مجله غدد درون ریز و متابولیسم ایران
سال یازدهم شماره 4 (پیاپی 46، آبان1388)

To investigate whether using the 2003 criteria for impaired fasting glucose (IFG) improves the prediction of Type 2 diabetes mellitus (T2DM) in comparison to the 1997 criteria. A total of 5794 non-diabetic subjects, aged 42±13 years, were followed for 6.5 years. T2DM was defined based on the WHO 1999 criteria. Cox regression analysis was used to calculate the relative risk (RR) of developing T2DM. Model discrimination was assessed by calculating the area under the receiver operating characteristic curve (AUC). During the follow-up, there were 351 new cases of T2DM. In univariate analysis, the RR of the 1997 and 2003 criteria were 9.6(7.5-12.3) and 8.4(6.4-10.0) respectively. After adjustment for a full range of diabetes risk factors, the RR of the 2003 criteria was higher compared to that of the 1997 definition [RR (95%CI): 3.3(2.6-4.2) vs. 2.4(1.8-3.2) respectively]. Inclusion of the 2003 criteria in the multivariate model significantly improved discrimination in comparison to the 1997 definition [AUC (95%CI): 0.78(0.74-0.83) vs. 0.74(0.70-0.79), P<0.01]. When fasting glucose is used in community screening for pre-diabetes state, the 2003 IDF criteria yield significantly better results than the original criteria for prediction of future T2DM.

One of the manifestations of diabetes mellitus is pain, induced by poly neuropathy. Pain relief is obtained using different methods of symptomatic treatments, one of which is electroanalgsia, the use of which is a controversial issue among scientists and researchers. The aim of this research is to determine the efficacy and types of Transcutaneous Electrical Nerve Stimulation (TENS) on pain relief in painful diabetic poly neuropathy. The design of study was a double blind randomized controlled trial. Forty one subjects with diabetic mellitus Type II, complaining of pain were selected, and assigned into three groups treated during two phases. Two kinds of Electrical Nerve Stimulation i.e.,TENS and Diadynamic were given to two groups, and for the third we used sham stimulation. The outcome measure of the study was quality of pain (0-5) and visual analog scale (V.A.S.). Data collection and analysis was done by SPSS software. Mean score of pain decreased in all groups after treatment, but no significant differences were seen between groups. Although, using TENS and diadynamic are beneficial in some patients conditions, no significant differences in the effects of either TENS or the diadynamic current, or the placebo on pain in diabetic patients were observed.

Leptin, a hormone secreted by the adipocytes, has a role in the pathogenesis of obesity and non-insulin-dependent diabetes mellitus (NIDDM). There are relationships between Tumor Necrosis Factor-α (TNF-α) and Interleukin-6 (IL-6) with Body Mass Index (BMI) and insulin resistance. Increased lipid peroxidation leads to produce MDA in diabetic people. It have been shown that, there are relationships between leptin and TNF-α, IL-6, and MDA,showing that increased lipid peroxidation leads to MDA production in diabetics. This study investigates relationships between serum leptin concentration and inflammatory intermediate and oxidative stress in postmenopausal diabetic women. We studied 45 postmenopausal diabetic women and 45 postmenopausal healthy women (controls), aged between 45-60 y and with BMI 25-30 kg/m2. Fasting blood sugar, serum leptin, TNF-α, IL-6, and MDA were determined in postmenopausal diabetics and healthy women, and comparisons were performed using the t test in the diabetic and healthy groups. Pearson correlation was used to evaluate the relations among different variables in two groups. There were non significant correlations between leptin and TNF-α (r=0.2) and IL-6 (r= -0.06) in postmenopausal diabetic women, and also between leptin and MDA (r= 0.04) in postmenopausal diabetic women. There were no significant relationships between serum leptin and TNF-α, IL-6, and MDA in postmenopausal diabetic women. It seems these relationships need to be further clarified in future studies with larger sample sizes.

Some animal studies have suggested that Conjugated Linoleic acid (CLA) supplementation may have therapeutic potential with respect to lipid metabolism, considered to be the most important cardiovascular disease (CVD) related risk factor, associated with type 2 diabetes mellitus (T2DM). However, results from human studies on risk markers of diabetes are ambiguous. This study was carried out to determine the effect of CLA supplementation (as 50:50 proportions of c9, t11 and t10, c12 CLA isomers) on serum lipid profiles, MDA, apo-B100, systolic and diastolic blood pressures in patients with T2DM.

The study was a randomized double-blind, placebo-controlled parallel intervention. Participants were 39 T2DM patients (35 to 50 y, 30>BMI >25) stratified, according to sex, age and BMI into two groups. The intervention group took 3.0 g CLA/d (3×1g, capsules), a 50:50 isomer blend of c9, t11 and t10, c12 CLA) while the control group took soy bean oil as CLA placebo for 8 weeks. Blood pressure, serum lipid profile, MDA, and Apo B were measured at baseline and at the end of the intervention.

There were no significant differences in serum triacylglycerol, total cholesterol, LDL-C, HDL-C, apo-B100 and MDA between the two groups after week 8 nor were any significant differences observed in systolic and diastolic blood pressure between the two groups after intervention.

Results of this study suggest that short term CLA supplementation (3g/d) may not improve lipid profiles, apo-B100 and MDA concentrations in T2DM patients.

Diabetes is a chronic disease with undesirable complications. In addition to physical complications, some psychological problems, especially stress and depression are prevalent among people with diabetes. The aim of present study was to determine the effectiveness of cognitive-behavioral stress management training on glycemic control and depression in patients with type 2 diabetes mellitus. In a randomized clinical trial, 40 members of the Isfahan Diabetes charity, with type 2 diabetes mellitus were selected through voluntary accessible sampling. Participants were randomized to the cognitive-behavioral (n=20) and the control groups (n=20). The case group participated in two-hour sessions of cognitive-behavior stress management training for 12 weeks. To evaluate the effects of intervention, the glycosylated hemoglobin(HbA­1c) test was administered before and 3 months after interventions and the depression subscale of the DASS scale was administered before, after, and again 3 months following intervention. Data were analyzed using repeated measures analysis of variance and analysis of covariance. After intervention, the mean of HbA1c in the experimental group was significantly lower than the control group (p< 0/001). Also the mean for depression in the experimental group was significantly lower than in controls (p< 0/001), a finding that remained as such at the 3 month follow-up assessment. Stress management training can improve glycemic control and depression in patients with type 2 diabetes mellitus. It is recommended that such trainings programs be intergrated into comprehensive treatment of diabetes mellitus.

In recent years, much attention has been focused on the metabolic syndrome and its association with development of non insulin dependent diabetes mellitus (NIDDM) and cardiovascular disease. Although androgen deficiency in men is associated with obesity, whether the deficiency predisposes to, or is a consequence of the syndrome is still unclear. This study aimed at assessing the association between low levels of total testosterone, the sex hormone binding globulin (SHBG) and free testosterone index, and development of the syndrome, based on ATP III and IDF criteria. We assessed 836 men, aged ≥ 20 years, participants of the Tehran Lipid Glucose Study, at baseline and over 6.5 years follow-up, according to both definitions for occurrence of metabolic syndrome, following adjustment for confounding factors such as age, physical activity, smoking, education, fasting plasma glucose, triglycerides, serum HDL-C, waist circumference, systolic and diastolic hypertension. Using logistic regression models, the association between serum total, free testosterone index and SHBG and metabolic syndrome was investigated. After 6.5 years of follow-up, metabolic syndrome was found to have developed in 131 men and 207 men according to ATP III and IDF criteria respectively. Multiple logistic regression analysis showed an inverse relationship for total testosterone in the lower tertile concentration and serum triglycerides according to both criteria [odds ratio (OR)=1.6 95% confidence interval (CI), 1.02-2.5)]. According to ATP III criteria, adjustment of waist circumference eliminated most of the correlations between total testosterone and metabolic syndrome (OR=1.34, 95% CI (0.8-2.3), while SHBG and free testosterone index were not significantly associated with the syndrome. According to IDF criteria, statistical adjustment of waist circumference eliminated most of the correlations between total testosterone and metabolic syndrome [(OR=1.45, 95% CI (0.9-2.3)], and adjustment with triglycerides eliminated any correlation between SHBG and metabolic syndrome (OR=1.5, 95% CI (0.9-2.5). Our data do not support a predictive or causative role androgen deficiency in the development of metabolic syndrome according to ATP III and IDF definitions but do demonstrate that androgen deficiency may be consequence of the effect of poorly controlled triglycerides and increased waist circumference on, rather that a cause of, poor metabolic status.

Metabolic syndrome (MS) is a risk factor for type 2 diabetes mellitus and cardiovascular disease. Limited information is available about the prevalence of the metabolic syndrome in rural areas of Iran.

A total 1402 adults (1042 females and 360 males), aged between 18-90 yrs, participated in a community-based cross-sectional study. Prevalence of metabolic syndrome was determined by the definition of the National Cholestrol Education Program Adult Treatment Panel III (NCEP ATPIII), and results were compared with those based on the revised ATPIII and International Diabetes Federation (IDF) definitions.

Overall prevalence of ATP III defined metabolic syndrome was 25.6% compared to 29% and 33% using the revised ATP III, IDF definition respectively. The results of multiple logistic regression model showed after adjusting for age, sex, Body Mass Index (BMI), marital status, and education level, there was no difference between men and women for metabolic syndrome (P=0.2) by ATP III and revised ATP III definitions while prevalence of metabolic syndrome was 1.97 times greater in women versus men (95% CI: 1.4 – 2.7, p< 0.001) by the IDF-definition. Sex-adjusted prevalence of metabolic syndrome (by three definitions) increased 1.05%, for each one year increase in age [95% CI: (1.04-1.06)]. In the current study, low serum High Density Lipoprotein Cholesterol (HDL-C) was the most common component of metabolic syndrome, while high fasting plasma glucose was the least common.

These results show that the metabolic syndrome is prevalent in rural areas and interventional strategies should be considered for weight reduction and treating components of metabolic syndrome in this population.

Menarcheal age is an important event in human life and is influenced by various genetic, demographic, socio-economic and inviromental factors. Limited current data shows controversy regarding the effect of antropometric and biochemical variables on age of menarche and the related factors among Iranian girls. The objective of the present study is to evaluate the effect of antropometric,demographic and serum lipoproteins on the age of menarche. in the present descriptive study, we enrolled 370 girls aged 10-16 year, from the Tehran Lipid and Glucose Study (TLGS), whose menstruation had begun 6 months prior to the study. The mean age of menarche, weight, height, waist circumference and body mass index were 12.6±1.1years, 53.7 ±10.5kg, 157.3±5.5cm, 72.5 ±9.8cm and 21.7 ±3.9 kg/m2, respectively. Although there were statistically significant relationships between age of menarche and body mass index, height, waist circumference and level of mother’s education, there was no significat correlation between menarcheal age and weight or serum lipoprotiens. Serum lipoprotiens were not found to have any influence on the menarcheal age in girls.

Traumatic brain injury is a cause of death in adult populations. Adrenal insufficiency has a great impact on the prognosis of patients with traumatic brain injury. However there is a lack of consensus regarding the diagnostic criteria of adrenal insufficiency. Our aim was to assess adrenal function in patients with moderate to severe traumatic brain injury. In a multicenter case-series study, 50 patients, aged 15 to 70 years, with moderate to severe traumatic brain injury were enrolled from 4 intensive care units in Tehran. Adrenal function was assessed using the 1 and 250µg ACTH stimulation tests. The incidence of adrenal insufficiency in the first 10 days after traumatic brain injury varied from 34% to 82%, based on various definitions of adrenal insufficiency. More cases of adrenal insufficiency were detected by 1µg ACTH stimulation test compared to the basal cortisol and 250µg ACTH tests. Since the gold standard insulin stimulation test is regarded as potentially dangerous in the acute phase of post traumatic brain injury, the sensitivity and specificity of the stimulation tests could not be assessed. Kappa test showed no agreement between the two tests (Kappa=0.17). The incidence of hypotension and vasopressor requirement was higher in patients diagnosed by the 250µg ACTH test. Baseline cortisol had linear correlation with the 60-minute cortisol of both the 1 and 250µg ACTH tests (P<0.0001). The prevalence and associated morbidity of adrenal insufficiency in patients with traumatic brain injury warrant early diagnosis of subclinical cases by dynamic stimulation tests and judicious corticosteroid therapy.

Diabetes mellitus is associated with histologic alterations of the testis. In the present study, we aimed to investigate both preventive and protective effects of garlic juice on testicular damage in male rats with streptozotocin (STZ)-induced diabetes. Forty male wistar rats were divided into 5 groups: 1) Group normal (N), 2) Group Normal+Garlic (N+G), 3) Diabetic (D) received STZ, 60mg/kg BW /i.p., 4) Group diabetic+garlic before (D+Gb) received garlic juice for 3 weeks before STZ injection and for 3 weeks after, and 5) Group diabetic+garlic after (D+Ga) three days after STZ injection, received garlic juice for 3 weeks. Garlic juice was given by gavage (1ml/100g BW). Testicular damage was examined using hematoxylin and eosin staining. Diabetic rats showed a significant reduction in seminiferous tubule diameter and the number of germ cells. Garlic significantly attenuated the diabetes-induced morphological changes and the decrease in germ cells. The diabetic group receiving garlic before STZ injection (D+Gb) showed more amelioration in complications than that receiving it after STZ injection. In this study, for the first time, we showed that administration of garlic juice could play both preventive and therapeutic roles in testicular damage in male diabetic rats.

Diabetes mellitus is associated with biochemical, physiological, and pathologic alterations in the liver. In this study, we investigated the preventive effect of garlic juice on changes in the structure of rat liver and serum activities of alanine and aspartate aminotransferases after streptozotocin injection. Forty rats were divided into five groups of 8 rats each: a) Normal group (N), b) Normal+Garlic group (N+G) received 1 ml of garlic juice/100g BW/day for 6 weeks, c) Diabetic group (D) was injected with streptozotocin (60mg/kg BW, i.p.), d) Diabetic+Garlic_before group (D+Gb) received garlic juice for 3 weeks before STZ injection and continued for another 3 weeks, e) Diabetic+Garlic_after group (D+Ga) received garlic juice for 3 weeks after being injected with STZ. Hepatic histological changes were assessed with hematoxylin-eosine staining using a light microscope. In diabetic rats, the activities of serum ALT and AST were significantly increased (p<0.05) compared to other groups. In D+Gb and D+Ga rats the activity of serum ALT was significantly decreased compared to the D group. The activity of serum AST in D+Gb group had no significant difference with the N and N+G groups and was significantly decreased compared to the D group. In the D group, separated necrosis of hepatocytes, anarchism of liver plates, and lymphocytic inflammation were observed in the D+Gb and D+Ga groups compared to the D group, all of previous signs improved. Garlic juice was found to influence changes of aminotransferases and prevent the histopathological changes of liver associated with STZ diabetes in rats.

Appetite regulation is one of the most important issues in exercise physiology. AGRP is one of the most important neuropeptide in appetite regulation and energy homeostasis. The aim of this study was to investigate the effect of treadmill running on plasma and muscle (Soleus) concentration of AGRP in male Wistar rats. Forty rats were randomly assigned into two groups. The training group was given exercise on a motor-driven treadmill at 28 m/min (equal to 75% vo2max) for 60 min/day, 5 days/week for 10 weeks. After finishing the exercise protocol, each group was divided into 2 subgroups, the fasting and the fed (n=10) groups. Each subgroup was anesthetized and sacrificed after an overnight fast and the other, after 3 hours of food deprivation. The results showed muscle and plasma AGRP were significantly (P < 0.001) higher in the trained rats in comparison to the control rats. Also there was a significant and positive correlation between Soleus AGRP and plasma AGRP. It can be speculated that negative energy balance as well as local hyperphagia in muscle, induced by exercise produces satiety, signals the hypothalamus, which therefore increases release of AGRP facilitating energy recovery. This mechanism may be involved in glycogen supercompensation as well.

The nucleus bed of the stria terminalis (BST) is a part of the limbic system. Previous studies have shown that inhibition of GABA A receptor increases blood pressure and heart rate. This study was performed to find the possible mechanisms and circuits that mediate these responses. In 39 urethane-anesthetized male rats the femoral artery and vein were cannulated for recording the blood pressure and heart rate and drug injection respectively. Trachea was cannulated to ease ventilation, and bicuculline was unilaterally microinjected into the BST using micropipette. The maximum changes of mean arterial pressure (MAP) heart rate (HR) were compared with the preinjection values using the paired t-test. Injection of bicuculline methiodide (BMI, 100 pmol/100 nl), a GABAA antagonist, caused a significant increase in the MAP (41.3±5.1 mmHg) as well as in the HR (33.2±5.6 beats/min). Administration (i.v.) of the muscarinic receptor blocker, homatropine methyl bromide had no effect on the magnitude of mean arterial pressure or heart rate responses to BMI, suggesting that the parasympathetic system is not involved in these responses. However administration (i.v.) of the nicotinic receptor blocker, hexamethonium bromide, althought it had no effect on the magnitude of mean arterial pressure response, did abolish heart rate response to BMI, indicating that the sympathetic system is involved in the bradycardic effect of GABA. On the other hand, administration (i.v.) of a selective vasopressin V1 receptor antagonist abolished the pressor effect of BMI, which suggests that the GABAergic system of the BST decreases the arterial pressure via tonic inhibition of vasopressin release. We demonstrated, for the first time, that inhibition of GABAA, receptors increase blood pressure and heart rate via tonically inhibiting vasopressin release and sympathetic outflow to the heart.