مجله غدد درون ریز و متابولیسم ایران
سال چهارم شماره 4 (پیاپی 16، زمستان 1381)

As the control of diabetes is important, finding the ways which facilitates patient’s, treatment is the major aim for this research. Chloroquine was considered for diabetes treatment because of its hypoglycemic effects. This study was conducted to detect the effect of chloroquine on diabetes control in type 2 diabetic patients. In a clinical trial, type 2 diabetic patients referred to Isfahan Endocrine and Metabolism Research Center during the year of 1999-2001 who had inclusion criteria using a convenience sampling method were selected. Selected patients were type 2 diabetic patients under treatment with oral antidiabetic agents, in whom the disease had not been controlled, and so were candidates for insulin therapy. In this group, beside other drugs, one tablet of chloroquine was recommended for two months. Weight, blood pressure, fasting blood glucose (FBS), glycosylated hemoglobin (HbA1c) and other laboratory tests were checked before and after 2 months administration of the drugs and the corresponding values were compared. Mean FBS, HbA1c and BS2hpp were decreased significantly (FBS1= 183.07±65.12, FBS2 = 131.92±26.59, P<0.05), HbA1c1 = 10.36±2.05, HbA1C2 = 8.36±1.32, P<0.05), (BS2hpp1 = 254.7±104.2, BS2hpp2 = 195.54±59.8, P<0.05). Other variables did not change significantly. Results of this study show that chloroquine decreases did serum glucose level in type 2 diabetic patients who are resistant to oral anti-diabetic agents. This effect is due to role of chloroquine in decreasing degradation, thus increased glucose exposure to cells.

This study was undertaken to compare the effect of animal protein and that of soy protein on blood indices and renal function of type 2 diabetic patients with nephropathy, attending a private kidney disease clinic and Imam Hossein hospital (a university hospital) in Tehran. This cross-over randomized clinical trial was conducted on 14 patients who were free of any chronic conditions or other renal diseases. The patients were asked to follow a diet containing 0.8 gr/kg protein (70% animal and 30% vegetable protein) for 7 weeks. Then after a washout period of 4 weeks during which the prestudy diet was followed, subjects were readmitted to repeat the same cycle of consuming a similar diet with 0.8 gr/kg protein containing 35% soy protein. A 24-hour dietary recall was completed every two weeks and anthropometric indices were assessed. Hematological values and renal function were evaluated at the beginning, after 7, 11 and 18 weeks of the study. Paired t test was used for statistical analysis. There were 10 (71.5%) men and 4 (28.5%) women in this study. Mean (SD) of weight and age were 70.6(10.3) kg and 62.1(12.1) years, respectively. The differerence the effects of soy and animal protein on proteinuria was significant (P<0.001). There were no significant changes in serum and urine creatinine, blood urea nitrogen, glomerular filtration rate, serum calcium, sodium, potassium, HDL-C, LDL-C/HDL-C levels and glycemic indices between the two diets. Significant reductions were seen in urinary urea nitrogen (P<0.001), serum phosphate (P<0.006), total cholesterol (P<0.01), triglycerides (P<0.002) and LDL-C (P<0.04) after soy versus animal protein consumption. It is concluded that soy inclusion in the diet can modify the risk factors of heart disease and also reduce proteinuria and urinary urea nitrogen level.

Several studies have shown a higher prevalence of celiac disease and elevation of serum antigliadin antibody (AGA) and antiendomysial antibody (AEA) in patients with diabetes mellitus type 1. But there is scant data of the prevalence of celiac disease in Iranian patients with type 1 diabetes. In a prospective, case-control study, 80 consecutive patients with type 1 diabetes referred to endocrine clinic of Imam Khomeini hospital, in a two-year period, between March, 2000 and March 2001, were enrolled as cases. 80 age and sex matched nondiabetic patients, who had referred to the Clinic of Internal Medicine of the same hospital at the same period were included in control group. Blood levels of AGA-IgA and AEA-IgA were measured in all patients and patients with elevation of these antibodies underwent a duodenal biopsy. From 80 patients in the case group, 3 patients (3.8%) had an elevation in both AGA and AEA, while none of the controls had elevation in either AGA or AEA. Duodenal biopsy in two of three cases who had elevated AEA and AGA revealed subtotal villous atrophy indicating celiac disease, and in the other case, changes were nonspecific. Prevalence of celiac disease in our study is similar to others, emphasizing the importance of screening with AGA and AEA in patients with type 1 diabetes.

Increased frequency of thyroid antibodies (Abs) following correction of iodine deficiency has been reported in several studies, although its clinical implications are still unclear. Ten years after initiation of universal salt iodization, the prevalence of thyroid dysfunction and antibodies were investigated in Tehran adults. A systematic sample of 1434 people aged >20 years, selected from Tehran Lipid and Glucose Study population, participated in this cross-sectional study from Dec 1999 to Sept 2000. Thyroid size was graded according to WHO grading system and thyroid nodules were detected by palpation. A fasting blood sample was taken for serum TSH, total T4, T3 uptake, antithyroperoxidase (TPOAb), and antithyroglobulin (TgAb) antibodies. Urinary iodine concentration was measured for a random subsample of 160 people. In persons with no history of taking thyroid drugs during the previous month, overt and subclinical hypothyroidism was defined as TSH>3.5 μU/mL and low (<1.0) and normal FT4I, while overt and subclinical thyrotoxicosis as TSH<0.3 μU/mL and high (>4.2) and normal FT4I respectively. Median urinary iodine concentration was 18.5 μg/dL. Total goiter prevalence decreased with age and was higher in women than men (33.0% vs.15.5%, P<0.001). In this study, 5.9% of people had thyroid nodules and the prevalence was higher in females than males (8.3% vs. 3.0%, P<0.001). The prevalence of overt and subclinical hypothyroidism were 3.5/1000 (1.6/1000 in males and 5.1/1000 in females) and 2.2% (0.9% in males and 3.2% in females), respectively. No new case of overt thyrotoxicosis was found and the prevalence of subclinical thyrotoxicosis was 4.2/1000 (3.1/1000 in males and 5.1/1000 in females). Mean TSH was higher in females than males (P<0.01). In women, positive Abs were more prevalent (P<0.001) and the frequency of TPOAb+ increased with age. The frequencies of TPOAb+ and TgAb+ were in agreement (P<0.001), 8.3% in men and 15.9% in women for TPOAb+ and 11.0% in men and 21.5% in women for TgAb+. In logistic regression model, TPOAb+, TgAb+ and female sex were determinants of TSH>3.5 μU/mL. On the other hand, TgAb+, TSH>3.5 μU/mL and goiter were determinants of TPOAb+. TPOAb+, TSH>3.5 μU/mL, nonsmoking and female sex were determinants of TgAb+. Using different categories for TSH in the model, TSH>0.3 μU/mL predicted TPOAb+ (Odds ratio=1.77, P<0.05) and TSH>2.1 μU/mL predicted TgAb+ (Odds ratio=1.73, P<0.05). There is a relatively high prevalence of subclinical hypothyroidism in Tehran adults. One decade after initiation of universal salt iodization, the association between positive Abs with elevated TSH and goiter suggests the pathogenic importance of thyroid Abs, especially TPOAb.

Awareness of the distribution of recall rate and CH incidence in different seasons could provide a better understanding of their etiologies and appropriate allocation of resources in a CH screening program. This report illustrates the distribution of recall rate and CH incidence in different seasons during the program of screening for CH in Tehran and Damavand. From March 1998 to March 2002 (48 months), cord blood spot samples from 8 hospitals and a rural birth center in Tehran and Damavand were collected on filter papers. TSH values were measured using a two-site IRMA method. Cord TSH levels  20 mU/L were considered abnormal and recalled for serum confirmatory tests. CH was diagnosed by abnormal serum TSH and T4 levels using age adjusted reference values for the age. The odds ratios and 95% confidence intervals (CI) for the occurrence of cord TSH levels  20 mU/L and CH in winter and other seasons were assessed. Also, the effect of using iodine-containing antiseptics for the maternal preparation prior to delivery was assessed. Out of 29908 cord blood samples, 314 had TSH levels of  20 mU/L (recall rate: 10.5‰). The recall rate was 13.1‰ and 9.5‰ of live births in winter and other seasons, respectively. The odds ratio of occurrence of cord TSH  20 mU/L in winter to other seasons was 1.39 with a 95% CI of 1.10-1.76 (P<0.01). The effect of iodine-containing antiseptics on the increased recall rate in winter as compared to other seasons was not significant. Sixteen (1: 502 live births) and 15 (1: 1458 live births) CH neonates were born in winter and other seasons, respectively (odds ratio: 2.91 95% CI: 1.44-5.89 [p<0.01]). The recall rate and CH occurrence are higher in winter than in other seasons.

Iron deficiency anemia is recognized as the most prevalent nutrient deficiency in pregnancy and iron supplements, which are prescribed daily in pregnant women for prevention of this anemia, may lead to unfavorable effects in zinc absorption. The aim of this study was to assess the effects of ferrus sulfate tablets on serum zinc in pregnant women. In a historical cohort study, among all pregnant women at third trimester who visited health centers, 20 pregnant women who had not taken iron tablets (Tl) and 21 pregnant women who took iron tablet (DTI) were randomly selected. Serum zinc levels were measured by atomic absorption spectrophotometry and serum iron, TIBC, and ferritin levels were measured by spectrophotometer. The mean daily intakes of nutrients were estimated by using 24-hour dietary recall questionnaire and FP2 software. The data were analyzed statistically using student’s t-test, χ2 and Pearson’s correlation coefficient. In case group, the mean intake of zinc increased signifcantly after iron intake compared with control group (P<0.05). There was a significant negative correlation between serum zinc concentration and TIBC of cases (P<0.05). There was a significant difference between mean serum iron and TIBC in two groups, but no significant difference between the mean serum zinc levels of cases compared with the controls. Iron supplementation does not affect serum zinc status of pregnant women. Serum zinc levels of 17.2 percent of pregnant women were lower than normal range.

The production of neonatal TSH kits for the measurement of the analyte on filter papers has been considered a necessity for national screening program of congenital hypothyroidism (CH) in the I. R. Iran. This report aims at evaluating the afore mentioned kit, which has been produced for the first time in the I. R. Iran and used by Endocrine Research Center in the screening program for CH. From February 1998 to June 2001, cord dried blood spot (DBS) samples applied onto filter papers were sent to Endocrine Research Center laboratory from 8 hospitals in Tehran and Damavand for TSH measurement using a two-site IRMA kit produced by Atomic Energy Organization of Iran according to the NETRIA company instructions. Validity of the method including precision (intra- and inter-assay tests), accuracy (recovery tests), sensitivity, and specificity were assessed. Also, absolute values in difference of TSH values of 41 randomly selected cord DBS samples measured by both the present and DRG (ELISA) neonatal TSH kits were calculated and their correlation was assessed using Pearson’s correlation coefficient. For statistical analyses, the SPSS version 9.05 software was employed. Cord DBS TSH levels of 20107 samples were measured. Three CH cases with borderline cord TSH values (23-35 mIU/L) were detected. The sensitivity of the method was 1 mIU/L. The coefficients of variation (%) were 10.7, 8.7, 9.4, and 9.6 (intra-assay) and 12.2, 9.1, 10.2, and 11.1 (inter-assay) for TSH values of 3, 23, 45, and 82 mIU/L. Recovery tests showed a recovery of 108, 112, and 109% for the proportion of the measured (13, 36, 69 mIU/L) to the expected (12, 32, 63 mIU/L) TSH concentrations. Specificities of the method for TSH, LH, hCG, FSH, PRL, and GH were 100, <0.005, <0.005, <0.003, <0.01, and <0.02%, respectively. The differences of corresponding TSH values as measured by both kits were less than 1.5 mIU/L in 95% of comparisons. There was a significant correlation between TSH levels measured by both kits (r = 0.96, p < 0.001). The quality of TSH kits was considered acceptable for the detection of CH, especially in mildly abnormal cord DBS values, according to the findings of the screening program for CH and of the methodologic evaluation.

The aim of this study was to find out whether there is seasonality of month of birth in children with diabetes in Mashhad and if so whether it differs from that of general papulation. 161 children and adolescents (0-18 years) with type 1 diabetes born between 1983-2001 were included the study. The results were analyzed by student’s t test and chi-square test and a P value<0.05 was considered significant. The children and adolescents with diabetes had a statistically significant different seasonality of month of birth compared to that of the general population (P<0.01). More children with type 1 diabetes were born in spring (P<0.05). The observations made are in accordance with observation made in other countries and support the hypothesis that a virus infection transmitted by the mother to the fetus during the annual viral epidemic may induce the autoimmune process in the pancreatic β-cells in genetically susceptible individuals who may subsequently develop clinical diabetes during childhood.