Iranian Journal of Endocrinology & Metabolism
Year:2009 | Volume:11 | Issue:1 (SN 43)|Papers Count:17

Introduction: Proprioceptive loss in diabetic peripheral neuropathy patients (DPN) has been known to cause postural imbalance, which may affect the quality of functions and activities of daily living of these patients. The aim of this study was to compare functional balance in diabetic neuropathic patients and normal subjects. Materials and Methods: Fifteen DPN patients whom neuropathy was diagnosed by Diabetic Neuropathy Examination (DNE) and 15 healthy gender-, age- and BMI-matched, subjects were evaluated using the Berg Balance Scale (BBS). In addition to the overall functional balance, five groups of BBS tests based on the probable effects of proprioceptive loss on various functions were taken into more consideration. These test groups were: The ability to control weight shifting (CWS), ability to transfer (T), and ability to control balance under different base of support (BOS) and visual (V) conditions. Results: Comparison of the two groups showed significant decreases in BBS, CWS, T, BOS, and V scores the DPN patients, compared to healthy controls (P<0.05). There were significant negative (sig. level: 0.001) good to strong correlations between DNE score and BBS, CWS, T, BOS, and V, Scores (Pearson’s correlation coefficient: -0.88, -0.91, -0.87, -0.76, and -0.70, respectively) in patients. Conclusion: To control their balance, DPN patients rely on visual information, and the current findings demonstrate that DPN results in a functional imbalance, exposing these patients to the danger of falling during of their daily living activities, the condition becoming more acute as severity of neuropathy aggravates.

Introduction: Athough a controversial issue, the Metabolic Syndrome (MS) is known to by be related to certain genetic and lifestyle factors such as hypertension. The object of this study is to evaluate the prevalence of MS and its association to hypertension among diabetic patients with and without hypertension, in the Fatemeh Zahra hospital in Najafabad, Iran. Materials and Methods: This cross-sectional descriptive study was performed on diabetic patients referring to the Fatemeh Zahra Hospital, of whom 66 subjects were randomly selected and data was obtained from their hospital files, including systolic and diastolic blood pressure, Body Mass Index (BMI), Fasting Blood Sugar (FBS), lipid profiles, waist circumference, age, sex, family history and history of diabetes. Patients with blood pressure 140/90 were considered hypertensive. MS was confirmed according to the Adult Treatment Panel (ATP) III criteria. Data was analyzed with SPSS software using the independent Student t- test, regression and chi-square, P<0.05. Results: MS was more prevalent in hypertensive than in normotensive patients (93.3% vs 62.7%, p<0.02). Mean systolic and diastolic blood pressures were higher in MS patients than in patients without the syndrome, (136.85±25.20 vs 121.25± 28.00 and 81.63±17.00 vs 72.00±11.96 respectively). Conclusion: The findings of this study indicate the need for MS screening among diabetic hypertensive patients and importance of primary and secondary prevention of hypertension in order to curtail the impending epidemic of non-communicable diseases in our society.

Introduction: The aim of this study was to determine which indicator of obesity index is the best predictor of type 2 diabetes mellitus in Iranian women. Materials and Methods: In an urban Iranian population, we examined 2801 females, aged ≥ 20 years who were non-diabetic at baseline. Over a median 3.5 year (11months to 6.3y) follow up, we compared the ability of central obesity indicators [waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR)] to body mass index (BMI) in the prediction of type 2 diabetes, based on American Diabetes Association 2003 criteria. To estimate odds ratio (OR) of developing diabetes associated with each quartile of anthropometric variables, we used a multivariate model adjusted for age, hypertension, triglycerides, HDL-C, family history of diabetes (model 1) and a full model adjusted for the variables in model (1) plus abnormal glucose tolerance at the baseline (model 2). Receiver operator characteristic (ROC) analyses were used to determine the predictive power of each indicator in the development of type 2 diabetes, after adjustment for age. Results: During our follow up, 114 individuals developed diabetes (4.1%). The OR (95% CIs) of developing diabetes increased to 4.8 (2.1-10.9), 6.7 (2.6-17.1), 8.7 (3.0-24.7), 8.0 (3.1-20.6) for the highest quartiles of BMI, WC, WHR and WHtR compared to the lowest quartile in model (1) respectively. In model (2) the ORs (95% CIs) of the fourth quartile of anthropometric variables decreased, compared to value in model (1), but remained significant [BMI: 3.1 (1.3-7.2), WC: 3.1 (1.1-8.3), WHR: 4.0 (1.3-11.8), WHtR: 3.3 (1.2-8.8)]. Compared to BMI, the WHtR had a higher area under ROC curve (0.72 vs 0.69 P<0.05), while there was no difference between ROCs of BMI and other anthropometric variables. Conclusion: In Iranian women, WHtR is a better predictor of type 2 diabetes than BMI.

Introduction: Nutrition therapy is an important component of treatment for type 2 diabetic patients. Despite of strong evidence on the effect of diet therapy on diabetes treatment, changes in dietary intakes are difficult for these patients, and often they do not follow dietary recommendations appropriately. This study was conducted to assess the nutritional value and adequacy dietary intakes, in a group of diabetic patients in fall 1383 (Jan-Feb 2004). Materials & Methods: Fifty-severn diabetic patients (34 males and 23 females), age range 35-65 years, were recruited for this study. Anthropometric measurements including - at the weight, height and body mass index (BMI), were obtained twice, during a one-month period, beginning and end of the study. Daily nutrient intakes of energy, macronutrients, fiber, vitamin A, Beta Carotene, vitamin E, C, calcium, zinc, magnesium and selenium were assessed by a 24-hour recall questionnaire on four non-consecutive days during the study. Results: The mean for energy intake was less than RDA recommendations in both genders, being significantly higher in males than females (p<0.02). The mean contribution of carbohydrate to total energy (53.4±7.4%), was comparable to RDA recommendations, while energy percentage from protein (15.4±3.2%) was close to the lower range of the recommendations and energy percentage from fat (31.1 ±6.5%), was higher than the recommendations for a prudent diet. Mean intakes of fiber and micronutrients were less than RDAs. Conclusion: Food intake of these patients did not conform to the RDAs. Diabetic patients need to be educated in order to increase their knowledge, improve attitudes and implement changes in behavior regarding their daily food intake.

Introduction: Diabetes mellitus (DM) is a major cause of morbidity and mortality affecting millions of people worldwide, making metabolic control & care assessment in these diabetics very important. The aim of this study was to identify and determine metabolic control rate and care assessment among type 2 diabetics in Chaharmahal & Bakhtiyari Province. Materials and Methods: In this 2008 Analytic- Descriptive (Cross-sectional) study, 256 patients with diabetes type 2 were selected by a two stage random sampling; data were analysed by Software SPSS 13. Results: Mean age of patients was 54.8±8.6 years and their mean duration of disease was 7.4 ± 5.8 years. Extent of achievement of aims in control and care of metabolic care and assessment among patients was 1.2% 73.6%, 37%, 39.4%, 79.9%, 61.4%, 35.4%, 62.6% and 37.7% in Hba1c, cholesterol, triglycerides, systolic blood pressure, diastolic blood pressure, HDL in men, HDL in women, LDL and BMI, respectively.  Conclusion: Hypertension, HbA1c, BMI and triglyceride levels were inappropriately controlled, requiring intervention planning and implemention for control of these factors in this province.

Introduction: Metabolic syndrome is complex of metabolic disorders that correlates with cardiovascular disease. This study aimed at investigating the effect of processed Berberis vulgaris (B.vulgaris) on some metabolic syndrome components. Materials and Methods: Participants, type2 diabetics, were recruited in a randomized controlled clinical trial (n = 57) and randomly assigned into three groups: 1) processed B.vulgaris (n =19), 2) apple vinegar group (n =19) and 3) control group (n =19). Height, weight, serum total cholesterol, HDL-, LDL-cholesterol, triglycerides, glucose and insulin concentrations were measured at baseline and at the end of the 8th week and BMI, total/HDL-cholesterol ratio and insulin resistance were estimated. Results: Processed B.vulgaris group showed no significant effects on BMI, total cholesterol, triglycerides and glucose concentrations, whereas LDL-cholesterol concentration (22.48±35.44mg/dl) and total/HDLcholesterol ratio (2.56±4.87) significantly decreased and HDL-cholesterol concentration (12.33±20.58mg/dl) increased (P<0.05). No significant effect on lipid profiles was found in the apple vinegar group. Increased insulin concentration and insulin resistance was observed in all of these groups (P<0.001), independent of processed B.vulgaris and apple vinegar effects. Conclusion: Findings of the present study showed the beneficial effects of processed B.vulgaris on certain atherosclerosis risk factors.

Introduction: Autoimmune diseases are caused by immune systems reacting against self antigens. One important feature of autoimmune diseases is the tendency for overlap, such that an individual with a specific syndrome is more likely to simultaneously develop a second syndrome. Autoimmune thyroid disorders are frequently associated with autoimmune diseases of other organs such as Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE). The aim of this study was to evaluate the occurrence of thyroid disorders in patients with RA or Systemic Lupus Erythematosus (SLE). Materials & Methods: In this case-control study, 200 patients with diagnoses of RA or SLE, referred to the rheumatology clinic of Shahid Mohammadi hospital (Bandar abbas- Iran) between May 2004 and December 2006 and following thyroid investigations were categorized in 3 groups (T3, T4, TSH, Anti TPO, and Anti TG); 57 patients with RA, 59 patients with SLE and 66 patients with mechanical low back pain or osteoarthritis as controls. Results: Sub clinical hypothyroidism was more frequent in the RA (10.7%) and SLE (10.2%) groups than in controls (0%) (P<0.05). Clinical hypothyroidism was found in 8% of RA patients & 15.2% of SLE patients. None of the controls had clinical hypothyroidism (P<0.02). Hyperthyroidism (Graves disease) was found in only 1 patient with RA (1.13%) (P>0.05). Anti TG & Anti TPO were found more frequently in RA and SLE cases than in controls. Conclusion: Autoimmune thyroid disorders are more frequent in patients with RA and SLE than in controls.

Introduction: Both clinical and laboratory evidence confirm that hearing loss can result from congenital and acquired hypothyroidism. There is a confirmed correlation between congenital hypothyroidism and hearing loss, but significant controversy still surrounds the association between acquired hypothyroidism and hearing loss. The aim of this study was to evaluate this relationship. Materials and Methods: Fifty patients with confirmed primary hypothyroidism, were studied and compared with 50 age- and sex- matched controls. All patients were evaluated in the hypothyroidism state before treatment with thyroxine. Auditory assessments included: Toutine ENT examinations, speech reception threshold, pure tone audiometry, speech discrimination score, acoustic reflex and tympanometery. Results: The hearing thresholds in all frequencies in both ears of the case group were higher than in controls. Also hearing loss frequencies, i.e. 2000, 4000, 8000 dB in the left and 4000, 8000 dB in the right ears in the case group, were higher than in controls. Hearing loss was symmetric, sensory neural and mild to moderate. Mean speech reception threshold in the right and left ears in the case group were 15 and 15.1 respectively and in controls, 10.6 dB for both the right and left ears. Mean speech discrimination score in the right and left ears in the case group was 97 and in the control group was 99 dB. Conclusion: Results demonstrate a strong correlation between acquired primary hypothyroidism and hearing loss.

Introduction: The prevalence of goiter, especially in iodine deficient regions, is higher in women than men. This investigation was conducted to determine the effect of testosterone on thyroid weight and function in iodine deficient normal and castrated rats. Materials and Methods: Male Wistar rats were divided into 6 groups, of 7 animals each: Castrated, hormone treated (C+T), castrated, non-hormone treated (C+NT), normal (N), iodine deficient diet, castrated, hormone treated (ID+C+T), iodine deficient diet, castrated, non-hormone treated (ID+C+NT), iodine deficient diet, normal (ID+N). Three weeks after castration, the C+T and ID+C+T groups received daily intraperitoneal injections of 1 mg/kg testosterone enontate, for 9 weeks. At the end, of the study, we measured thyroid weight and serum testosterone, T4, free T4, T3 and TSH and urinary iodine concentrations. Results: Serum testosterone levels significantly decreased in the C+NT and ID+C+NT groups (p<0.001). In ID groups, serum TSH, T3 and thyroid weight levels significantly increased and serum T4 and free T4 levels significantly decreased as compared with the iodine sufficient groups (p<0.001). The ID+C+NT group, had higher serum TSH and thyroid weight and lower serum freeT4 than the ID+C+T and ID+N groups (p<0.01). The C+NT group had higher serum TSH and lower serum free T4 than C+T and N groups (p<0.01). Conclusion: These results suggest that testosterone decreases thyroid enlargement and serum free T4 levels in ID castrated rats, which may explain the lower incidence of goiter in men than women in iodine deficient regions.

Introduction: Considering the beneficial anti-lipidemic effects of Commiphora Mukul (CM) (ashwagandha) on metabolism, the hypoglycemic and hypolipidemic effects of this plant were investigated in an experimental model of diabetes mellitus. Materials and Methods: Fifty-six male Wistar rats were randomly divided into 4 groups, i.e. control, CM-treated control, diabetic, and CMtreated diabetic groups. The treatment groups received oral administration of plant-mixed pelleted food (6.25%) for two months. Serum glucose, triglyceride, total cholesterol, LDL- and HDLcholesterol levels were determined before the study, and at 4 and 8th weeks after the experiment. Results: The weight loss (%) in CM-treated diabetic rats (7.8± 2.2%) compared to diabetic (29.8 ±  2.2%) ones showed a significant difference (P< 0.05). Serum glucose levels in diabetic rats increased significantly, compared to CM-diabetic animals (0.05), and in both groups compared to controls (0.01). Triglyceride and cholesterol levels in the diabetic group increased non significantly, but in CM-treated diabetic rats, these levels decreased more significantly. Finally, in CM-treated control and the CM-diabetic animals, mild decrease in LDL and increase in HDL, demonstrateds a suitable HDL/LDL ratio in CM-treated control (24%) and CM-diabetic rats (248%) as compared to controls.Conclusion: Oral chronic administration of CM diminished the weight loss of animals with STZ inducted diabetes (STZ-groups) more significantly. Also, a marked hypoglycemic effect was seen in CM-treated rats. Feeding animals with CM leads to appropriate changes in blood lipid profiles i.e. high ratio of HDL/LDL.

Introduction: Diabetes mellitus is often accompanied by chronic neuropathic pain. Studies indicate that oxidative stress has an important role in the appearance of neurological and behavioral changes in diabetes. Necessitating researching therefore the antioxidants effects in alleviation of diabetic neuropathic pain. Materials and Methods: In this study, 32 male Wistar rats weighing 200±20 g were used, and were divided into four groups: Control(C), melatonin(M), diabetic(D) and melatonin-treated diabetic(MD). Experimental diabetes was induced by intraperitoneal injection of 50 mg/kg streptozotocin (STZ). Melatonin was injected (10 mg/kg/day, i.p.) for 2 weeks, after 21 days of diabetes induction. At the end of administration period, nociceptive biphasic behavior in rats was assessed using the 0.5% formalin test, and then observed for up to 60 min, according to spontaneous flinching and licking responses. In this study, lipid peroxidation levels, glutathione-peroxidase and catalase activities were measured in spinal L4-S3 dorsal root ganglia. Experimental data were then statistically analyzed. Results: Formalinevoked flinching increased in both acute and chronic phases of pain in diabetic rats as compared to non-diabetic ones, whereas administration of melatonin reduced flinching frequency in both phases in MD rats. Total time of licking in diabetic rats was significantly (p<0.05) more than the control rats in both acute and chronic phases of pain; melatonins injection significantly reduced this time in both phases of pain in the MD as compared D group, whereas was no significant difference between M and C rats in the indices mentioned. Assessment of dorsal root ganglia homogenates indicated an increase in Lipid peroxidation levels and a decrease in GSH-Px and CAT activities in the D group as compared to the controls (C). While melatonin administration ameliorated these in diabetic rats. Conclusion: Results suggest that oxidative stress contributes to appearance of pain in diabetes and melatonin, as an antioxidant, is effective in reducing the acute and chronic pain in diabetic rats.

Introduction: Estrogen deficiency is associated with unfavorable changes in body composition and abdominal fat deposition. The consequences of these changes lead to metabolic abnormalities and differential fat distribution. Materials and Methods: Seventy female Wistar rats (weight: 170.73±15.82gr; mean±SD) were divided into 7 groups: Intact (one group), sham (two groups), ovariectomized (two groups), ovariectomized, receiving estradiol valerate(one group) and ovariectomized, receiving sesame oil (one group). The intact rats were anesthetized and visceral fat was then taken from the abdominal cavity and weighed immediately. Two weeks after operation, one group of ovariectomized rats and one group of sham rats were sacrified and visceral fat was measured. The estradiol receiving ovariectomized group and vehicle group were given equal volumes of 17b-estradiol (30mg/kg, sc, 5 d/wk) and sesame oil for 8 weeks, respectively. After 8 weeks, all animals were sacrificied and intraabdominal fat depots were dissected and weighed. Data were analyzed with one-way ANOVA and posthoc and using paired t test. The differences were considered significant at P<0.05. Results: After two weeks of surgery, the ovariectomized rats showed insignificant increase in body weight and visceral fat weight, whereas, after eight weeks, body weight increased significantly in ovariectomized rats (P<0.05). Estradiol replacement decreased body weight and visceral fat weight, however this decrease was only significant in body weight (P<0.05). Conclusion: The results indicate that estrogen deficiency following ovariectomy leads to increase in both body weight and visceral fat, showing that replacement of this hormone could decrease body weight without affecting visceral fat.