مجله دیابت و متابولیسم ایران
سال هفتم شماره 1 (پیاپی 22، پاییز 1386)

The behavior of tissue fragments in permissive jells is like liquid drops. Under appropriate conditions this phenomenon could be used to print tissues of prescribed shape. Application of the principles of rapid prototyping to tissue engineering or robotic biofabrication is a novel technology that holds promising future in producing suitable human organs in large scale. An introductory discussion of the new interdisciplinary technology of bioprinting is presented in this article.

The interaction of reducing carbohydrates with proteins leads to a cascade of reactions that are known as glycation or Maillard reaction that have important roles in diabetic complications. In this minireview, structural changes of glycated human serum albumin (GHSA) via various sugars in different incubation times, which reported in scientific literature as well as our research, were reported. Our studies showed glycation induced structural changes for Human Serum Albumin (HSA). In glycation process of HSA after 21 days incubation, glucose separates from HSA and induced the formation of molten globule state that is relative to several diseases that originate from molten globule state in proteins. Also, glycation of HSA induced aggregation states and amyloid formation as well as decreased surface tension which plays a role of denaturant for protein as a surfactant. In following, we showed that alginate as a sugar polymer decreased glycation reaction in HSA. Finally, it is compared the structural changes of artificial and in vitro interaction of sugars with HSA as well as diabetic patients HSA. The results show the number of arginine residues in HSA of diabetic patients is more modified relative to lab samples.

The oxidative modification of low density lipoprotein (LDL) may play an important role in atherogenesis. Mechanism of LDL oxidation and factors that determine its susceptibility to oxidation is unknown. Copper is account as an attributing factor in LDL oxidation atherosclerotic lesions. The binding of copper ions to LDL is usually thought to be a prerequisite for LDL oxidation by copper. The aim of study was to investigate the effect of Naringin and Quercetin on copper bound to LDL and furthermore effect of this binding on the susceptibility of LDL to oxidative modification. LDL was isolated from EDTA-plasma by ultracentrifugation using a discontinuous gradient. The oxidizability of LDL was measured by thiobarbitoric acid reactive substances (TBARS) after addition of CuSO4 in absence and/or presence of Naringin and Quercetin. Finally effect of Naringin and Quercetin on formation of LDL-copper complex was studied by gel filtration. This study showed that Naringin suppresses formation of TBARS and LDL-copper complex, whereas Quercetin enhances formation of TBARS and LDL-copper complex. Results revealed that Naringin with inhibition of binding of Copper to LDL may decrease the susceptibility of LDL oxidation in counter to this ion and thus may have a role in prevention of atherosclerosis. But Quercetin with stimulation of binding of copper to LDL may increase the susceptibility of LDL oxidation to this ion and thus may have a role in progression atherosclerosis.

The alteration of IGF-I systemic level in diabetes is typically characterized by depletion of free IGF-I plasma level and its decreased bioavailability. With regard to protective and advantageous effects of IGF-I on tissue healing and cellular regeneration such depletion could facilitate or accelerate tissue damages and complications. By contrast, the local concentration of IGF-I is reportedly increased in particular tissues during some occasions, which has also clinical implications as IGF-I could function in an autocrine and paracrine manner.The present study was conducted to assess that whether the differential outcome of diabetic subjects relative to diabetic retinopathy (DR) is linked to some extent to the structural variations of IGF-I gene. Two polymorphisms of the IGF-I gene at positions -383*C/T and -1089*C/T were employed for genotyping analysis by ARMS-PCR assay and the data of genotype/allele distribution was compared between two subgroups of 248 British Caucasian type 1 diabetic subjects, 135 cases with DR and 113 controls (DR-). The distribution of these polymorphisms did not associate significantly with presence or absence of DR (P≥ 0.05). Since the involvement of IGF-I in development of DR is fairly rational, our results firstly may reflect some reservations about the functionality of the employed polymorphic markers and secondly may indicate that all regulators of IGF-I functionality or its local concentration level including IGFBPs and IGFRs should be taken into account, so their genes could be the subject of new study to accomplish current investigation. Keywords:

LADA is a subgroup of type 1 diabetes mellitus characterized by its age at diagnosis being more than 30 years, presence of Glutamic Acid Decarboxylase65 (GAD65) autoantibody, and insulin independency in the first 6 months of diagnosis. Our aim was to determine the prevalence and predictors of LADA in a large population-based drug naïve newly diagnosed adult diabetics of Tehran urban population.

In this cross-sectional study, all newly diagnosed diabetics of Tehran Lipid and Glucose Study aged more than 30 years who were not initialy treated with insulin were tested for GAD antibody titer. Thirty two GAD antibody positive (LADA) and 556 GAD antidody negative patients (type 2 diabetics) were found and compared for anthropometric, clinical and laboratory features.

Mean age of all 588 cases was 54.2±11.6. The prevalence of LADA was %5.44 (CI %95: %3.6-%7.3). Age, sex, BMI, family history of diabetes, diastolic blood pressure, glucose and lipid profile and the prevalence of metabolic syndrome were similar between LADA and type 2 diabetics. Systolic blood pressure were greater in type 2 diabetics than in LADA group. No model could predict the result of GAD antibody measurement.

autoimmune process is present in early stages of diabetes in %5.4 of newly diagnosed adult diabetics assumed to suffer type 2 diabetes mellitus. Using clinical and laboratory features, no model could reliably screen these cases. It seems reasonable to test GAD antibody in all such cases to early find persons more probable to have a more rapid process toward pancreas insufficiency.

Resistin, an adipocyte secreted factor, has been suggested to link obesity with type 2 diabetes and insulin resistance in rodent models but its relevance to human diabetes remains uncertain. The aim of this study was to investigate the relationship between serum resistin concentrations with insulin resistance and obesity indices in type 2 diabetes and non-diabetic obese subjects. As a case- control study 35 obese subjects with type 2 diabetes (age, 44.60 ± 6.39yr; BMI, 34.23±3.92 kg/m2) and 35 obese non-diabetics (age, 43.14±9.13yr; BMI, 35.54 ± 4.07 kg/m2) are recruited. Fasting lipid profile was measured by enzymatic methods. NycoCard HbA1c Kit was used to measure HbA1c.The Serum resistin, insulin and glucose levels were measured by an enzyme immunoassay using a commercially available kit and glucose oxidase methods respectively. The insulin resistance index was calculated from fasting glucose and insulin by the homeostasis model assessment (HOMA-IR) formula. The mean of insulin resistance index (HOMA-IR), HbA1c, diastolic blood pressure, triglyceride and fasting glucose in diabetics were significantly higher than non-diabetics subjects (P<0.05). Serum resistin concentrations were not different between diabetics and non-diabetics obese subjects but were significantly higher in women as compared to men (8.15±4.40 vs. 5.97±2.31 in non-diabetic) and (7.46±3.98 vs. 5.51±3.98 in diabetic) in both groups. Serum resistin was not significantly related to variables measured in both groups. In control group only, we observed a significant and negative correlation between diastolic blood pressure and resistin (r = -0.381; P = 0.024). Serum resistin concentrations were not significantly different between type 2 diabetes and non-diabetic obese subjects and resistin is unlikely to be a major link between obesity and diabetes in humans.

Increasing number of people with diabetes make it the greatest world-wide epidemy which indicates importance of education in physical and mental health of the patients. Since researches report different results about cognition status of diabetic patients, this study was conducted to determine and compare cognitive status in older people with and without type 2 diabetes. In this case- control study 80 patients with type 2 diabetes mellitus compare with 80 persons without diabetes. Cases were selected from the patients refer to diabetes outpatient clinic and control group were patients referred to other clinics. Instruments were questionnaire for gathering demographic data, glucometer, DSM-IR-TR questionnaire, FBS for control group and TSH - T4- HbA1c for cases.. The mean scores of MMSE were 23.3 and 26.8 in case and control group respectively. Difference between two groups was significant in MMSE scores (P<0.01), furthermore between men and women of two groups (P<0.01 for both). No significant difference of MMSE scores between men and women in case group was seen (P=0.45). There was negative association between MMSE scores and age also duration of illness according to the results. Elderly diabetic patients encounter some cognitive impairment which is exacerbated with increasing age.

Glucose metabolism impairment may occur during some pregnancies especially of advanced age and history of previous gestational diabetes and may result in hazardous consequences both for mother and neonate. The present study as a case-control was conducted on 420 referred pregnant women to Shiraz hospitals that involve 70 diabetic patients and 350 non-diabetic women. Data analyzed by analysis of variance and χ square for univariate and logistic regression for multivariate analysis. From 70 diabetic patients 22(31.4%) afflicted with overt diabetes as well as 48 (68.6%) gestational diabetes. Gestational diabetes history (OR=23.14), hydramnious (OR=13.26), glucosuria at 3rd trimester (OR=11.49), family history of diabetes (OR=4.09) and age (OR=1.03) were the most important risk factors for gestational diabetes, respectively. History of macrosomia in previous pregnancies (OR=18.83) and history of previous cesarean section (OR=11.96) were the most important predictors for overt diabetes. In view of several threatening consequences of diabetes during pregnancy, screening for diabetes especially in mothers with gestational diabetes history and family history of diabetes is essential in order to control and prevention of these outcomes in mother and neonate.

High prevalence of consanguineous marriages has been reported in Iran. Since this pattern of marriage may increase the prevalence of diseases with autosomal recessive pattern of expression, the study was assigned to determine this among patients referred to diabetes and osteoporosis clinics of Dr Shariati hospital, Tehran, Iran. The consanguineous marriage was studied among 1789 couples of three successive generations via Questionnaire. The prevalence of consanguineous marriages in three successive generations was 9%, 17% and 19%, respectively with an increasing pattern of prevalence. Overall the prevalence of first cousins marriage was 10% with 69% among consanguineous marriage group. The higher the level of education, the lower the prevalence of consanguineous marriage. In view of the increasing prevalence of consanguineous marriage that may be followed by some trouble consequences about disease expression, it seems necessary to provide facilities for genetic counseling before marriage for youth.

The aim of this study was to examine the prevalence of the metabolic syndrome (MetS) and its association with coronary heart disease (CHD) in Iranian older individuals. In this cross-sectional study, the prevalence of the MetS was determined according to the Third Adult Treatment Panel (ATPIII), the World Health Organization (WHO) and the International Diabetes Federation (IDF) definitions in 720 men and women aged≥65 years. Logistic regression analysis was used to estimate the Odds Ratio (OR) of developing CHD in model 1 an age adjusted model, in model 2 adjusted for age, smoking status, premature history of CHD and LDL cholesterol and in model 3 adjusted for mentioned variables in model 2 plus the components of the MetS according to each definition. The prevalence of MetS was 50.8%, 41.9% and 41.8% by ATPIII, IDF and the WHO definitions, respectively. IDF had high agreement with the ATPIII definition. In model 2, the ATPIII and the WHO definitions of MetS were associated with CHD by the odds ratio of 1.6 (1.1-2.2) and 1.7 (1.9-2.4), respectively. In model 3, obesity (WHO definition) and high blood pressure (ATPIII and WHO definitions) were associated with CHD. As defined by the ATPIII and WHO definitions, the MetS was associated with CHD even after adjustment for the conventional CHD risks, but after further adjustment for their components none of these definitions showed association with CHD.

Little evidence exists regarding the effects of soy consumption on the metabolic syndrome in humans. We aimed to determine the effects of soy consumption on components of the metabolic syndrome, plasma lipids, lipoproteins, insulin resistance and glycemic control in postmenopausal women with the metabolic syndrome. This randomized cross-over clinical trial was undertaken on 42 postmenopausal women with the metabolic syndrome. Participants were randomly assigned to consume a control diet (Dietary Approaches to Stop Hypertension= DASH), soy protein diet, or soy nut diet, each for eight weeks. Red meat in the DASH diet was replaced by soy protein in the soy protein period and by soy nut in the soy nut period. Total cholesterol was significantly reduced compared to the control (P<0.01) and soy protein groups (P<0.01). The results were the same regarding the fasting insulin serum (P<0.01 compared with the control and soy protein group), HOMA-IR (P<0.01 compared with the control and soy protein group), Fasting blood sugar (P<0.01 compared with the control and soy protein group), and LDL cholesterol (P<0.01 compared with the control and P<0.05 compared with the soy protein group). Both soy nut and soy protein reduced Apo B100 compared to the control group (P<0.01). Short-term soy nut consumption improved glycemic control and lipid profiles in postmenopausal women with the metabolic syndrome

Diabetes accounts as one of the most prevalent diseases worldwide that affects roughly 2 million people with a prevalence of 4.67% in Iran. Despite clinical knowledge of the benefits of optimal glycemic control and preventive care, current studies show that many people with diabetes dont receive such care. Changing physician behavior is a crucial step in implant of scientific evidence into improved patient outcomes. Clinical practice guidelines (CPGs) have emerged as a means for this and for reducing variation in care. "Iranian guidelines for diabetes mellitus care" is intended for use by health care practitioners involved in the care of people with diabetes in the community, such as general physicians endocrinoligists, podiatrists, nutritionists and optometristsIranian Diabetes Guidelines (IDGs) was designed for the Iranian physicians who manage diabetic patients. IDGs consist management of types of diabetes and their acute and chronic complications in primary, secondary and tertiary care levels, also screening and life style modifications.IDGs are the first practical guideline for management of diabetic patients in Iran.