مجله دیابت و متابولیسم ایران
سال چهاردهم شماره 3 (پیاپی 60، بهمن و اسفند 1393)

There are situations in medical studies، wherein it is impossible to use the methods based on normal distribution (parametric methods). This paper objects to introduce common nonparametric methods and the inferences based on the methods in medical studies. Principles and method of calculations along with the software codes for common nonparametric methods and inference based on them were presented taking into account the considerations relevant to choose the nonparametric methods and their relative efficiency with examples in medical studies. In the situation where the assumptions are not satisfied، the nonparametric methods should be used without caution to lose the efficiency or even with higher efficiency of these methods. To compare a non-normal or ordinal variable between two groups Mann-Whitney test، to compare a non-normal or ordinal variable among more than two groups Kruskal-Wallis test، to compare a non-normal variable between two related situations or matched groups Wilcoxon test and to compare an ordinal variable between two related situations or matched groups Sign test should be used. In each of these tests the results of research based examples were presented along with the methods of their calculations. To assess the relation or difference in all types of medical studies، these tests are recommended considering the situation and purpose of study.

Alpha-amylase is the most important enzyme in the digestion of starch. Activators of this enzyme could be potentially used as digestive aids and its inhibitors block the absorption of starch compounds and result in the control of blood sugar levels. This study aimed at the investigation of aromatic compounds on bovine serum alpha-amylase. Effect of carvacrol, cumyl phenol, tryptamine, tryptophan, N-acetyl-L-tryptophan, Bis phenol A, 2-benzyloxy phenol, 2,6 diisopropyl phenol and 4-chloro-2-isopropyl-5-methyl phenol was investigated on bovine serum alpha-amylase with use of artificial substrate (laboratory kit). Most of tested aromatic compounds showed a similar pattern. All these compounds had 5-30% inhibitory effect on the tested serum with the exception of tryptamine which showed a 20% increase in the enzyme activity. The best inhibitory effect was obtained from cumyl phenol in the range of 30%. This study showed that aromatic compounds with one and two cycles have moderate inhibitory effect on bovine serum alpha-amylase and tryptamine showed a slight activator effect. With regard to these results, indolic and phenolic structures may be effective on alpha-amylase, and in the next step, investigation of these compounds derivatives is suggested.

Diabetic neuropathy leads to skeletal muscle atrophy; however atrophy signaling mechanisms are not well documented. The aim of the present study was to investigate Sunday Driver (Syd) gene expression in soleus muscle of Wistar male rats with diabetic neuropathy. Twelve male Wistar rats were randomly assigned in 3 groups: diabetic trained, diabetic untrained and healthy control. Two weeks after STZ injection (45 mg/Kg), diabetic neuropathy was demonstrated with mechanical allodynia and thermal hyperalgesia tests and after which moderate endurance training protocol was performed for 6 weeks. 48 hours after final training session, the rats were dissected and soleus muscle tissues were removed. Also Sydgene expression was measured with Real time- PCR methods. Soleus muscle weight was decreased in diabetic groups (P=0.001), but compared with diabetic untrained group, was higher in diabetic trained group (P=0.001). Sydgene expression in diabetic untrained group was higher than healthy control group (P=0.001). Also, compared with diabetic untrained group, training significantly decreased Sydgene expression and blood glucose levels in diabetic trained group. (P=0.001 and P=0.0001, respectively). In soleus muscle of diabetic rats, Sydm RNAup-regulation is involved in development of muscle atrophy and training as a non-pharmacotherapy strategy can modulate and get it close to normal levels. So, it is suggested that Syd should be noted as a novel treatment in diabetes disease.

Nesfatin-1 is an adipokine that released by adipose tissue and participated in the regulation of insulin activity and glucose metabolism. The aim of this research is the investigation the effect of 10 week resistance exercise training on serum levels of nesfatin-1 and insulin resistance index in women with type 2 diabetes. Eighteen women with type 2 diabetes recruited this study by using of the Purposive Sampling method and were randomly divided into two experimental (n= 10) and control (n= 8) groups. The experimental group participated in resistance exercise training (the exercises training started with 30-50% intensity of one maximum repetition in the first training session and increased to 70-80% intensity of one maximum repetition in the final session) in three times per week for 10 weeks. Also, the control group not participated in exercise program. Blood samples were taken pre-and post-exercise test in the 12 h fasting conditions for evaluation of nesfatin-1, insulin and glucose levels. The resulting data was analyzed by SPSS 21 and used of Kolmogorov-Smirnov, t-independent and dependent t-tests at a significance level of α<0.05. Intra-group changes in the experimental group showed that a significant increase in nesfatin-1 levels and a significant reduction in blood glucose and insulin resistance levels after 10 weeks resistance training (P<0.05). However, there was no significant change in insulin levels (P>0.05). In the comparison between groups, the changes of nesfatin-1 and glucose levels were significantly in pre- and post-exercise test in the experimental group compared with the control group (P<0.05). According to the results of this research, resistance exercise training could be recommended as adjunctive therapy method for women with type 2 diabetes.

According to the importance of the family physicians program results in rural areas and government decision to apply this program in urban areas of Iran, This study aimed to determine the quality of care and blood sugar control, blood pressure and blood lipids in diabetic type ΙΙ patients in rural areas covered by family physicians. In this study, 380 patients 30-76 years old with medical records in the health centers of the malekan-Iran in rural areas in 2013, after informed consents were enrolled. Data were collected by interview and HbA1c examinations and using a standard questionnaire. Data analyzed by SPSS19 version. Multivariate logistic regression was used to estimate odds ratios adjusting for diabetes complications and related risk factors. Results showed that 68% Study participants was women’s and average age of patients was 57.86±11.9 and sex ratio of females to males was almost 2.2 with 1. Final analysis showed that HbA1c levels more than 7% (PHbA1c=0.002), cholesterol over 240 mm/dl (Pcholesterol=0.04) and hypertensive over 140/90mm/Hg (PHTN=0.007) 1.52, 2.44 and 1.44 times increased risk of diabetes complications, respectively. The quality of care and blood sugar control in diabetic patients was lower than compared to the American Diabetes Association (ADA) standards, but our results are near to results of Country studies.

Diabetes is a chronic disease that can cause severe complications such as cardiovascular disease, blindness and kidney failure. Given the importance of self-care in diabetic patients, and considering that inadequate health literacy is a serious barrier for the management of diabetes that can affect patient's participation in self-care, Therefore this study aimed to assess the status of health literacy in patients with type 2 diabetes in three domains of functional, communicative and critical and Determine the factors associated with self-care behaviors in these patients. A cross-sectional study on 187 diabetic patients referred to Hazrat Ali diabetes clinic in Isfahan. The samples were selected by randomly Convenience sampling method. The level of health literacy and Status of self-care behaviors in patients was assessed by a standardized questionnaire (FCCHL) and (DMSES) respectively. Collected data were analyzed Using the ANOVA, t-independent, Pearson correlation coefficient at SPSS v.21 statistical software. The mean age of the study population was 57.40 ± 11.07. Average health literacy score and self-care behaviors of the participants were 2.28± 0.57 and 3.84 ± 1.56 respectively. There was significant relationship between total health literacy, communicational and critical health literacy with self-care behaviors. There was no significant relationship between functional health literacy and self-care behaviors. Communicational health literacy was associated with diet, physical activity, blood glucose monitoring and foot care. Critical health literacy was associated with physical activity, blood glucose monitoring, foot care, and taking medication. There was no significant relationship between Communicational health literacy and taking medication and also between critical health literacy and diet. Considering that communication and critical health literacy was associated with the self-care of patients with diabetes so Emphasis and consideration should primarily be given on skills related to these domains of health literacy. Since that Patients’ functional HL capabilities that was associated with basic skills in reading and writing was not related to self-care, therefore assessment of education levels alone in the clinical setting is not recommended.

The aim of this project is to investigate the relation between disease perception and the coping methods in confrontation with the stress of being mother of a type1 diabetic child. Statistical populations under investigation were all those mothers with type1 diabetic child Who were referred to Kermanshah Taleghani Hospital Clinic in 1392 (during summer).According to simple randomized sampling considering The Morgan method 103 mothers were selected To gather data Illness Perception Questionnaire and Coping Inventory for stressful situation were used Research design was on correlation. Statistical analyses were done through significance test o Pearson correlation coefficient and step by step regression. Results has shown a significant correlation between emotional centered confrontation approach and approach of inevitable confrontation with disease perception. There is also a significant relation between emotional centered confrontation approach and the consequences of self control of disease nature, anxiety, disease cognition and emotional responses. There is significant relation between task specific centered approach and sequences, self control, disease nature, anxiety, disease cognition and emotional responses. There is significant relation between inevitable confrontation approach and sequences, self control, disease nature, anxiety and disease cognition. Also results have shown that variables including task oriented confrontation approach, emotional centered and inevitable one are good predictors of mothers with type one diabetic ‘disease perception. In the light of the above we can conclude that stress confrontation methods are effective on disease perception of mothers with type one diabetic child and more perception of mothers would lead to application of more proper stress confrontation methods.

Evidences exist that abdominal obesity is a difference in terms of body mass index (BMI) and these two factors have different effects on bone density. This study examined the association between body mass index, obesity, the history of fracture and bone mineral density in Iranian population. There exist evidences on the effects of body mass index (BMI) and abdominal obesity, and the role of this two factor on bone density. This study examined the association between body mass index, abdominal obesity, and the frequency of fracture with bone mineral density in Iranian population. The Study was done as a cross-sectional, population-based retrospective study. People over 18 years were included in the third part of the IMOS project (National comprehensive plan for the prevention, diagnosis and treatment of osteoporosis). Abdominal obesity was calculated based on waist to hip ratio that was considered positive > 0.95 in men and 0.85 in women. The linear regression test was used to examine the relationship between BMI and abdominal obesity with bone densitometry. A total 2019 cases (717 men, 1302 women) with 41.85 ± 13.95 years enrolled in this study. Almost, 36% of men and women were obese based on waist circumference. Correlation coefficients of BMI with bone density were equal 0.236 for Hip, 0.133 for femoral neck, 0.138 for lumbar spine. Waist to hip ratio was inversely associated with bone density. Bone densities in the hip and lumbar spine, in individuals with a positive history of wrist fracture were significantly lower than those with a negative history of fracture. contrary to the total body fat, abdominal obesity based on waist to hip ratio is inversely associated with bone density. In other words, abdominal obesity increases the risk of fractures by reducing the bone density without creating protective shield of adipose tissue in vulnerable areas.