International Journal of Endocrinology and Metabolism
Volume:4 Issue: 2, Jun 2006

To investigate the responses in terms of body weight, glycemic control, metabolic control, and the side effects to acarbose add-on therapy in obese and non-obese type 2 diabetes patients with inadequately controlled by sulfonylureas and metformin. Forty obese (BMI≤ 27) and 80 sex- and age-matched non-obese patients with type 2 diabetes mellitus were enrolled in this 3-month, open-label, case-controlled trial for acarbose add-on therapy. Totally 111 (73 non-obese and 38 obese) patients completed 3-month acarbose add-on therapy. This study adopted a 2-center open-label parallel group design. After a 4-week run-in period, acarbose was added (ti-trated up to 100 mg t.i.d.) to the current sulfony-lureas and metformin combined therapy of sub-jects. Both obese patients (9.3±1.3% vs. 8.3±1.6%, p<0.0001) and non-obese patients (9.4±1.2% vs. 8.4±1.2%, p<0.0001) showed decreased HbA1c af-ter therapy. While obese patients showed a sig-nificant serum alanine aminotransferase (ALT) (61±26 vs. 49±18, p<0.0001) and triglyceride re-duction (242±127 vs. 187±71, p<0.01) after add-on therapy, non-obese patients did not. Neither obese (74.8±9.2 vs. 74.4±9.8 kg, N.S.) nor non-obese patients (61.9±7.9 vs. 61.6±7.7 kg, p=0.0579) show significant decrease in body weight. Both obese patients and non-obese patients showed decreased HbA1c after acarbose therapy. Obese patients had an additional bene-fit of a decrease in their previoulsly elevated ALT and triglyceride levels after acarbose ther-apy.

Obesity is associated with both higher bone mineral density (BMD) and plasma leptin con-centration. Inconsistent data are available about the relationship of leptin concentration and BMD, and the aim of this study was to explore the relationship of plasma leptin concentration with BMD as well as bone-related markers in healthy postmenopausal Iranian women. Two-hundred and ninety-six postmenopausal women from a popu-lation-based study on prevalence of osteoporosis in Shiraz participated in this study. The BMD was determined at the lumbar spine (L1-L4) and neck of femur by dual-energy X-ray absorpti-ometry. Blood samples were taken in the fasting state for plasma leptin, serum parathyroid hor-mone, creatinin, calcium, albumin, phosphorus and alkaline phosphatase evaluations. The mean age of the participants was 60.75±7.46 years and the mean body mass index (BMI) was 27.51±5.3 kg/m2. Mean leptin concen-tration was 18.12±9.08 ng/ml. One-hundred and forty-two (48%) individuals were osteoporotic, with mean plasma leptin concentration being significantly lower in these individuals (P<0.0001). BMDs at both the lumbar spine (r=0.25; P<0.0001) and the neck of femur (r=0.29; P<0.0001) had significant positive correlation with plasma leptin. The association between BMD and plasma leptin concentration was no longer significant when adjusted for BMI. There was no correlation between plasma leptin con-centration and bone-related markers. This cross-sectional study suggests that the relationship of plasma leptin concentra-tion with BMD is mediated through obesity and plasma leptin is dependently associated with BMD.

Peripheral nerve dysfunction is a well docu-mented feature of clinical hypothyroidism. Only a few studies have evaluated the functional al-terations in central and peripheral nervous sys-tems in subjects with subclinical hypothyroid-ism and results obtained have been controver-sial. The purpose of the present study was to in-vestigate the effects of subclinical hypothyroid-ism on peripheral nerve function. Twenty-eight individu-als (25 females and 3 males) with subclinical hy-pothyroidism (defined biochemically as high se-rum TSH with simultaneously normal serum free T4) as the study group and 30 age and sex matched subjects (27 females and 3 males) with normal thyroid function tests as the control group were enrolled into the study. None of the patients or controls had history of diabetes mel-litus, neuromuscular, metabolic, vasculitic or rheumatologic diseases or were taking medica-tions that may alter central or peripheral nerve function. Standard electrodiagnostic methods were used to study motor parameters including motor nerve conduction velocity, distal motor la-tencies, compound muscle action potential am-plitude from median, ulnar, tibial and deep per-oneal nerves, minimal-F-response from tibial, median and ulner nerves and sensory parameters including sensory nerve conduction velocity, sensory nerve action potential amplitude and distal sensory latencies from median, ulnar and sural nerves. In all patients and controls, values were obtained from both right and left sides. Values from patients were compared with those of controls by unpaired student''s t-test. Motor and sensory nerve function val-ues obtained from this electrophysiological study yielded no significant differences between patients with subclinical hypothyroidism and those with normal thyroid function. The results of this study show that there are no significant alterations in peripheral nerve function in patients with subclinical hypo-thyroidism.

Congenital Hypothyroidism (CH) is one of the most preventable causes of mental retardation and can be detected through neonatal screening; it is estimated 1200 CH patients are born in Iran, annually. The aim of this investigation was to provide a report on the outcome and estimate the cost-benefit ratio of the screening program im-plementation for CH in Iran based on the pilot study. The cost of the screen-ing program for CH for each newborn was based on data gathered from the pilot study of three provinces and the amount then multiplied by the number of births per year. The care cost of men-tally retarded individuals is calculated based on the Welfare budget of caring for these people. Total cost of implementation of the neonatal screening program for CH during the first year is 16, 256, 400, 000 Rials ($ 2, 000, 000). The ratio of the cost of care for the children to the cost of implementation of the screening pro-gram is about 1 to 16 and the ratio of the benefit (cost saving) to the implementation cost is 1 to 15. The neonatal screening program for CH has a very high potential for implementation in the country. As a result, the implementation of the CH screening program as the first screen-ing of newborns provides a basis for better un-derstanding and timely detection of CH and other metabolic diseases in Iran.

High plasma total homocystein (tHcy) level, as a source of free radicals, hydrogen peroxide may affect vascular resistance via changes in endothelial cell function. This study was designed to investigate the possible indirect effect of Hcy and common C677T Methylentetrahydrofolate Reductas (MTHFR) gene mutation (a mutant genotype revealed to be accompanied with high plasma Hcy level) on the mean arterial blood pressure (MABP). From among 280 postmenopausal women selected on the basis of simple randomized sampling, 266 women participated in this study. Ninety-Five were known cases of hypertension under anti-hypertensive therapy with controlled blood pressure and 171 were normotensive subjects. Anthropometrics, blood pressure, plasma tHcy, plasma folic acid and vitamins B12 as well as C677T mutation in MTHFR gene were assessed for each postmenopausal female. MABP was positively and significantly associated with plasma tHcy level(r=0.230, P=0.003) but not with the common C677T MTHFR gene mutation. In regression analysis, plasma tHcy was the only predictor of MABP (R2=0.05, P=0.004). High plasma tHcy level increased hypertension risk in comparison to normal plasma tHcy level (OR=3.11, CI=1.07-9.18) whereas the mutant MTHFR genotype, TT allele, in comparison to the wild MTHFR genotype, CC allele, did not. Mean arterial blood pressure was significantly associated with plasma tHcy level but not with the common C677T MTHFR gene mutation

In recent years, several plant extracts have been examined for their antidiabetic propertics in an effort to identify alternative treatment strategies that pose less of a risk for diabetics. The present study was undertaken to investigate the antidia-betic effects of Syzygium cumini bark in ex-perimental diabetes mellitus. Diabetes was induced in male albino Wistar rats by a single intraperito-neal injection of streptozotocin (45 mg/kg body weight), after which, the animals were randomly allocated into five experimental groups as fol-lows: Group 1: normal rats, Group 2: normal rats received Syzygium cumini bark extract (SBEt; 300mg/kg body weight), Group 3: diabetic con-trol rats, Group 4: diabetic rats receiving SBEt (300mg/kg), Group 5: diabetic rats received glibenclamide (600μg/kg body weight). The ef-fects of 45 days treatment of SBEt on blood glu-cose, plasma insulin, C-peptide, urine sugar and body weight were studied in comparison to those of glibenclamide. Blood glucose levels (268.1019.25 mg/dL) and urine sugar increased significantly whereas the levels of plasma insulin (5.010.29 μU/L) and C-peptide (167.68 8.50 pmol/L) decreased sig-nificantly in diabetic rats as compared to normal rats. Oral administration of SBEt exhibited antidiabetic activity by significantly (p<0.05) lowering blood glucose (84.304.25) and urine sugar levels in diabetic rats. Additionally, dia-betic rats treated with SBEt had significantly (p<0.05) elevated levels of plasma insulin (10.290.59) and C-peptide (236.5011.87). During OGTT, long-term administration of SBEt was able to significantly (p<0.05) decrease blood glu-cose concentrations (93.94  3.17; 120min) at vari-ous time intervals when compared to the OGTT pattern of diabetic rats (316.03  18.03). As com-pared to glibenclamide, SBEt has better antidia-betic effects. The findings of this study indicate that the antidiabetic activity of SBEt, and both the pancreatic and the extrapancreatic mecha-nisms might be involved such apparent dual ac-tions of SBEt would be more advantageous to the existing oral antidiabetic monotherapy.

Data on the effect of thyroxine therapy on lipid profiles and signs and symptoms of mild hypo-thyroid patients is controversial. This study was conducted to elucidate the issue. In a single blind placebo control clinical trial, 80 patients with subclinical hypothyroidism (TSH> 5 m U/L on two occa-sions, positive anti TPO and normal FTI) were recruited and allocated into two groups by fixed block randomization (thyroxine therapy- 40 pa-tients and placebo- 40) The patients did not have any disease, nor were they taking any medica-tion influencing serum lipids and thyroid hor-mone levels. After physical examination, blood was drawn for measurement of serum TSH (IRMA), T4, T3, (RIA), and total cholesterol (TC), triglyceride (TG), low density lipoprotein (LDL), high density lipoprotein (HDL) with enzymatic method by commercial kits before and after thy-roxine therapy and placebo. The adequacy of thyroxine therapy was documented by a normal TSH after 3 months. Data were statistically ana-lyzed by t test, paired t test and Fisher''s exact test. Attrition rate was 10 percent (72 patients followed completely). The mean ages in the therapy and placebo groups were 35.82 ± 12.3 yr and 36.3 ± 11.5 yr and the female to male ratio in each group was 36/4 and 26/6 respectively. There was no significant difference in the BMI of the two groups (28.1 ± 5.5 vs. 25.9 ± 3.7 Kg/m2 respec-tively). The mean of lipid profile and thyroid hormones were not significantly different in the two groups before intervention. The mean dif-ference of total cholesterol (18.27 ± 30.7 vs. 1.5 ± 33.8 mg/dL, p= 0.019) and LDL (22.45 ± 28.4 vs. 2.08±37.0 mg/dL, p= 0.005) before and after ther-apy between the two groups were significant. Triglyceride levels and HDL were not signifi-cantly changed in both groups. With regard to clinical findings, only skin dryness and fatigue were significantly improved with thyroxine therapy (p<0.05). There is a significant decrease in se-rum total cholesterol and LDL levels and im-provement of some clinical findings in patients with subclinical hypothyroidism treated with levothyroxine.

Agranulocytosis is a rare but life-threatening side effect of thionamides. Some data indicate that the susceptibility to thionamide-associated agranulocytosis in patients with Gravesُ disease has a genetic basis. The case histories of a mother and her daughter with Gravesُ disease who developed agranulocytosis with methima-zole are presented here. It seems reasonable to avoid the use of thionamide derivates in hyper-thyroid relatives of patients who have had thionamide-induced agranulocytosis.