مجله غدد درون ریز و متابولیسم ایران
سال بیست و چهارم شماره 5 (پیاپی 125، آذر و دی 1401)

Sleep disorders have an adverse effect on the physical and mental health of patients with diabetes. Low quality of sleep can also affect disease control and complications. This study aimed to investigate the relationship between sleep quality and fasting blood sugar (FBS), and glycosylated hemoglobin (HbA1c) in patients with type 2 diabetes. In this cross-sectional descriptive study, 250 patients with type 2 diabetes referred to the diabetes clinic of Velayat Hospital, Qazvin, were included by convenience sampling. The data collection tool included the checklist of personal-social information and the Pittsburgh Sleep Quality Index (PSQI). Regression models, Spearman's correlation coefficient, and Mann-Whitney U test were used for data analysis. The mean and standard deviation of FBS was 207.72±75.40, and HbA1c was 8.58±1.92. Among the participants, 175 patients (70%) had poor sleep quality. Based on Spearman's correlation, there was a direct and significant relationship between the FBS (r=0.487, P<0.001) and HbA1c (r=0.465, P<0.001) with the total score of sleep quality. According to the logistic regression model, poor sleep quality increases the chance of poor blood sugar control by 3.17 times. The present findings showed a direct relationship between poor sleep quality and poor diabetes control. Therefore, ensuring sleep hygiene should be considered an important part of the treatment and care of patients with type 2 diabetes for better management of their blood sugar.

Diabetes and its complications have a significant economic effect on society. This study evaluated the annual cost of patients with diabetes in Ahvaz, Iran, for the first time to reduce diabetes costs by identification of cost-induced factors.  A questionnaire was completed for each of 752 patients referring to diabetes clinics in a university hospital. Then, the patients recorded all diabetes-related costs through face-to-face or telephone interviews for one year, including transportation, physician visit, drugs, laboratory tests and imaging, diet prescription, hospitalization, glucometer strips, etc. The patients reported their costs every three months.  The per capita cost of patients with diabetes was USD 1611.19 ± 1366.67 annually. Women had higher per capita costs than men did. The cost of taking medication was the highest compared to other costs (while the cost of diet prescription was the lowest. Of all patients, 14.2 % had at least one diabetic complication. Diabetes-related cardiovascular complications had the highest annual cost for patients. There is no statistically significant correlation between diabetes cost and gender or diabetes duration.   The cost of medications constitutes a major portion of the total direct cost of this disease, whereas the cost of diet prescription was the lowest. Diabetes and its complications have a significant economic effect on the health system. Control of diabetes and complication prevention should be considered to reduce the costs it imposes on the society.

The Covid-19 and the imposed restrictions, along with difficulty in accessing medical services, can affect the level of anxiety, stress, and depression of patients with diabetes. This study was conducted to determine the effect of the Covid-19 pandemic on the emotional status of these patients. A total of 318 individuals with type 2 diabetes who participated in the Tehran Lipid and Glucose Study between 2018 and 2020 were included in the current study. The data on perceived social support (PSS) and emotional state (ES) were collected before and after the Covid-19 outbreak using the multidimensional scale of perceived social support (MSPSS) and Depression, Anxiety, and Stress Scale-21 Items (DASS-21) questionnaires, respectively. Data were analyzed using paired T-tests and repeated measures tests. Mean total scores of PSS did not have significant differences before and after the outbreak of Covid-19. Comparison of the subscale scores indicates a significant increase in PSS from family (p=0.013) and a significant decrease in PSS from friends (p=0.039) in women, and an increase in PSS from significant others in both groups of women (p=0.019) and men (p=0.045). Comparing the ES scores before and after the outbreak of Covid-19 indicated that the adjusted model, anxiety, and stress scores decreased significantly after the Covid-19 outbreak in females. There was no significant difference in anxiety and stress scores in males and depression scores in both sexes. After the outbreak of Covid-19, levels of anxiety and stress in women have decreased, which can be due to the improvement of PSS from the family and, consequently, the reduction of diabetes-related concerns.

To investigate the effect of the selection of different race-specific normal databases on the densitometric results and diagnosis. Eighty-two participants included in the study were selected consecutively from the archived scans. Analysis was conducted three times for each participant using different ethnicities (White, Asian and Hispanic) as the race-specific normal database for comparison with the patient’s data. The densitometric data, including bone mineral density (BMD), as well as T- and Z-scores, were extracted for three standard regions, including the spine, femoral neck, and total femur. The agreement among the diagnoses based on three different ethnicities (White Vs. Asian, White Vs. Hispanic, and Asian Vs. Hispanic) was tested by cross-tabulation and calculation of the coefficient of Kappa. The mean and standard deviation of the T-score of participants with the selected reference types were exactly the same in all three regions. The mean and standard deviation of the Z-score of all participants, in comparison with "Asian" and "white" references, was exactly the same, but with the cases where the "Latin" race was selected as the reference, in the region of the neck, thigh (p<0.001) and the whole thigh (p<0.001) was different. Z-score values of the spine were the same in all three racial groups. The Z-scores of the spine were the same in all three types of races. Bland-Altman analysis demonstrated a significant difference in the femoral neck but not in the spine and total femur. All the diagnoses based on WHO and ISCD criteria were the same (Agreement test: Kappa coefficient=1.00 and P-value<0.001). The study shows that the effect of the selection of different race-specific normal databases is insignificant on the densitometric results and diagnosis.

Thyroid cancer is the most common endocrine cancer. The study of the signaling pathways involved in thyroid cancer, such as PI3K/AKT/mTOR and their driver mutations, has significantly improved the understanding of the molecular pathogenesis of thyroid cancer. Consequently, targeted therapies have been developed using tyrosine kinase receptors and cascade proteins inhibitors. PubMed database and Science Direct website were searched to investigate the alterations in this signaling pathway in thyroid cancer from January 2016 to January 2023. Articles related to clinical symptoms, conventional treatments, histopathology, and diagnostic tests, as well as reports, letters to the editor, results of confer ences, and annual meetings, were excluded from the study. Then the remaining articles were carefully studied. Keywords included thyroid neoplasm, thyroid carcinoma, thyroid cancer, and PI3K. Somatic mutations and increased expression of the PIK3CA gene, the mutations in PTEN tumor suppressor gene, RAS, BRAF, and RET proto-oncogene mutations, CTNNB1 and EIF1AX gene mutations, RET/PTC, PAX8/PPARγ, and NTRK rearrangements, as well as AKT mutations and rearrangements, were the most important alterations that increased the expression of PI3K/AKT pathway proteins. This pathway and its connections with other signaling pathways were one of the leading reasons for the development and recurrence of thyroid cancer. Understanding the intracellular network of signaling pathways based on tyrosine kinase receptors, such as PI3K, and their cross-talk in physiological and pathological conditions, as well as their driver mutations, are the goal of research in recent years to develop combination therapies using inhibitors of these pathways.

Osteoporosis is the most common metabolic bone disease. It is a chronic disease and a socio-economic threat. The aim of this study was to develop a clinical guideline for osteoporosis to integrate service delivery. This study was designed and conducted in two phases: comprehensive systematic review and expert panel method. First, a comprehensive search of sources was conducted in reliable databases. Then, in the expert panel phase, the clinical questions and recommendations were presented to members of the panel of experts. Finally, among various recommendations for a clinical question, the recommendation, which was approved by more than 70% of the panel of experts, was chosen as the final recommendation. By reviewing the valid guidelines of the world, five guidelines were selected according to the screening criteria of the study and entered into the study. After holding several sessions with the panel of experts and reviewing the recommendations in the initial version, 28 questions and 181 recommendations were extracted. After obtaining the opinions of professors from different disciplines, the final recommendations were reviewed in a meeting with clinical experts, and based on the submitted opinions, the final version of the guideline update, in the form of 34 questions and 111 recommendations in the field of bone health (four questions, 12 recommendations), diagnosis and Evaluation (six questions, 19 recommendations), treatment and rehabilitation (17 questions, 67 recommendations), and Sarcopenia (seven questions, 13 recommendations), were presented. Due to the emphasis on the need for accessing valid protocols to provide optimal and useful services and address the care gap has developed the Osteoporosis Clinical Guide.