مجله غدد درون ریز و متابولیسم ایران
سال سیزدهم شماره 5 (پیاپی 59، دی 1390)

Complications of gestational diabetes mellitus (GDM) have drastic effects on the health of the mother and fetus from different aspects. Sufficient knowledge and self care skills, especially regarding nutrition and exercise, play a major role in the management of GDM. This study aimed at determining the impact of education on nutrition and exercise awareness and metabolic control indicators (fasting and post prandial blood sugars) among a group of gestational diabetes mellitus (GDM) patients, referred to hospitals of Shiraz University of Medical Sciences. In this interventional study, 61 class A1 gestational diabetes mellitus (GDM) patients were selected through easy sampling and randomly assigned to two groups of experimental and controls. Before the intervention, we measured metabolic control indicators and levels of knowledge in both groups, using laboratory tests and a specifically designed and validated written test (containing 34 multiple choice questions respectively, with a reliability of KR20: 0.81). Educational interventions were then implemented for about 6 hours weekly for the experimental group, and the expected outcomes were measured in both groups immediately following and again two weeks after the end of the intervention. Finally, the data collected were analyzed by SPSS software, version 11.5, using independent sample t-test, Chi-square and Bonferroni. The results of data analysis revealed that after educational intervention the means for knowledge and post-prandial blood sugars (1 and 2hpp) were significantly different in the experimental group (p<0/001). Results show that the effectiveness of the educational intervention in the improvement of the level of knowledge and metabolic control indicators, emphasizing hence the need for appropriate interactive education among such groups.

Improvements in lipid profiles and blood pressure are essential for preventing complications of diabetes. Considering the strong inclination people have to use herbal medicines, we aimed to investigate the effects of hydro alcoholic nettle extract on lipid profiles and blood pressure in type 2 diabetes patients. A single-blind, randomized clinical trial was conducted on 50 type 2 diabetes patients, randomly divided into two groups the intervention (n=25) and control (n=25). Subjects in the intervention group consumed 100 mg/kg of hydro alcoholic nettle extract daily, while those in the control group consumed 100 mg/kg of placebo daily for 8 weeks. Lipid profiles, systolic) and diastolic blood pressure were measured at baseline and at the end of 8th week of intervention. The intervention group showed a significant reduction in levels of triglycerides (TG), SBP and plasma atherogenic indexes (LDL-C / HDL-C and TC / HDL-C) (P<0.05), and a significant increase in level of High Density Lipoproteins (HDL-C) (P<0.05), at the end of 8th week of intervention, compared to control group. No significant changes however were observed in Total Cholesterol (TC), Low density lipoproteins (LDL-C), and DBP at the end of 8th week of intervention. Hydro alcoholic extract of nettle had positive effects on the lipid profiles and blood pressure status of type 2 diabetes patients, indicating its consumption can be recommended as auxiliary therapy in patients for type 2 diabetes.

Long-standing uncontrolled type 2 DM may affect the motility and function of the gastrointestinal (GI) system, throughout the GI tract, from the esophagus to the anorectal region. This study was designed to evaluate the prevalence of GI symptoms in type 2 DM patients and its association to age, sex, glycemic control and duration of diabetes.

This was a cross-sectional study conducted on 350 adult type 2 DM patients, selected with sequential sampling from the Ahvaz Diabetes Research Center Clinic in 2010. Data were collected by a questionnaires and analyzed using independent t-test and Chi-score with SPSS version18.

Patient mean age was 56 ± 11 years, and the prevalence of GI symptoms was 67%. The most prevalent GI symptoms were constipation (43%), bloating (35%) and regurgitation (31%). Prevalence of GI symptoms was related to duration of diabetes (P<0.001). Higher levels of fasting plasma glucose increased the prevalence of GI symptoms (P=0.003), which were significantly higher in females than in males (P<0.001), and also in older patients (P=0.003). There was no association between prevalence of GI symptoms and levels of HbA1C or BMI.

Prevalence of GI symptoms in type 2 DM was 67%, the most prevalent being constipation, bloating and regurgitation. There was significant association between prevalence of GI symptoms and acute glycemic control (FBS), duration of type 2 diabetes, female gender and age.

Self-management of diabetes, an important aspect of diabetes treatment, is strongly affected by psychological and sociostructural factors. The aim of this research was to investigate the psychological, social and structural determinants of diabetes self-management in patients with type 2 diabetes. In cross-sectional design study, 500 out patients (245 men and 255 women) with type II diabetes were selected by convenience sampling. Data collected by demographic questionnaires on the Scales of diabetes self-management, diabetes self- efficacy, belief to treatment effectiveness, belief to illness certainty, treatment motivation, patient- provider therapeutic communication, diabetic knowledge, satisfaction for therapeutic services, access to therapeutic services, familial social support, and on collaborative decision-making, were analyzed by correlation and stepwise multiple regressions. Diabetes self-management mean (standard deviation) was 45.77 (21.81). Self-efficacy, belief of treatment effectiveness, social support, >HbA1c%7 and Insulin therapy significantly predicted diabetes self-management variance (P<0.001). The variables explained 91% of diabetes self-management (R2 = 0.91). Self-efficacy has highest weight in prediction of diabetes self-management (β = 0.338, P<0.001). Self-efficacy, belief of treatment effectiveness, social support, mild HbA1c and treatment type are important factors for diabetes self-management and these variables explained the high rate of the diabetes self-management variance, emphasizing the importance of improvement of self-management behaviors in these patients.

Metabolic syndrome is a physiologic syndrome, characterized by increasing coronary heart disease risk factors like hypertension, diabetes, dyslipidemias and obesity. The aim of this study was to determine some metabolic syndrome factors and percent age of body fat and its relationship with maximal oxygen consumption among patients with Coronary Artery Disease hospitalized in the Coronary Care Unit. This was descriptive correlative study that 90 coronary patients 40-80 years old participated by available sampling. We used Non-Exercise Test formulas for maximal oxygen consumption Predicting. Fasting blood sample used for TG, FBS, HDL-C. Percent body fat was estimated by measuring 4 skin fold thicknesses and blood pressure was measured. The means of the factors of Metabolic syndrome and percent body fat were higher among females, compared to males. Decrease in HDL and increased blood pressure were the most prevalent among risk factors. There was a significant negative relationship between maximal oxygen consumption and body fat, FBS, SBP. According to our findings, the prevalence of risk factors of metabolic syndrome and percentage of body fat were high. With increase of body fat, FBS and SBP, all results of unhealthy lifestyles, maximal oxygen consumption is decreased.

Exercise significantly prevents the progression of atherosclerosis and oxidized LDL-C (ox-LDL-C), facilitates monocyte-related atherogenesis. The effects of Lifestyle Activity Modification (LAM) training based on guidelines of the Centers for Disease Control (CDC) and the American College of Sports Medicine (ACSM) on serum oxidized LDL-C (ox-LDL-C) in obese people are not well known. We investigated the effect of LAM on serum ox-LDL-C in obese middle aged men. Sixteen healthy obese middle aged men (aged 42.06±6.01 years, mean ± SD) were randomly assigned to the LAM (n=8) and the control (n=8) groups. Subjects in the LAM group walked 2 miles daily in 30 minutes 4 days weekly for 12 weeks on treadmills, according to the CDC and ACSM guidelines. Results showed that body weight, BMI, body fat mass, body fat percent, waist to hip ratio (WHR) and LDL-C decreased significantly after 12 weeks in the LAM group compared to the controls (P<0.05), and their maximum oxygen uptake was increased significantly compared to the controls after 12 weeks (P<0.05). On the other hand, after 12 weeks of LAM training, no significant differences were observed in serum ox-LDL-C, total cholesterol (TC), triglycerides (TG) and HDL-C between the groups. Although twelve weeks of LAM improved body composition and cardio-respiratory fitness and decreased LDL-C levels in obese middle aged men, serum ox-LDL-C were not affected by this protocol in this group.

Physical activities represent an independent risk factor for a number of chronic diseases. The aim of this study was to assess physical inactivity in a sample of Tehranian adults. We selected 7285 TLGS participants (≥ 20 years), who had completed physical activity questionnaires between 2002-2004. Leisure time physical activity level was assessed using the modifiable Activity Questionnaire (MAQ), with each activity being weighted by its relative intensity, referred to as a Metabolic Equivalent (MET). Subjects were asked to report the activities they had participated in during past 12 months and to estimate the frequency and duration for each leisure time activity indentified and were categorized into the active and inactive groups. The overall prevalence of inactivity was 69.8% and only 30.2% (95%CI=27.2-33.1%) of males and 30.3% (95%CI=27.7-32.8%) of females were considered active. In males, the prevalence of inactivity increased with age and the highest rate of physical inactivity was observed in the 40-49 year group. There was a statistically significant decrease in leisure time physical activity level (LTPA) with increasing body mass index, and smoking and hours of work. A positive association was observed between LTPA and high educational levels in males. Moreover, a statistically significant difference was found between the physical activity and occupations between men and women (p<0.05). Findings of the present study showed that a high prevalence of physical inactivity among Tehranian adults, raising concerns about public health, and necessitating health policies encouraging the population to be more active.

Changes in lipids and apo lipoproteins levels are considered a risk factor for cardiovascular disease. The APOAI-CIII-AIV gene cluster plays an important role in regulating of the metabolism and level of lipids. The aim of this study was to elucidate the associations of five single nucleotide polymorphisms in the Apo11q cluster gene with lipid levels. A cross-sectional study of 823 subjects (340 males and 483 females) from the Tehran Lipid and Glucose Study (TLGS) was performed. Anthropometrical and serum concentrations of TG, Chol, HDL, Apo AI, Apo AIV, Apo B, Apo CIII were measured. The segments of the APOAI-CIII-AIV gene cluster were amplified by PCR and the polymorphisms were revealed by RFLP using restriction enzymes. Allele frequencies of each SNP did not differ significantly between males and females. Genotypes and alleles distributions were in Hardy-Weinberg equilibrium, except for Apo AI (+83C>T). Results demonstrated a significant association between TG, HDL-C, HDL2, Apo AI and Apo B levels and the presence of some alleles in the polymorphisms studied. After haplotype analysis not only did the association between these variables and SNPs remain, but the levels of total cholesterol and LDL-C were also added. The results of the present study showed that in addition to environmental factors, genetic variations are also important in the regulation of the metabolism and level of lipids such as TG and HDL-C.

Restricted mineral bioavailability of minerals in Iranian breads due to high levels of phytic acid has been reported for more than 50 years. Bread intakes still provide over one-third of the food energy through out the country. Hence improving bread mineral bioavailability can play an important role in decreasing the prevalence of many mineral deficiencies. The aim of this study was to assess the effect of phytase supplementation on blood, liver and bone zinc, blood and liver iron and femur bone calcium in growing Wistar male rats, fed a diet containing high phytate Iranian bread (Sangak). Thirty weaning Wistar rats were assigned to the phytase (Aspergillus niger) or the control group for 6 weeks. The diet was designed based on Iranian food patterns and 34.2 % of energy was supplied from Sangak bread with high amount of phytic acid. Feed intakes, weight gain, liver and femur bone weight did not differ between the groups. Blood zinc was higher in the phytase group (p=0.03), indicating the positive effect of phytase supplementation on blood zinc levels, independent of the growth process. Other variables did not show any differences between groups. We conclude that the addition of high phytate Iranian bread phytase to the diet can improve blood zinc status in growing rats.

Neuroendocrine dysfunction following traumatic brain injury (TBI) is frequently missed due to the absence of major symptoms and very often, no appropriate management is prescribed, thus delaying the patient recovery. This study is aimed to determine the frequency and pattern of anterior pituitary dysfunction following TBI.

From June to December 2009, overaperiod of seven months, a total of 156 cases were admitted to a trauma center following TBI. Of the seventy patients, (61 males and 9 females mean age 30 years) included in the study, 39 patients had moderate (GCS; 9 – 12) and 31 cases had severe (GCS < 8) TBI. Patients were tested 6 months after injury for possible secretory abnormalities of anterior pituitary hormones. Anterior pituitary secretary function was assessed by measurement of serum levels of FT4, TSH, basal GH, IGF-1, 8 am Cortisol, FSH, LH, total testosterone and prolactin. Dynamic tests of ACTH and glucagon stimulation were used to evaluate the pituitary-adrenal axis and GH secretory status.

Forty-one patients (58.6%) were found to be suffereding from at least one hormonal secretory abnormality, with patterns and frequencies of: Gonadotropins (LH, FSH), 12.9%, corticotropin (ACTH), 12.9%, somatotropin (GH), 4.3%, and prolactin (PRL), 1.4%. There was no case with thyrotropin deficiency. Hyperprolactinemia was found to be present in 23 cases (31.5%).

The results of this study showed that anterior pituitary hormone deficiencies occur frequently, 6 months following traumatic brain injury. The two most commonly involved axes were the pituitary-gonadal and the pituitary-adrenal. Hypocortisolism may be particularly harmful for the patient's health.

The role of morphine in blood glucose changes has been documented. The aim of the present study was to investigate the hormonal mechanisms involved in changes caused by morphine on blood glucose in diabetic and non-diabetic mice. Animals were divided into two, the diabetic and non-diabetic, groups. Each group was further divided into subgroups: 1. Saline+saline 2. Naloxone+morphine and 3. Control (saline+saline). Blood samples were used for determining the blood glucose as well as for hormonal (insulin, cortisol and epinephrine) analyses. In non-diabetic and diabetic mice, blood glucose was significantly decreased in the saline+morphine group, compared to controls at 3h and 1h respectively, a decrease which compensated in the naloxone+morphine group, compared to saline+morphine group. After 3h, the level of insulin in non-diabetic mice was significantly decreased compared to the controls and was compensated in the naloxone+morphine group. At this time, the level of insulin showed no changes in diabetic animals. The level of cortisol remained constant both in diabetic and non-diabetic animals at 3h. The level of epinephrine displayed a significant decrease in diabetic and non-diabetic mice at 3h when compared to the controls and was compensated in the naloxone+morphine compared to the saline+morphine group. The administration of subcutaneous morphine caused hypoglycemia in diabetic and non-diabetic mice. The hypoglycemia and the decrease of insulin level in non-diabetic mice as well as the unchanged level of this hormone in diabetic animals may suggest an insulin-independent hypoglycemia induced by morphine.