Journal of Shahid Sadoughi University of Medical Sciences
Year:2003 | Volume:10 | Issue:4 (Supplement On Diabetes)|Papers Count:22

Diabetes and obesity are the most wide spread metabolic disorders. It has been known since several decades that Diabetes frequently occurs in persons who are obese and those with a sedentary life style. Recently, several prospective studies have shown that obesity and low physical activity are risk factors for Diabetes (type II). In short period, sensivity to insulin and insulin secretion can improve by reduction of weight and exercise. About 85% of patients with Diabetic type II are obese. It has been shown & suggested that changing the dietary habits and body activity. Swedish and Chinese people have lead to decrease in weight & it could. Could lead to delayed onset of diabetes. Obesity is one of the oldest and common metabolic disturbances which are recognized by BMI 30 and more than 30. It now affects 15% of the population in the world. The epidemy of obesity as a result of extension of immobile life and easy availability for food is increasing. An estimated 97 million United States adults are overweight. Of those, 22 percent are classified as obese. The etiology of obesity includes both genetic and environmental factors. Totally, obesity is the result of a positive energy balance; input exceeds output. Obesity is a risk factor for several chronic diseases, including hypertension, dyslipidaemia, diabetes mellitus, coronary heart disease, sleep apnea, osteoarthritis, pulmonary disease, gallbladder and some cancers (breast, uterus, prostate, colon). Obesity is a chronic disease. But often, people, doctors and endocrinologists don't take it as a disease unfortunately. However, it is one of the basic factors for a lot of diseases. Despite of the fact that there are medical treatments and surgery, the epidemey of obesity has increased since 1950. And the effects of treatment haven't been very satisfactory. About 2/3 of people (who lose weight) will be fat within one year. Decrease in morbidity must be the result of obesity treatment. The obese patients have to change their life style and exercise more and get less calories. Some need drugs for weight loss. There are some drugs to treat the obesity like: noradrenergics (phentermin, mazindol, phenylpropnolamin) seronergics (fenfluramine, dexfenfluoramine, fluoxetine) and noradrenergic & serotonergic (sibotramin), beta-3-adernergic and orlistat. If they don't become well after the above ways of treatment (exercise, diet and drug) and their BMI is more than 40 , surgery should be the lest option.    

Diabetic mellitus is becoming a major medical problem in developing countries and Yazd province too. The key point two preventing complications of this disease is early identification of patients who are at high risk for developing its complications. Screening for micro albuminuria is a well established way for this purpose. This screening program was performed on 593 diabetic patients attending the Yazd diabetes out patient clinic. This measurement was performed using klinitek 100. Which is a self - read BAYER manufactured machine for detecting Albuminuria. Mean age and disease duration of patients were 50±10 years and 10±6 years respectively. 24 patients were IDDM, 560 were NIDDM and 31% had hypertension. Prevalence of micro albuminuria was 26% and macroalbuminuria was 12% .There was no difference between the two sexes or type of diabetes. Mean duration for normo; micro and macro albuminuria were 8-10 & 15 years respectively (p<0.05). Hypertension and duration of disease were two facto re which correlated with albuminuria. Our results were similar to other reports from Korea & European countries.      

Diabetes mellitus is a metabolic commonly associated with periodontal disease. Periodontal disease has been hailed as the sixth complication of diabetes. The aim of this study was to investigate prevalence and diversity of periodontal disease in diabetic patients by using CPITN index. A comparison was made between 264 diabetic patients (NIDDM, 226, IDDM, 38) from Yazd. Diabetes center and 246 control subjects from oral disease department of Yazd dental school. The spss program (non parametric chi-square test) was used for statistical analysis. We concluded that the prevalence and severity of periodontal disease in diabetics is more than nondiabetic populations. We also found that there is significant correlation between the increase of age and prevalence of periodontal -disease in all groups. In diabetic patients, there is a significant correlation between duration of diabetes (up to 4 years) and prevalence and severity of periodontal disease. Prevalence and severity of periodontal disease in the two type of diabetes the same.      

Prevalence of diabetes mellitus as a major cardiovascular risk factors are increasing in Isfahan urban population. On the other hand, this disease has unfavorable effects on other sites of the body. So, it is necessary to find any way for controlling this disease. This triple blind placebo-controlled clinical trial was performed aimed to determine the effects of antioxidant vitamin E on fasting blood sugar (FBS), serum insulin and glycated hemoglobin (GHb) in patients with type II diabetes (NIDDM). Diabetic group included 100 patients with uncomplicated NIDDM. The subjects were age4 20-60 years with only one cardiovascular risk factor (diabetes) Drug and placebo groups were the same in age, sex, education and job. They were randomly selected among diabetic patients from Diabetes Clinics in Isfahan Human Service. The subjects were divided in to two randomized subgroups of drug or placebo. Drug subgroups were received vitamin E as 200 IV/day pills and placebo subgroup was only received placebo. At the beginning and the end of the study, the vitamin E level was measured in all subjects. Fasting blood and blood sugar (FBS), serum insulin and glycated hemoglobin, (GHb) were assayed in two groups. These measurements were done at the beginning, during and at the end study. Also, serum total cholesterol (T.cho) and triglycerids were measured in diabetic patients. Serum lipids, FBS, insulin and GHb were measured by ELAN 2000 autoanalyzer in the laboratory of Isfahan cardiovascular Research Center. Vitamin E was assayed according to Hansen & Warwick methoed by florimetry method. At the end of the study, it was found that in patients with type II diabetes mellitus there was no positive effect as GHb did not change and FBS level decreased nonsignificantly (-4.3% versus -14.0% in placebo group). Also, serum insulin level showed an increase (p=0.15). Also, serum lipids did not show any change in two groups during study. Finally, it is concluded that in patients with type II diabetes the obtained results did not show any beneficial effect of the vitamin E during this period. But regarding the effects of this vitamin on other factors in the diabetic people, the prescription of vitamin E supplement can not be avoided and even we can no conclude it to be ineffective for diabetic patients because it needs more extensive studies.      

Diabetic Retinopathy (DR) is one of the leading causes of blindness in the world. In USA it is the most important cause of blindness in the 20-74 years age group. Recent medical treatment and surgery can reduce the rate of blindness up to 90%. The most important causes of blindness in diabetic retinopathy include, macular ischemia, macular edema, neovascularization on the disk, retina or iris. We don't know the exact frequency of DR and it causes in our population. The aim of this study was to determine patients at risk and early treatment to reduce costs and visual complications. A cross - sectional study was performed between Oct. 2000 and July 2001 on diabetic type II patients who were referred to the yazd Diabetic center .Dilation of the pupil by a midriatic droplet indirect ophthalmoscopic examination and in some cases a +90 lens or a 3 mirror were used for examination of macula. Patients were divided into 6 groups according to the clinical findings: O) Without retinopathy. I) Mild non-proliferative retinopathy (NPR). II) Moderate NPR. III ) severe NPR . IV) proliferative retinopathy and V) Proliferative retinopathy with complications such as vitreous hemorrhage or deculman . CIME was also recorded. Data wase collected and results were statistically analysed by X2 using spss for windows. A total of 590 NIDDM patients were examined of which, 358 patients (60.7%) had no any signs of retinopathy. One hundred and thirteen patients (19.3%) had mild NPR, 71 patients (12%) moderate NPR, 16 patients (12.7%) severe NPR 18 patients (3.1%), PDR without complications, and 14 patients (2. 4 %) PDR plus complications. In other words, 39.3'% patients had diabetic retinopathy. The frequency of diabetes in our province is considerably higher than the rest of the world (14 % VS 3 % ) and its occular complications are also higher (39.3% in Yazd vs world 25%).We concluded that age, BMI, blood sugar level & glycolised hemoglobin levels are important risk factors for occular complications in diabetics.      

Cigarette smoking is the leading avoidable cause of mortality in society. Recent studies suggest the role of smoking in the development of diabetes. For better recognition of metabolic effects of smoking, this study compares the oral glucose tolerance test (OGTT) and Insulin sensitivity in smokers and non smokers. In this cross - sectional study, we compared the area under the curve (ADC) of the OGTT, insulin and the insulin sensitivity index (ISI) in 48 healthy male volunteer smokers and 48 non smokers, matched for age, sex and BMI. The (ADC) of Glucose (600.6 ×129 VS 696.6 ×172mg/ml), the ADC of insulin (155.3×57, VS 248.4×99) and plasma Insulin (11.4×4.2, VS 14.5×7.4pg) were significantly lower in smokers. The mean of Insulin sensitivity index (ISI) (0.82 ×0.15 VS 0.9 × 0.24 P<0.05), was significantly lower in smokers. The low ISI in smokers indicates increased insulin resistance in this group. This condition is seen despite lower levels of insulin and ADC of glucose in smokers.      

Nutrition therapy is an elementary constituent in diabetes control level trials. It is proved that the composition of food can significantly affect the postmeal blood glucose level in diabetic patients. Recent investigations have shown beneficial effects of fructose on postprandial blood glucose level. In this investigation, we studied the effect of dates which contain 25% fructose on 2hpp blood glucose levels in type 2 diabetic patients. In a clinical trial study, 16 type 2 diabetic patients who had bread and cheese as their usual breakfast regimen, had 50% of the carbohydrate content of their breakfast (bread) replaced with an equal amount of dates for one day. They were asked to keep their diet and physical activity unaltered during the study. FBG and 2hpp blood glucose levels were measured for two successive days (before and after intervention). Paired t-test was used to compare the means of 2hpp blood glucose levels and the rate of decrease in 2hpp glucose levels. P value < 0.05 was considered significant. The mean±SD for age and BMI in patients were 48.5±7.9 and 29.59±3.39 respectively. 2hpp blood glucose level was significantly lower after adding dates to breakfast (117 ±21.6 vs 148 ±32.46and P = 0.02). The mean of the decrease in 2hpp blood glucose level was 31.43±28.94 after intervention as compared to 6.69 ±37.5 before that (P=0.04). There was no significant change in the carbohydrate, fat and protein content of the diet during the study. Our findings show that by partly replacing the bread content in a diabetic diet with dates, the 2hpp blood glucose levels decrease substantially. It is therefore suggested that more extensive and accurate studies should be performed in this field so that by adding dates to a diabetic diet, the blood glucose levels can be maintained at a lower level.      

Diabetes mellitus is one of the most common metabolic disorders; its prevalence is estimated to be about 1-2 percent in the general population; of which 90 percent are NIDDM cases ( Type II Diabetics). Diabetes mellitus is related to genetic- environmental risk factors. The correlation between diabetes mellitus type I and MHC has been documented (DR3 , DR4). Genetics plays an important role in type II Diabetes Mellitus. The concordance rate for Diabetes Mellitus in monozygote twins is 90 - 100% , but its exact mechanism of inheritance is unclear. It is probable that more than one mechanism contribute to its occurrence. There is no documented relationship between Diabetes Mellitus type II and MHC; however some investigators suggest that NIDDM is also related to various phenotypes of HLA. In this descriptive-cross sectional study, 46 cases and 53 controls were simply randomized, and then phenotype of HLA class 1 was determined in both the groups. The difference between the types of phenotype (HLA class 1) was examined in both the groups. Results showed that HLA CW1 (p=0.027), B35 (p=0.02) and B22 (p=0.027) were more in the control group while HLA BW4 (P=0.001) was more in the case group. The relationship of NIDDM and HLA BW4 antigens in Yazd suggests that the MHC or other genes on chromosome 6 play a role in NIDDM in Yazd province.      

Diabetes mellitus is one of the most common endocrine disorders that involves many organs such as joints. Hands is common site of joint involvement (diabetic stiff hand syndrome referred to as diabetic cheiroarthropathy. One hundred and fifty patients with diabetes mellitus and 152 age and gender matched controls were studied to assess the prevalence of Limited joint mobility. Joint mobility was measured by goniometry at metacarpophalangeal and subtalar joints, and those in whom a prayer sign was elicited were said to have cheiroarthopathy. 105 diabetic patients and 10 controls had cheiroarthopathy. The mean range of motion was reduced at metacarpophalangeal joints in diabetic patients (30.2 ±7.6°) as compared to controls (39.6±6.6°, p<0.0001).mobility at subtalar joints was reduced in diabetic patients; inversion (21.7 ±5.8°), eversion (16.3 ±3.7°) as compared to controls inversion (24.1±4.3°, p<0.0001), eversion (17.7 ±2.5°, p<0.0001). We conclude that significant limitation of joint mobility is present in patients with diabetes mellitus.      

Diabetes is one of the most prevalent metabolic diseases .It is a metabolic disorder, and leading fifth cause of mortality in the west .The diabetes international federation estimates that there are more than 100 million diabetic individuals world wide. In Iran, more than two million people suffer from diabetes. Prevalence of diabetes in some parts of Iran, especially in Yazd is high. Deficiency of chromium was observed in some societies with special food habits, especially in some geographical areas. This research was therefore necessary. Chromium is considered an essential food and also an essential part of glucose tolerance factor. It is (also an important factor) for activating insulin in removing glucose from cells. This research was carried out to evaluate the blood serum chromium levels of diabetic individuals who referred to the diabetic center of Shahid Sadoughi University of medical university on the basis of age and sex. They were compared with group of IGT and control. 370 diabetic patients participated in this study. They were divided into four groups of IDDM , NIDDM, IGT and control. Fasting blood sugar (FBS) & glycosylated hemoglobim (HBAIC) were measured. Chromium concentration was measured by Atomic Absorption. Serum chromium concentration in diabetic patients (IDDM mean= 0.096±0.002 µ g/l), (NIDDM mean = 0.097±0.002 µ g/l), IGT group (Mean=0.17±0.002 µ g/l) were significantly lower than control groups (mean =0.24±0.002 µ g/l) (P=0.004). Furthermore, a negative correlation was found between FBS and chromium, HBAIC and chromium in diabetic patients (NIDDM r = -0.110), IGT group (r= -0.176) and control (r=- 0.234). But no correlation was observed in IDDM patients. There is a positive correlation between FBS and HBAIC in all groups. It is recommended that estimation of chromium levels in Diabetic patients is a good guide for control of diabetes.      

Non Insulin Dependent Diabetic Mellitus (NIDDM) is the most common type of diabetes. Diabetic patients aiming to control their blood sugar have to use anti-diabetic table ts. However, after a period, resistance to antidiabetic medicines develops and use of high dosage of medicine cannot reduce the blood sugar. Most of these patients don't like to inject insulin and therefore other oral drugs capable of decreasing blood sugar levels are considered important. From several studies, it has been shown that some non- antidiabetic medicines such as fluoxetine cause a reduction in blood sugar. In this study the effect of fluoxetine (inhibitor of returning serotonin) on reduction of fasting blood sugar was evaluated. A clinical trial study (before and after) was done. Forty two NIDDM patients (10 males and 32 females) with a BMI> 25 and average FBS< 250 were randomly selected. They were given 40mg fluoxetine day for & weeks. Fasting blood sugar was measured after the 4th and 8th weeks following treatment with fluoxetine & then 4 weeks after discontinuation of fluoxetine .The results were analysed by "t-student test" using spss for windows. Average fasting blood sugar in patients at the first time (before taking fluoxetine) was 181mg/dl . The average FBS of patients after 4 and 8 weeks of fluoxetine use were 156 mg/dl and 149mg/dl respectively. The FBS at 4 weeks after discontinuation of fluoxetine was 152 mg/dl after the first four weeks of fluoxetine use, FBS reduced by 24mg/dl and after 8 weeks by 31 mg/dl. From our results it could be concluded that fluoxetine can decrease the fasting blood sugar and it can be prescribed as a complementary drug in diabetics.    

Diabetes mellitus type II is a major health problem and the primary objective in the treatment of diabetes mellitus type II is to achieve normoglycemia without aggravating coexisting abnormalities. Our study was done using experimental, analytic, clinical trial method and by before and after design. The effects of 7 day oral hydroxy chlroquine treatment administered at a dosage of 150 mg four times daily on fasting serum levels of glucose and cholesterol were studied in 30 patients with diabetes mellitus type II. Chloroquine reduced the fasting plasma glucose levels (96.8±58.3mg/dl, p<0.0001) and also caused a decrease in fasting serum concentration of total cholesterol (39±44.2mg/dl, P<0.001). This study demonstrates that 7 days of oral chloroquine treatment improves abnormalities of fasting plasma glucose and cholesterol levels in patients with diabetes mellitus type II.