مجله دیابت و متابولیسم ایران
سال سوم شماره 1 (پیاپی 5، پاییز و زمستان 1382)

Celiac disease and typel diabetes mellirus have been linked to the same HLA markers and chromosomal loci, which may account for the concurrence of the two disorders in a significant number of patients. This study was designed to investigate the frequency of anti-gliadin antibodies, a marker for celiac disease, in diabetic patients. In this study, 182 diabetic patients (52 with typel and 130 with type2 diabetes) were screened for anti-gliadin IgG by indirect immunofluorescence. Age range was 3-29.5 and 42-65 years for type 1 and type 2 diabetes groups. Anti-gliadin IgG was found in 1.9% and 1.5% of patients with type land type 2 diabetes. In Tehran, 0.02% of healthy blood donors have been reported to be seropositivitive for anti-gliadin IgG. The prevalence of anti-gliadin seropositivity in type 1 and type 2 diabetics, was respectively 30 and 24 times higher than the general population of Tehran. This concurs with other reports indicating higher occurrence of celiac disease in diabetic populations. The rather low sensitivity and specificity (both around 80%) of the antigliadin antibody test has made it a suboptimal diagnostic test. However, it is quick and inexpensive and can be suitable for screening programs. We recommend the test in all at-risk populations including diabetics.

Diabetes mellitus is the commonest endocrine-metabolic disorder during the early years of life. As many as one in five of insulin-dependent diabetics may have thyroid antibodies in their sera, which is 2-20 times higher than the general population. Tpo-ab, Tg-ab, TSH and HbAlC were measured in 48 children and adolescents with diabetes and compared with for sex/age-matched controls. Clinical data including sex, age at onset and duration of diabetes, family history and signs and symptoms of thyroid disorders were recorded. Statistical analysis was made using SPSS software. In diabetic group, twelve patients had positive thyroid autoantibodies; Tg-ab was positive in ten and Tp-ab was positive in nine and both were positive in seven patients. The prevalence of thyroid antibodies in our study was 25% and in the control group, nobody had thyroid antibodies (P=0.006). Of the twelve patients with autoimmune thyroid disorders, three had hypothyroidism. The prevalence of autoimmune thyroid disorders was not influenced by sex, age, duration of diabetes or HbAlc level. On the whole, nearly one-fourth of diabetic patients had thyroid antibodies, and annual thyroid antibodies investigation for these patients is suggested.

There are controversies on the effects of diabetes and lifestyle of affected patients on their bone mineral densities (BMDs). This study has investigated the effects of lifestyle of type 2 diabetics on BMD at the lumbar spine and proximal femur in pre and postmenopausal women. In a historical cohort study, 20 pre-menopausal type 2 diabetics and 57 non-diabetics and 126 type 2 Diabetics and 315 non-diabetics postmenopausal women, were recruited. BMD measurements were also made to the spine and proximal femur (Neck, Wards, and Shaft) by dual energy X-ray absorptiometry (DXA) technique. Exclusion criteria were endocrine, rheumatologic or chronic diseases. Type 2 diabetic cases and non-diabetics were matched for age and body mass index (BMI) in both pre menopausal or postmenopausal groups. A total of 146 type 2 Diabetic patients without any other endocrine disorder and 372 non-diabetic women, aged 40-81 years were enrolled. No significant differences were found between diabetics and healthy controls in terms of BMD values of spine and femur regions in the pre‌menopausal women. Postmenopausal diabetics, however, had higher BMD at the lumbar spine compared with the healthy postmenopausal controls. An age-related decrease in BMD values (lumbar and femur) was observable in all groups and a significant correlation between BMI and BMD was found. Adjusting for age and BMI, the effect of lifestyle on BMD at all sites was investigated. Occupation was associated with BMD in postmenopausal, but not in premenopausal women. Among the investigated dietary items, milk, yogurt and cheese were all associated with increased BMD in at least one region in diabetic patients. Smoking was not associated with BMD. Type 2 Diabetes does not seem to be complicated by bone loss and osteoporosis. Physical activity and milk consumption in postmenopausal diabetic women can be a protective factor against bone loss.

Diabetes is a common endocrine disease with complications such as retinopathy, nephropathy and neuropathy which has its monitoring through biomarkers desirable. At present, glycosylated hemoglobin (HbAic) is used for monitoring the long term control of glucose levels in diabetic patients. However, absence of a standardized range, has led to investigations that recently have suggested insulin-like growth factor-I (IGF-I) as a good biomarker for monitoring blood glucose levels in diabetics. The aim of this study was to examine the correlation between IGF-I and HbAic in Type 1 diabetes. We designed a cross-sectional case-control study. The study composed of 26 newly diagnosed patients with Type 1 diabetes (15 male and 11 female; mean age, 23.7±9.1 years) and 26 healthy controls (9 male and 17 female; mean age, 24.1±4.4 years). Levels of fasting plasma glucose (FPG), HbA]C) IGF-I and IGF-binding protein-3 (IGFBP-3) were measured in both groups. FPG was measured by enzymatic glucose oxidase method and the colorimetric method was used to measure HbAlc. Determination of total serum levels of IGF-I and IGFBP-3 were done using immunoassay methods. P-value<0.05 was considered as statistically significant. The mean value of IGF-I concentrations in type 1 diabetics was significantly lower than controls (p< 0.05). A reverse correlation was observed between IGF-I and HbAic. The study indicates that in poorly controlled diabetics, levels of FPG and HbAic rise concurrent with a drop in levels of IGF-I decreases. Our study also showed a significant correlation between IGF-I and HbAie. Therefore, IGF-I could be indirectly used as a biomarker for controlling glucose levels in diabetics.

Diabetes mellitus (DM) is the commonest cause of renal failure, blindness and non traumatic amputation. According to ADA, prevention of DM complications is possible through monitoring and control of blood glucose levels. The Betachek strip, produced in Australia, is able to determine biood glucose level with no need for electronic glucometer devices. In this study, we compared venous and capillary blood glucose levels as determined by lest strips with measurements of enzymatic method (the standard laboratory kit). The mean capillary and venous blood glucose measured by the strip test was 21.85 mg/dl (P< 0.0001) and 17.9 mg/dl (P< 0.002); respectively that was 11.13% more than the standard method. In this study, standard method had higher correlation with venous samples glucose level, than capillary samples (as measured by Betachek) (0.84 vs. 0.824). This difference was statistically significant (P< 0.0001).Good correlation between the Betachek strip and the standard enzymatic method of blood glucose measurements, advocate its usage in home setting.

Increased prevalence of Helicobacter Pylori (HP) infection is a common feature in diabetics, which is attributable to the presence of diverse predisposing factors. In this study, the prevalence of HP infection has been investigated in type 1 diabetic children. In a cross-sectional study, anti-HP antibody (IgG) was measured in 75 type 1 diabetics (aged 2-18 years) and the results were compared with 75 healthy children who were matched for age, sex and socio-economic status. In seropositive diabetic patients with gastrointestinal (GI) symptoms, gastroduodenoscopy was performed to establish the diagnosis. Sera were positive for anti-HP in 22.7% of diabetics versus 17.3% in controls (P>0.05). No significant difference was observable between seropositive and seronegative diabetic groups as regard to age, sex, age at onset of diabetes, number of outpatient visits during the last 6 months, HbAlc and insulin requirements. Gastrointestinal symptoms were more common in diabetics than the healthy controls; the prevalence of these symptoms, however, did not differ significantly between seropositive and seronegative diabetics. The study indicated that type 1 diabetes is not associated with increased risk of HP infection. Further studies are required to investigate the impact of HP infection treatment on the glycemic control in diabetic children.

At least 2 million people are affected by type II diabetes mellitus in Iran. Neuropathy is one of the commonest complications of diabetes affecting the quality of life of patients and can result in foot ulcer and amputation. The current study aimed to examine possible factors that could alter development of diabetic neuropathy. In this case-control study, 110 diabetic patients were selected from Shariati hospital diabetes clinic. Michigan Neuropathic Diabetic Scoring (MNDS) was used to distinguish cases from controls. The neuropathic status of patients was confirmed with EMG-NCV. Multiple factors were compared between the two groups including ACE-I consumption, blood pressure, serum lipid level, sex, smoking, method of diabetes control and its quality. Statistically significant relations were found between neuropathy and age, gender, quality of glycemic control and duration of diabetes (P values: 0.04, 0.04, 0.000 and 0.005, respectively). No correlation existed between atherosclerotic risk factors (high BP, hyperlipidemia, cigarette smoking) and diabetic neuropathy. In this study, hyperglycemia was the only modifiable risk factor for diabetic neuropathy. Glycemic control can decrease the incidence of neuropathy and delay its progression leading to improvement in the quality of life in diabetics. Aged and male diabetic patients and those with poor diabetes control are groups in most need of regular foot exam and more practical educations.

Diabetes is one of the most common metabolic diseases. The prevalence of diabetes, which is around 4.5 - 6% in Iran, reaches as high as 14.2% in population of age 30 years and over in Yazd. Microalbuminuria is diagnosable before development of nephropathy and could be detected at an early stage when effective therapy can still be carried out. In this stage near normalization of blood glucose, strict blood pressure control and administration of ACE inhibitors can prevent nephropathic complications.This study was aimed to determine the correlation among microalbuminuria, age, duration of diabetes, body mass Index, serum triglyceride, serum cholesterol and blood pressure in type 2 diabetic inhabitants of Yazd diabetes research center. This cross-sectional study was carried out during November 2002-July 2003 to investigate the correlation between microalbuminuria and assumed risk factors. Two hundred and eighty eight type 2 diabetic patients (141 males and 147 females) were selected through consecutive sampling. Overall prevalence of microalbuminuria was 14.2%. Chi-square analysis revealed the association between microalbuminuria and high diastolic blood pressure (P-value=0.003) and duration of diabetes (P-value = 0.001). No statistically significant correlation was found between microalbuminuria and body mass index, serum triglyceride, serum cholesterol and systolic blood pressure. Determination of urine albumin/creatinin ratio is an easy method for screening microalbuminuria which is recommended for all diabetics especially those with hypertension and a long term history of diabetes.

Neuropathy is a common complication of diabetes mellitus. Meticulous neurological examination and electrodiagnosis are valuable tools in early diagnosis of neuropathy and prevention of its sequels. A hundred and three randomly selected diabetic patients were recruited from the endocrine clinic. Mean age of patients was 52.6 ±14 years. 29.4% had type 1 and 70.6% had type 2 diabetes.Medical history was taken from patients and neurological examination was done. Electroneurographic examination included nerve conduction velocity, action potential amplitude, distal latency and H reflex measurements. Neuropathy was found in 79.4% of patients. The prevalence of neuropathy had a direct relation with duration of the disease. The most common complaints were tingling and numbness of extremities (72%) and burning sensation of the feet (36%). The most common physical findings were abnormal ankle jerk (92%), and decreased vibration perception (76%) in feet. Abnormal H reflex(92.5%) and decreased amplitude of action potentials (79%) were the most common electroneurographic findings. There was a strong correlation between clinical and electroneurographic findings. Neuropathy was quite common in diabetic patients. Neurologic examination is, therefore, recommended to prevent unnecessary workups and prevent complications.

Alterations in carbohydrate metabolism are frequently observed in cirrhosis. We conducted this study to define the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in patients with chronic liver disease (CLD), and explore the factors that may be potentially associated with the development of DM in these patients. From October 2002 to March 2003, 185 consecutive patients with CLD, who referred to "Tehran Hepatitis Center", were enrolled into the study. Fasting plasma glucose and two-hour plasma glucose were measured in patient's sera. DM and IGT were diagnosed according to latest American Diabetes Association criteria. The subjects included 42 inactive HBV carriers, 102 patients with HBV or HCV chronic hepatitis, and 41 cirrhotic patients. Mean age was 43.8±12.0 years ranging between 22 to 84 years. DM and IGT were diagnosed in 40 (21.6%) and 21(11.4%) patients, respectively. Univariate analysis showed that age (P=0.000), CLD status (P=0.000), history of hypertension (P=0.007), family history of DM (P=0.000), and body mass index (BMI) (P=0.009) were associated with DM. Using Multivariate analysis, age (P=0.01), family history of DM (P=0.0001), chronic hepatitis (0.0004), and cirrhosis (P=0.0004) remained as the factors independently associated with DM. When patients with cirrhosis and chronic hepatitis were analyzed separately, higher Child-Pugh's score in cirrhosis (P=0.04) and older age (P=0.04), higher fibrosis score (P=0.04), and higher BMI (P=0.003) in patients with chronic hepatitis were found to be associated with higher prevalence of DM. Our findings indicated that patients with cirrhosis and chronic hepatitis are at risk of developing DM. Older age, sever liver disease, and obesity were associated with development of DM.

Patients with type 2 diabetes have a higher risk of coronary heart disease and a worse prognosis compared with patients without diabetes. In this study, the prevalence of cardiovascular risk factors have been investigated in type 2 diabetic patients. A Cross Sectional study with a target population of known type 2 diabetic subjects was conducted in 2002 in Isfahan. From registered patients, 1150 were selected and evaluated for age. sex.duration of diabetes, BMI, hypertension, lipid profile, proteinuria, fasting blood glucose. HbAlc and smoking using convenience sampling methods. Mean fasting blood glucose and HbAl were 165.16 x 53.4 mg/dl and 9.2+ 3.5 percent respectively. The number of women with 3 cardiovascular risk factors was significantly greater than men (50.7% VS 33.5% PO.001). 19.5% of men and 50.2% of wjomen had high serum cholesterol level (>230 mg/dl). The prevalence of obesity (BMI >30Kg/m2) was 13.6% for men and 30.8% for women. 56.6% were hypertensive and 29.3% had proteinuria (P<0.001). Cardiovascular risk factors are present in a considerable proportion of studied type 2 diabetic patients. Control of risk factors and life style modifications should be tightly considered in order to decrease the prevalence ofTHD in the up -coming years of their life.

Depression is one of the most prevalent mental disorders in diabetics, which affects treatment course and disease prognosis. This study focuses on the association between diabetes and depression as well as depression and glycemic control. 375 diabetic patients (type I and II) of diabetes clinic of Doctor Shariati Hospital and diabetes association of Iran participated in this cross-sectional study.Patients were screened for depression with Beck Depression Inventory. Then depressed subjects wereevaluated with DSM IV criteria for determination of the depressive disorders category. Depression was diagnosed with Beck Depression Inventory in 41.9% of patients. Of these patients major depressive disorder was defined in 23.7%, dysthymic disorder in 9.3% and association of two disorders in 0.8% of patients. Major depressive disorder was more prevalent in 31-59 year old group and dysthymic disorder in more than 60 year age group. Also depression was more prevalent in women, diabetics with uncontrolled blood glucose and patients with diabetes complications. Depression is a prevalent psychiatric disorder in diabetics, which is associated with female gender, poor glycemic control and diabetes complications. Therefore, glycemic control and prevention and treatment of diabetes complications can prevent depressive disorders in diabetics.

Hyperlipidemia is a major risk factor for cardiovascular diseases (CVDs). A hundred and sixty six people die each day due to cardiovascular diseases in Iran which accounts for 12500 annual deaths. Several studies have revealed that changes in lifestyle are keys to the prevention of CVDs. This urges the role of continuous and comprehensive educational programs, which should be designed and performed by medical staff specially education nurses.In this study the effect of patient education thorough group discussion or an educational booklet is compared on knowledge and practice of patients with hyerlipidemia. This was an interventional study. Participants were randomly assigned to the "interactive discussion" group or "booklet" group. Knowledge and practice of participants in both groups were assessed before and after intervention using a standardized questionnaire. A total number of 304 patients with hyperlipidemia were studied which were equally divided into "booklet" or "Interactivediscussion" groups. "Interactive discussion" group showed %27 rise in knowledge and practice. This figure was %26 in the "booklet" group and no significant difference was observable. It was concluded that interventional sessions and educational booklets had comparable efficacies. We suggest that these sessions be held on regular Intervals so as to achieve better results.

New studies have introduced atherosclerosis as an inflammatory disorder. Usage of anti-inflammatory drugs thus can be useful in preventing atherosclerosis and anti-inflammatory herbal medicines without side effects seem desirable in this view.Amirkahiria Odorutissima (AO) (umbelliferae) is an Iranian flora being traditionally used a:> an anti‌inflammatory drug. This study assessed the effects of this plant on the development and progression of fatty streaks. Twenty male rabbits were obtained from Iran Pasture institute and were kept under standard condition for two weeks, then randomly divided into four groups with different diets. Groups 1 were fed on rabbit chow (normal cholesterol), group 2 were fed on a high cholesterol diet. group 3 were fed on normal cholesterol diet supplemented with AO, group 4 were fed on high cholesterol diet supplemented with AO. After 12 weeks, the animals were killed and biopsied for their aortas and right and left branches of coronary arteries. Biochemical factors were measured at baseline and after 12 weeks. Levels of cholesterol, LDL, HDL. triglyceride and fasting blood sugar (FBS) were determined by enzymatic methods, and quantitative CRP were determined with turbidometrie methods, malondialdehyde (MDA) and antioxidant capacity were determined with spectrophotometry. The results indicated that there was a significant difference between AO supplemented group compared with other groups (p<0.05) in terms of mean grade o"' fatty streak o"' right and left coronary arteries and aorta. At the end of the 12 weeks period, cholesterol. LDL and CRP were significantly reduced in the groups 3 and 4 (p<0.05). This study suggests a protective role for Amirkahiria odoratissima Mozaffahan against the development of fatty streak; the mechanism of which should be investigated in future studies.