and compared it with a control group that matched for sex and age. Clinical data including sex, age at onset and duration of diabetes, family history and sign and symptom of thyroid disease and goiter were recorded. Statistical analysis was made using SPSS soft wear.
In diabetic group 12 patients had positive thyroid auto antibodies; Tg-ab was positive in ten and Tp-ab was positive in nine and both were positive in seven patients. The prevalence of thyroid antibodies in our study was 25% and in control group no one had thyroid antibodies (P=0.006). Among 12 patients with autoimmune thyroid disorder, three had hypothyroidism.
The prevalence of autoimmune thyroid disorder was not influenced by the sex, age, duration of diabetes and HbA1C. In conclusion about one-fourth of our diabetic patients had thyroid antibodies, and yearly routine determinations of thyroid antibodies are recommended.

There have been conflicting reports about the effect of diabetes and the lifestyle of diabetic patients on bone mineral density (BMD). The aim of this study is to investigate the relation between effects of life style in type 2 diabetic patients and BMD at lumbar spine and proximal of femur in pre and postmenopausal women.
In a historical cohort study 20 type 2 Diabetics and 57 non-diabetics pre-menopausal and 126 type 2 Diabetics and 315 non-diabetics postmenopausal, were recruited from women referred to bone densitometry unit of Endocrinology and Metabolism Research Center of Tehran University of Medical Sciences. BMD measurements were also made to the spine and proximal femur (Neck, Wards, and Shaft) by dual energy X-ray absorptiometry technique. Exclusion criteria were endocrine, rheumatologic or chronic diseases in both groups. Type 2 diabetic cases and non-diabetics were matched for age and body mass index (BMI) for each pre- and postmenopausal group.
A total of 146 type 2 Diabetic patients without other endocrine disorders and 372 non-diabetic women, aged 40-81 years were enrolled. Among the pre-menopausal women there were no significant differences in BMD of spine and femur in type 2 Diabetic and non-diabetic women. Postmenopausal type 2 Diabetic patients had higher BMD at the lumbar spine than non-diabetic women.
There was an age-related decrease in BMD (lumbar and femur) in all groups and a significant correlation between BMI and BMD was observed. After adjusting for age and BMI, we investigated the effect of lifestyle on BMD at all sites. Occupation was positively associated with BMD in postmenopausals, but not in premenopausal women. Among the dietary variables considered, milk, yogurt and cheese were all associated with increases in BMD in at least one site in type 2 Diabetic patients. Smoking was not associated with BMD; this result may be due to the fact that the exposure was far smaller in women (only 7.8% of Type 2 Diabetics had ever smoked).
Bone loss and osteoporosis cannot be considered a complication of type 2 Diabetes mellitus. Physical activity and milk consumption in postmenopausal type 2 Diabetic women might act as a protective factor against bone loss.

Diabetes is a common endocrine disease and complications such as retinopathy, nephropathy and neuropathy are major stimuli for enhancing efforts on controlling it using biomarkers. At present, glycosylated hemoglobin (HbA1c) is used for monitoring the long term control of glucose levels in diabetic patients. But due to the lack of availability of a standard range, recent findings suggest that insulin-like growth factor-I (IGF-I) may be used as a standard biomarker for monitoring blood glucose levels in diabetic patients. The aim of this study was to examine the correlation between IGF-I and HbA1c in Type 1 diabetes.
We designed a cross-sectional case-control study. The study composed of 26 newly diagnosed patients with Type 1 diabetes (15 male and 11 female; mean age, 23.7±9.1 years) and 26 healthy controls (9 male and 17 female; mean age, 24.1±4.4 years). We measured the concentrations of fasting plasma glucose (FPG), HbA1C, IGF-I and IGF-binding protein-3 (IGFBP-3) in both groups. FPG was measured by enzymatic glucose oxidase method and the colorimetric method was used to measure HbA1C. Determination of total serum levels of IGF-I and IGFBP-3 were carried out using immunoassay methods. P-value The mean value of IGF-I concentration in type 1 diabetics was significantly lower than controls (p It is speculated that based on this findings, when diabetes is poorly controlled, levels of FPG and HbA1c increase while level of IGF-I decreases. Our study also showed a significant correlation between IGF-I and HbA1c. Therefore, IGF-I could be indirectly used as a biomarker for controlling glucose levels in diabetes.

Diabetes mellitus is the most common cause of renal failure, blindness and non traumatic amputation. ADA recommends that prevention of the complications of diabetes mellitus is possible by monitoring the control of blood glucose levels.
The Betachek strip, which is produced in Australia, determines the patient's blood glucose level and doesnt need electronic glucometer devices.
In this study we compared the mean level of venous and capillary blood glucose levels which had been determined by test strips and by enzymatic method (the standard laboratory kit). The mean capillary and venous blood glucose measured by the strip test was 21.85 mg/dl (P In this study the correlation of venous blood glucose with standard method was more than that of the capillary blood glucose according to the Pearson Correlation (0.84 vs. 0.824) and the correlation was statistically significant (P

An increased prevalence of Helicobacter pylori infection (H.P) is common in diabetic patients, due to the presence of miscellaneous predisposing factors. In this study, the prevalence of H.P infection has been investigated in type 1 diabetic children.
In a cross-sectional study, anti H.P antibody (IgG) was measured in 75 type 1 diabetic patients (aged 2-18 years) and the results were compared with that of 75 healthy children matched for age, sex and socio-economic status. In seropositive diabetic patients with gastrointestinal (GI) symptoms, gastrodeoudenoscopy was performed to establish the diagnosis.
Seropositivity for H.P was detected in 22.7% of diabetic patients, as compared to 17.3% in control group (P>0.05). No significant difference was observed between seropositive and seronegative diabetic groups regarding age, sex, age at onset of diabetes, number of outpatient visits during the last 6 months, HbA1c and insulin requirements. Gastrointestinal symptoms were more prevalent in diabetic children in comparison with healthy subjects but the prevalence of GI complaints did not differ significantly between seropositive and seronegative diabetic groups.
Results show that type 1 diabetes is not associated with an increased risk for Helicobacter pylori infection, although further studies are required to investigate the impact of treatment for H.P infection on glycemic control in diabetic children.

type II Diabetes mellitus afflict at least 2 million people in Iran. Neuropathy is one of the most common complications of diabetes and lowers the quality of life of diabetic patients. Since neuropathy can lead to ulcer and amputation; we tried to elucidate the factors that change the progression of diabetic neuropathy.
In this case-control study, 110 diabetic patients were selected from Shariati hospital diabetes clinic. Michigan Neuropathic Diabetic Scoring (MNDS) was used to differentiate cases from controls. The neuropathic status of patients was confirmed with EMG-NCV. Multiple factors were compared between two groups including ACEI consumption, blood pressure, serum lipid level, sex, smoking, method of diabetes control and its quality.
Statistically significant relations were found between age, gender, quality of diabetes control and duration of disease and neuropathy (P values: 0.04, 0.04, 0.000 and 0.005). No correlations were found between atherosclerotic risk factors (high BP, hyperlipidemia, cigarette smoking) and diabetic neuropathy.
In this study hyperglycemia was the only modifiable risk factor of diabetic neuropathy. Glycemic control reduces incidence of neuropathy and slows its progression and improves the quality of life in diabetic patients. More attention should be paid to old, male diabetic patients with poor diabetes control for regular foot exam and more practical educations.

Diabetes is one of the most common metabolic diseases. The prevalence of diabetes is 4.5-6% in Iran and 14.2% in over 30 years old residences of Yazd.
Microalbuminuria is diagnosable before nephropathy is developed and could be detected at an early stage when effective therapy can still be carried out. In this stage near normalization of blood glucose, strict blood pressure control and administration of ACE inhibitors can prevent nephropathic complications.
The aim of this study was to determine the correlation among microalbuminuria and age, duration of diabetes, body mass Index, serum triglyceride, serum cholesterol and blood pressure in type 2 diabetic patients attending Yazd diabetes research center.
A cross sectional study was carried out from November 2002 to July 2003 to investigate the correlation between microalbuminuria and its risk factors. 288 type 2 diabetic patients (141 males and 147 females) were examined through consecutive sampling.
Overall prevalence of microalbuminuria was 14.2%.
Chi-square analysis revealed microalbuminuria was associated with diastolic blood pressure (P-value=0.003) and duration of diabetes (P-value = 0.001). No statistically significant correlation was found between microalbuminuria and body mass index, serum triglyceride, serum cholesterol and systolic blood pressure.
Determination of urine albumin to creatinin ratio is an easy method for screening microalbuminuria which is suggested for all diabetic patients especially diabetic patients with hypertension and a long term history of diabetes.

Neuropathy is a common complication of diabetes mellitus. Careful neurological examination and electro diagnosis are valuable in early diagnosis of neuropathy and prevention of its sequels.
103 randomly selected diabetic patients referred from the endocrine clinic were evaluated. Mean age of patients was 52.6 ±14 years. 29.4% had type 1 and 70.6% had type 2 diabetes. History was taken for each patient and neurological examination was carried out. Electroneurographic examination included nerve conduction velocity, action potential amplitude, distal latency and H reflex measurements.
79.4% of patients had neuropathy. The prevalence of neuropathy had a direct relation with duration of the disease. The most common complaints were tingling and numbness of extremities (72%) and burning sensation of the feet (36%). The most common physical findings were abnormal ankle jerk (92%), and decreased vibration perception (76%) in feet. Abnormal H reflex (92.5%) and decreased amplitude of action potentials (79%) were the most common electroneurographic findings. There was a good correlation between clinical and electroneurographic findings.
Neuropathy is very common among our diabetic patients. Thus neurological examination is recommended to prevent unnecessary work ups and to help preventing untoward complications.

Alterations in carbohydrate metabolism are frequently observed in cirrhosis. We conducted this study to define the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in patients with chronic liver disease (CLD), and explore the factors that may be potentially associated with the development of DM in these patients.
From October 2002 to March 2003, 185 consecutive patients with CLD, who referred to "Tehran Hepatitis Center", were enrolled into the study. Fasting plasma glucose and two-hour plasma glucose were measured in patient's sera. DM and IGT were diagnosed according to latest American Diabetes Association criteria.
The subjects included 42 inactive HBV carriers, 102 patients with HBV or HCV chronic hepatitis, and 41 cirrhotic patients. Mean age was 43.8±12.0 years ranging between 22 to 84 years. DM and IGT were diagnosed in 40 (21.6%) and 21(11.4%) patients, respectively. Univariate analysis showed that age (P=0.000), CLD status (P=0.000), history of hypertension (P=0.007), family history of DM (P=0.000), and body mass index (BMI) (P=0.009) were associated with DM. Using Multivariate analysis, age (P=0.01), family history of DM (P=0.0001), chronic hepatitis (0.0004), and cirrhosis (P=0.0004) remained as the factors independently associated with DM. When patients with cirrhosis and chronic hepatitis were analyzed separately, higher Child-Pugh's score in cirrhosis (P=0.04) and older age (P=0.04), higher fibrosis score (P=0.04), and higher BMI (P=0.003) in patients with chronic hepatitis were found to be associated with higher prevalence of DM.
Our findings indicated that patients with cirrhosis and chronic hepatitis are at risk of developing DM. Older age, sever liver disease, and obesity were associated with development of DM.

Patients with type 2 diabetes have a higher risk of coronary heart disease and a worse prognosis compared with patients without diabetes. In this study, the prevalence of cardiovascular risk factors have been investigated in type 2 diabetic patients.
A Cross Sectional study with a target population of known type 2 diabetic subjects was conducted in 2002 in Isfahan. From registered patients, 1150 were selected and evaluated for age, sex, duration of diabetes, BMI, hypertension, lipid profile, proteinuria, fasting blood glucose, HbA1c and smoking using convenience sampling methods.
Mean fasting blood glucose and HbA1 were 165.16 ± 53.4 mg/dl and 9.2± 1.5 percent respectively. The number of women with 3 cardiovascular risk factors was significantly greater than men (50.7% VS 33.5% P230 mg/dl). The prevalence of obesity (BMI >30Kg/m2) was 13.6% for men and 30.8% for women. 56.6% were hypertensive and 29.3% had proteinuria (P Cardiovascular risk factors are present in a considerable proportion of studied type 2 diabetic patients. Control of risk factors and life style modifications should be tightly considered in order to decrease the prevalence of IHD in the up - coming years of their life.

Depression is one of the most prevalent psychiatric disorders in diabetics, which affects treatment course and disease prognosis. This study focuses on the association between diabetes and depression as well as depression and glycemic control.
Material and 375 diabetic patients (type I and II) of diabetes clinic of Doctor Shariati Hospital and diabetes association of Iran participated in this cross-sectional study.
Patients were screened for depression with Beck Depression Inventory. Then depressed subjects were evaluated with DSM IV criteria for determination of the depressive disorders category.
Depression was diagnosed with Beck Depression Inventory in 41.9% of patients. Of these patients major depressive disorder was defined in 23.7%, dysthymic disorder in 9.3% and association of two disorders in 0.8% of patients. Major depressive disorder was more prevalent in 31-59 year old group and dysthymic disorder in more than 60 year age group. Also depression was more prevalent in women, diabetics with uncontrolled blood glucose and patients with diabetes complications.
Depression is a prevalent psychiatric disorder in diabetics, which is associated with female gender, poor glycemic control and diabetes complications. Therefore, glycemic control and prevention and treatment of diabetes complications can prevent depressive disorders in diabetics.

New studies have introduced atherosclerosis as an inflammatory disease. Using anti- inflammatory drugs can be useful in preventing atherosclerosis. Finding drugs from a natural source and without side effects can also be useful.
Amirkabiria odoratissima (umbelliferae) is an Iranian flora and is used traditionally as an anti-inflammatory drug, this study was designed to assess the effects of this plant on the development and progression of fatty streaks.
Twenty male rabbits were purchased from Iran Pasture institute and were kept under standard condition for two weeks, then randomly divided in to 4 groups based on their diet.
Groups 1 were fed on rabbit chow (normal cholesterol), Group 2 were fed on a high cholesterol diet, Group 3 were fed on normal cholesterol diet supplemented by this plant, Group 4 were fed on high cholesterol diet supplemented by this plant. After 12 weeks, the animals were sacrificed and the aorta, right and left branches of coronary artery were dissected and histological processing was carried out. Biochemical factors were measured at base line and after 12 weeks. The amounts of cholesterol, LDL, HDL, triglyceride and fasting blood sugar (FBS) were determined by enzymatic methods, and quantitative CRP were determined by turbidometric methods, malondialdehyde (MDA) and antioxidant capacity were determined by spectrophotometric methods.
The results indicate that there is a significant difference between supplemented herbal medicine groups with others (p This study suggests that Amirkabiria odoratissima Mozaffarian has good effects on preventing development of fatty streak; however, further studies are needed to understand the exact mechanisms with which this plant exerts its anti-atherosclerotic effects.

Hyperlipidemia is a major risk factor for cardiovascular diseases (CVDs.). 166 people die per day due to cardiovascular diseases in Iran which sums up to 12500 annual deaths.
Several studies revealed that lifestyle changes are a key to prevention of CVDs. Thus continuous and comprehensive Educational programs are needed which should be designed and performed by medical staff specially educating nurses.
In this study the effect of patient education thorough group discussion or an educational booklet is compared on knowledge and practice of patients with hyerlipidemia.
This research is an interventional study. Participants were randomly allocated into discussion group or booklet group. Knowledge and practice of participant in both groups were assessed before and after intervention using a standardize questioner.
A total number of 304 patients with hyperlipidemia were studied which were equally divided into" booklet or Interactive discussion groups".
Interactive group discussion caused %27 increase in knowledge and practice of participants the booklet group had a %26 increase and the difference was not significant.
Regarding the results of this study and other studies carried out in different countries, we concluded that the efficacy of each Interventional session is equal to educational booklets.
In order to achieve better results we propose that these session be hold on regular Intervals.