Iranian Journal of Diabetes and Obesity
Volume:4 Issue: 1, Spring 2012

Due to the increased prevalence of thyroid dysfunction in subjects with type 2 diabetes and also this fact that antibodies could potentially identify subjects at risk of thyroid dysfunction, this study was conducted to investigate thyroid autoimmunity in type 2 diabetic patients. Among patients referred to Yazd Diabetes Research Center, 4000 type 2 diabetic patients were recruited and clinical examination was carried out and samples for thyroid function test including thyroxin (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH), T3 resin uptake (T3RU), thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibodies (Tg-Ab) were obtained. Among 4000 type 2 diabetic subjects (1649 male and 2351 female), 1762(44%) were known to have thyroid disease. A total of 1466 (36.7%) had positive TPO antibodies and 1072 (26.8%) had positive Tg-Ab antibodies. The logistic regression of thyroid dysfunction on Tg-Ab as well as TPO-Ab status (positive vs. negative) was significant (P=0.0001). Our results showed strong association of thyroid dysfunction with autoantibodies, especially in patients with Tg-Ab positive. Therefore, the findings suggest that all subjects with type 2 diabetes, particularly those with positive antibodies, should undergo annual screening to detect asymptomatic thyroid dysfunction.

Diabetic nephropathy is a major diabetes complication. Arterial resistance index (RI) may predict deterioration in kidney function. This study was designed to compare renal arterial RI in different stages of renal function according to glomerular filtration rate (GFR), serum creatinine level and proteinuria. In a cross-sectional study on 81 diabetic patients in three groups (Without albuminuria, with microalbuminuria, with macroalbuminuria), pulsatile Doppler ultrasonography was performed to measure intra-renal arterial resistance index and find the association of this parameter with features of diabetic nephropathy. Data was analyzed using SPSS (ver. 16). Serum creatinine, GFR and proteinuria were significantly different among three groups. RI was highest in the group with macroalbuminuria and the difference among three groups was statistically significant. (P value<0.001) RI was correlated with serum creatinine, GFR and proteinuria. Higher RI correlates with higher proteinuria in diabetic patients.

Social belief and experimental evidences indicate that opium and its alkaloids, morphine, produced hypoglycemic effects in animal models. This study was conducted in order to determine the role of morphine on blood glucose and insulin. This is an empirical analysis investigating the laboratory albino male rats weighing 250-200 g. Rats in the control group received saline and animals in the treatment group were injected 5mg/kg morphine intraperitoneally. Blood glucose and insulin rate were measured at the time of 0, 2, 4 and 6 hours after morphine injection. The results of this study showed that morphine could not change serum insulin and blood glucose in comparison to control group. It is concluded that the effects of morphine on blood glucose and insulin are dependent upon the route of administration, and that I.P. injection of morphine in rat had no effect on blood levels of glucose and insulin.

Level of serum homocysteine is remarkably common among patients with moderate to sever renal failure. We assessed whether serum homocysteine concentrations were correlated with proteinuria in overt diabetic nephropathy. A cross-sectional study was carried out on 45 patients (29 males, 16 females) with overt proteinuria. All subjects had type 2 diabetes. Data included age, sex, hypertension, serum creatinine, creatinine clearance, 24-hour urine proteinuria, lipid profiles and serum homocysteine. The mean of serum homocysteine concentrations was 18 ± 7.7 µmol/L (4.6-42), having 31 (70%) hyperhomocysteinemia. The mean of 24-hour urine proteinuria was 1515 ± 996 mg, for serum creatinine 1.9 ± 0.7 mg, and for creatinine clearance, it was 97 ± 26.6 mL/min. Serum homocysteine had a negative correlation with creatinine clearance (r=-0.4, p=0.007) and revealed no correlation with 24-hour proteinuria (p=0.9). In overt nephropathy in diabetes type 2, patients with higher homocysteine had lower creatinine clearance. However, there was no correlation between homocysteine and overt proteinuria.

For decades, exercise has been considered as a cornerstone for managing diabetes. The current study aimed to determine the effects of regular exercise on blood glucose, lipids and HbA1C in type-2 diabetes mellitus. A total of 61 diabetic patients were randomly selected. Later, subjects with capability of doing exercise took part in a special four-week exercise program. The blood glucose, lipid levels (before and after 4 weeks) and HbA1C (before and three months after exercise program) of 32 subjects were measured and compared in the time scales. Our results showed a significant reduction in blood glucose and lipid concentrations. However, the reduction observed in HbA1C was insignificant (P=0.12). Comparison of pre- and post-exercise results demonstrated a significant improved glycemic control. The findings confirm the benefits of exercise training in type 2 diabetic patients. There are many studies which support the importance of physical activities program in controlling and preventing the common metabolic disorder and its complication.

The aim of this study was to investigate the effect of pomegranate juice (PJ) on the paraoxonase and arylesterase activity of human serum paraoxonase(PON1). Fifty patients with type 2 diabetes mellitus consumed 200 ml of PJ daily for a period of 6 weeks. Blood was collected from the patients before and after PJ consumption after 12 h of fasting. Blood sugar, total cholesterol, triglyceride, and HDL-C were measured by enzymatic kit method and autoanalyzer. The concentration of LDL-C was calculated by using Friedwald formula. The malondialdehyde concentration (μmol/L) was determined by thiobarbituric acid (TBA) assay. Paraoxonase and arylesterase activity of PON1 enzyme were measured using paraoxone and phenylacetate as the substrates. The concentration of fasting blood sugar, total cholesterol, LDL-C and malondialdehyde significantly (p<0.001) decreased after the intervention. Paraoxonase and arylesterase activity of PON1 significantly (p<0.001) increased after the intervention. However, there were no significant changes in serum triglyceride and HDL-C. There was a significant positive correlation between paraoxonase and arylesterase activity of PON1 and serum HDL-C concentration. A significant negative correlation was detected between paraoxonase and arylesterase activity of PON1 and FBS. It can be concluded that PJ consumption as an antioxidant may have a contribution in changing fasting blood sugar, lipid profiles, lipoprotein oxidation, and PON1 activity.

Type 2 diabetes is one of the major public health challenges in 21st century. Both environmental changes and genetics are attributed for increased risk of type 2 diabetes. Obesity is the most critical and modifiable risk factor and should be targeted for successful management of diabetes. This review article discusses three main approaches to manage obesity. Three management modalities considered are lifestyle modifications including dietary counseling, behavior therapy and physical activity/exercise, use of pharmaceutical agents, and bariatric surgery. In most patients, lifestyle interventions produce only modest weight loss and have a diminishing effect over time. If patients are unable to respond lifestyle intervention with a weight loss of 5-10%, adjunctive pharmacological treatment may be considered. A variety of pharmacological agents have been shown to induce weight loss and preserve weight loss for longer, as well as ameliorate cardiovascular risk factors. However, the long term health benefits and safety remain unclear and thus, long term studies powered to examine mortality and cardiovascular morbidity are required. Bariatric surgery is the ultimate treatment producing massive weight loss and resolution of type 2 diabetes in nearly 100% of patients. However this is applicable only for patients with significant obesity.Successful treatment of most overweight and obese individuals will depend upon the future development of new therapies. It also requires a paradigm shift in viewing obesity as a disease that requires treatment, rather than deferring treatment until the complications develop.

Diabetes mellitus is one of the major metabolic disorders. It is a global epidemic with an estimated worldwide prevalence of 6% (246 million people) in 2007. Diabetes is recognized for severe complications including diabetic nephropathy, neuropathy, and retinopathy. Currently, available therapy acts by increasing insulin secretion (sulphonylurea and glinides), decreasing insulin resistance (glitazones and metformin) or delaying the absorption of glucose from the intestine (acarbose). Insulin treatment is expensive and induces weight gain. None of these drugs have been shown to stop the progressive decline of beta-cell function. Many traditional plant treatments exist as a hidden wealth of potentially useful natural products for diabetes control. There are approximately 800 to 1200 plants that exhibit hypoglycemic activity. Herbal medicine represents one of the most important fields of traditional medicine all over the world and provides a valuable alternative therapeutic. Herbal medicines are frequently considered to be less toxic and free from side effects rather than synthetic ones. Many plants like Citrullus colocynthis, fenugreek and ginger are useful in diabetes. The hypoglycemic properties of the plants are surveyed in this paper such as Citrullus colocynthis, fenugreek, and ginger.