Iranian Journal of Diabetes and Metabolism
Year:2005 | Volume:4 | Issue:2|Papers Count:19

Background: Polycystic ovary syndrome(PCOS) is the most endocrinopathy in women and the most common causes of anovulatory infertility. Women with this disorder moreover the common manifestations such as,irregular menses, hirsutism and infertility, are susceptible to serious consequences like increase risk of endometrial carcinoma, dyslipidemia, hypertention, glocose intolerance, diabetes, cardiovascular problems and probably breast cancer. This study was conducted to demostrate the demographic, clinical,metabolic and hormonal conditions of the PCOS patients. Methods: A case-control study was performed on females with PCOS age group 15-40 years referring to endocrine and gynecology clinics. A control healthy woman was selected for each patient. The diagnosis of PCOS was made based upon the prescence of chronic anovolation and hyperandrogenemia .Other causes of hyperandrogenism were excluded by appropriate clinical and laboratory evalution .In all patients with PCOS and control women, appropriate medical history was taken and physical examination was done.Blood pressure ,body weight, height ,BMI,waist/hip ratio,score of hirsotism,acne, and other signs of androgen excess were determined.A venous blood sample were obtained at morning after 12_14hours fasting for measuring FBS, TG, Chol., LDL, HDL and hormonal profile,souch as:PROL,17_OH Progestrone,Te,DHEA-S and TSH.Case of late onset adrenal hyperplasia ,hypotyroidism and pituitary prolactinoma were excluded.The diagnosis of dyslipidemia was made upon the base of NCEP guidelines.Data was analyzed with Mann_Whitney U,T tests and Fishers and Chi_Square Tests with SPSS-11. Results: Mean age were similar in both patients and controls.Mean of BMI and diastolic pressure were significantly higher in PCOS women in comparison with controls . Hirsutism and oligomenorrhea were the most frequent clinical features(72.7% and 69.1% respectively). SerumTG level was significantly higher in PCOS women in comparison with controls.There were no significant difference in FBS,Chol,LDL and HDL between patients and controls. The prevalence of high triglyceride ,high cholesterol and high LDL levels were significantly higher in PCOS women in comparison with controls,but there were no significant difference in the prevalence of IFG and low HDL levels. The prevalence of high TG and high Chol level were significantly higher in obese PCOS women in comparison with non obese patients.There was no significant difference in the prevalence of high LDL and low HDL levels between obese and nonobese patients. Serum level of total Testostrone was significantly higher in PCOS women in comparison with controls.There were no significant difference in serum levels of DHEA-S,17-OH Progestrone, Prolactine and TSH between patients and controls. Conclusion: The prevalence of obesity and dyslipidemia were higher in PCOS women in comparison with healthy women. For obese women with PCOS ,behevioral weight management is the main component of overall treatment strategy and these patients counseling about the importance of life style management ,diet and exercise shoud be emphasized. The patients should screened for dyslipidemia, diabetes and hypertension. In this study there was no significant difference in FBS between two groups and IGT and DM may be better detected by OGTT. In all PCOS women for detecting dyslipidemia a fasting lipid profile is indicated.

Background: This study was performed to evaluate the prevalence and risk factors of asymptomatic bacteriuria (ASB) in women with type 2 diabetes mellitus in Iranian population. Methods: Between March 2003 and December 2003, 202 nonpregnant women with diabetes type 2 who were between 31 to 78 years old and had no abnormalities of the urinary tract system were included. We defined ASB as the presence of at least 105 colony-forming units/ml of 1 or 2 bacterial species, in two separated cultures of clean-voided midstream urine. All the participants were free from any symptoms of urinary tract infection (UTI). Risk factors for developing bacteriuria was assessed and compared in participants with and without bacteriuria. Results: In this study, the prevalence of ASB was 10.9% among diabetic women. E.coli was the most prevalent microorganism responsible for positive urine culture. Most of the isolated microorganisms were resistant to Co-trimoxazole, Nalidixic acid and Ciprofloxacin. Pyuria (P<0.001) and glucosuria (P<0.05) had meaningful relation with bacteriuria but no association was evident between age (P<0.45), duration of diabetes (P<0.09), macroalbuminuria (P<0.10) and HbA1c level (P<0.75), and the presence of ASB. Conclusion: The prevalence of ASB is more prevalent in women with type 2 diabetes, which pyuria and glucosuria can be considered as risk factors in this regard. Routine urine culture can be recommended for diabetic women even when there is not any urinary symptom.

Background: Leptin is an adipocyte- derived hormone that plays an important role in the pathogenesis of obesity. Obesity is associated with insulin resistance and hyperinsulinemia. Insulin resistance is one of the factors which have been suggested to affect leptin serum levels. There are few studies evaluating the relation between leptin level and insulin resistance in childhood and adolescence obesity. The aim of the present study is to investigate this relationship in Iranian obese children. Methods: We screened 13089 primary school students aged 7-12 years. Children were divided to overweight and normal based on the recently published National Center for Health Statistics growth charts. The number of children which were overweight was 498, of whom 347 subjects particiated in the study. Fasting blood glucose, insulin and leptin levels were measured and homeostasis model assessment (HOMA) of insulin resistance (HOMA-IR) and fasting glucose to insulin ratio (FGIR) were calculated and compared between two groups. Results: Serum leptin levels were significantly higher in overweight compared to normal group. (11.58±8.1 and 8.1±5.2 respectively p<0.05). Before adjustment for BMI, there was a significant correlation between leptin and fasting insulin, HOMA -IR index and FGIR. (r=0.1, p< 0.05, r=0.1 , p<0.01, r=0.07, p<0.05 respectively). After adjustment for BMI, no significant correlation was found (r=0.097, p=0.20). Conclusion: The relation between leptin and insulin resistance was weak and disappeared after adjustment for BMI. It seems that many other factors including BMI and total fat amount may affect this relationship. Further studies in this field are required.

Background: Diabetes mellitus is a worldwide health problem affecting 1-2% of the population. It is responsible for numerous morbidity and mortality consequences due to vascular events such as hypertension, nephropathy and retinopathy. The precise mechanism of hyperglycemia-induced vascular damage is not clearly known. Alteration in Rennin Angiotensin-Aldosterone System (RAAS) and increased Angiotensin Converting Enzyme (ACE) activity is known to be involved in pathogenesis of vascular disorders. This study sought to investigate correlation between systolic blood pressure and ACE activity in STZ induced diabetic rats. Methods: Two groups of 8 male Sprauge Dawely rats including control (C) and diabetic group (D) were used in this study. Diabetes induced by injection of 60 mg/kg STZ intraperitoneally. Blood pressure was measured using tail cuff method. ACE activity was determined by HPLC method. Results: At the end of study (four weeks after induction of diabetes) systolic blood pressure increased significantly in D group compared to control rats. ACE activity was increased in aorta, heart, lung and serum of D group which this increment was more pronounced in aorta and heart. Renal ACE activity reduced significantly in this group compared to control. Conclusion: It is concluded that increased ACE activity particularly cardiovascular ACE, could be involved in the diabetes induced hypertension and vasculopathy

Background: Constipation is the most common gastrointestinal complication in diabetic patients. Erythromycin mimics the effects of the gastrointestinal hormone Motilin in gastric contractile activity and insulin secretion. In this study, we compared the effects of Erythromycin and Metoclopramide on glycemic control and constipation in type 2 diabetic patients. Methods: As a clinical trial, thirty-nine type 2 diabetic patients with constipation were divided into two groups. Patients in group 1 (n=24) were treated with erythromycin (400 mg/day before sleep) and participants in the second group (n=15) received metoclopramide (10mg 3 times / day before each meal) for 3 months. FBS, 2hPP BS, HbA1c and the frequency of defecations during a week were measured and compared before and after the intervention. Results: In Erythromycin treated group, 2hPP BS decreased from 199.7 ± 47.0 before treatment to 174.0±46.3 after intervention (P=0.01) and a significant improvement in constipational symptoms was observed in both groups. Conclusion: It seems that Erythromycin not only can improve symptoms of constipation but may have a role in glycemic control in type 2 diabetic patients.

Background: Family satisfaction in subpopulations referred to the endocrine clinic including diabetic and non diabetic patients and their spouses are compared in the present study. This study also assesses the correlation between family satisfaction and variables such as age, sex, educational level, economic status, type of diabetes, duration of the disease, type of therapy and dosage of drugs. A comparison of the frequency of sexual dysfunction between diabetics and non-diabetic pairs was also done. Methods: In this case- control study, 400 subjects were selected as simplified non-randomized method from outpatients referred to the Shahre Kord endocrine clinic in 2002. We assigned samples to group I (diabetic patients, n=100), group II (diabetic patients spouses, n=100), group III (non-diabetic patients, n=100) and group IV (non-diabetic patients spouses, n=100). Groups I and II were similar in sex, socioeconomic status and educational level. GRIMS family relationship questionnaire was used to evaluate family satisfaction. Results: Family satisfaction for diabetics in comparison with non-diabetics (P=0.05), diabetics in comparison with their spouses (P=0.003), and non-diabetics in comparison with their spouses (p=0.002) were significantly less. There was no significant difference between family satisfaction in diabetic and non-diabetic patients spouses (p>0.05). Relative frequency of sexual dysfunction was 76% and 29% and relative frequency of decreased libido was 32% an 12%, in diabetic and non- diabetic couples, respectively. Family satisfaction was less in patients with diabetes type I and whom using higher dosage of drugs. Conclusion: This study emphasized on the attention to the family as a part of approach to the diabetic patients. According to our results, it is recommended to focus the most attention in this field to the patients with type I diabetes and who consume more amounts of drugs.

Background: The goal of dietary recommendations in children with type 1 diabetes mellitus is to achieve moderate to good control of blood glucose regarding to decrease in diabetic long-term complications. Although educational programs on appropriate dietary habits are offered in Isfahan Endocrine and Metabolism Research Center for diabetic patients, there is no information about their dietary habits . This study has been performed to investigate dietary intake in children with diabetes mellitus type1 and to compare the results with that of non-diabetic ones. Methods: A cross-sectional study was performed in two groups of healthy and diabetic children. Data were collected by questionnaire and interview. The validity and reliability of the questionnaire were determined by content validity and pilot study. Data were described and analyzed by t-student and Pearson correlation tests in four age groups, using SPSS software. Results: Findings showed that in "A" age group the intake of total calorie and fiber, in "B" age group the intake of fiber, fat, protein, carbohydrate, sugar and SFA, also fat, protein, carbohydrate, sugar and SFA-derived calorie consumption, in "C" age group the intake of sugar and fiber, also PUFA and sugar-derived calorie consumption and in "D" age group the intake of fiber, total calorie, protein, carbohydrate and sugar were higher in diabetic children as compared with the control group. Conclusion: In all subjects, the intake of carbohydrate and total fat was the same as standard recommendations, while protein intake was a little higher which increases the risk of diabetic nephropathy. In all study groups, fiber intake has been decreased with increasing the age, so it is suggested to have dietary educational programs for general population with the goal of changing the life style of people, which itself can result in less social isolation in school-aged diabetic children.

Background: Homocysteine is regarded as a risk factor for metabolic syndrome and cardiovascular diseases. It is of great importance to determine exact risk factors of these disorders because of their high prevalence. Methods: The 25-64 year old individuals in 17th district of Tehran were studied. It was designed according to the WHO MONICA (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) project using the ATP III criteria. Homocysteine levels higher than 15 µmol/l and Folate and vitamin B12 lower than 11 nmol/l and 185 pmol/l, respectively were considered as abnormal. Results: Of the whole population, prevalence of abnormal homocysteine, Folic acid and vitamin B12 was 54.5%, 98.2% and 27%, respectively. Homocysteine levels were higher in men than women (P= 0.026). None of the differences between the means of these three risk factors were statistically significant in people with and without the metabolic syndrome. The only significant difference was higher homocysteine levels in women with metabolic syndrome (P= 0.010). Conclusions: According to this study, hyperhomocysteinemia and Folate and vitamin B12 deficiency are more prevalent in our population. But there was no correlation between these factors and risk of metabolic syndrome. Because of the controversy about this issue and high prevalence of cardiovascular diseases in our country, further studies are suggested.

Background: Diabetic nephropathy is a leading cause of end-stage renal disease (ESRD) in developed countries. This study was designed to determine the proportion of the diabetic patients among under-hemodialysis patients in ten hemodialysis centers of Tehran. Methods: This descriptive, cross-sectional study was done on all under-hemodialysis patients of ten hemodialysis centers (620 patients) during 2001-2002. Data were collected by taking history of the patients and reviewing their medical records. The data were analyzed to find out the frequency of the diabetes and the risk factors associated with diabetic nephropathy such as age, sex, type and duration of diabetes, smoking, hypertension, dyslipidemia, ischemic heart disease and the family history of diabetes and hypertension. Results: Diabetes was the cause of ESRD in 25% of patients aged 32 to 89 years old. The most frequent age group was 7th decade. 9% of diabetic patients suffered from type 1 and 91% of them suffered from type 2 diabetes. Patients with the diabetes duration of 15-19 years had the most frequency. 40% of patients were female and 60% of them were male. History of hyperglycemia, hypertension, dyslipidemia, ischemic heart diseases and smoking were positive in 48%, 82.5%, 46%, 41%, and 21% of patients, respectively. Conclusion: The results of this study are in agreement with other studies in this field. Diabetic patients compose a remarkable percentage of under-hemodialysis-patients. High frequency of risk factors in these patients should promote controlling them to prevention ESRD.

Background: Diabetes mellitus is the most common human metabolic disease. Chronic hyperglycemia and carbohydrate metabolism disorder accompany with plasma lipid and lipoprotein disorder. Cardiovascular disease is one of the macro vascular complications of diabetes type 2 which leads to high morbidity and mortality. Dyslipidemia is one of the major risk factors of cardiovascular diseases in diabetic patients. High TG and low HDL-C levels are the most prevalent type of dyslipidemia. Low levels of HDL-c considered as a risk factor for cardiovascular diseases. Methods: In this study 40 type 2 diabetic patients (13 male - 27 female) were included. Lovastatin and Gemfibrozil were recommended separately for 2 months and HDL-C were measured at the baseline and after taking drugs. In all patients BS, TG and TC at the baseline before and after these drugs were normal and so were not any change in their diet. Laboratorial findings gathered and analyzed. The relationship between increase level of HDL and decrease of TC with taking Lovastatin and Gemfibrozil were studied. Results: The averages of TC and HDL-C before taking drug as linear were 36.5mg/dl and 174.56 mg/dl and after taking Lovastatin as linear were 43.3 mg/dl and 150.44 mg/dl. The average of TC and HDL-C after taking Gemfibrozil were 43.33mg/dl and 146.36mg/dl. 18.54 % increase in HDL-C and 13.82% decrease in TC were seen with Lovastatin; and 18.54% increase in HDL-C and 16.05% decrease in TC were found with Gemfibrozil. Conclusion: In this study no difference was observed between the effect of Lovastatin and Gemfibrozil in increase of HDL-C (P=0.449). Also there was no difference between the effect of Lovastatin and Gemfibrozil in decrease of TC (P=0.992). The increase of HDL-C after taking Lovastatin had relation with sex and HDL-C increased in females (P=0.006); Also the increase of HDL-C after taking Gemfibrozil had relation with sex and females had more affected (P=0.035).

Background: Alloxan is on of the xenobiotic agents which is classified as diabetogenic materials. Magnesium is an important cofactor regulating the activity of carbohydrate enzymes and lipid synthesis. In this study the contrasting effects of Alloxan and magnesium on plasma free fatty acids (FFA) in rats was investigated. Methods: Male mature rats were used as test models for the diabetes induction. 28 rats received Alloxan (120mg/kg) intraperitoneally and plasma glucose level measurement after 72 hours demonstrated diabetes induction. Results: The results were compared to the control groups, and confirmed the presence of diabetes in rats. Analysis of plasma FFA showed a significant increase (751.25 mM), compared to the control group (286.68 mM). In contrast, Measurement of red blood cell (RBC) Magnesium showed a significant decrease from 7.18 mg/dL in control group to 4.89 mg/dL in diabetic rats. Conclusion: The results of this study showed that in diabetic condition, there was an inverse relationship between plasma FFA and RBC Magnesium. Therefore, these data suggest that analysis of the effects of Magnesium upon induction of diabetic condition could provide important information for management of diabetes.

Background: Diabetes mellitus is the most common cause of renal failure, blindness, non- traumatic amputation and neuropathy. Homocysteine, a sulfurated amino acid, has a close correlation with Methionine and Cysteine. The conversion of Methionine to Homocysteine and Cysteine is required coenzymes like vitamin B6, B12 and Folate. The effect of Metformin on serum Homocysteine level by decreasing vitamin B12 level in patients with type 2 diabetes mellitus was described previously. Methods: This is a prospective clinical trail study among patients with type 2 diabetes mellitus in Shiraz. 76 patients were divided into two groups (38 patients in each group). First group treated with Metformin 500-2000 mg/day and the second group treated with Glibenclamide 5-20 mg/day with follow up period of at least 6 months. Hb and MCV were used in follow up to detect megaloblastic anemia, indicator of B12 and folate deficiency. Fasting plasma Homocysteine level Hb A1C and blood sugar were measured in baseline and at 3 and 6 months follow up periods. Results: There was no significant difference between age, sex, weight, height and BMI and baseline serum profile between the two groups. Homocysteine level increased significantly in Metformin group at 3 and 6 months(P=0.003 and 0.001 respectively). Mean plasma homocysteine level after 6 months were 10.98±0.58 µmol/l in Metformin and 10.0± 0.88 µmol/l in Glibenclamide group, with significant difference between the two groups (P=0.001). Conclusion: Metformin increases the plasma Homocysteine level. Metformin will accumulate highly in gastrointestinal wall and cause malabsorption of vitamin B12, therefore we can conclude that the use of Metformin for 6 months can cause vitamin B12 malabsorption and increase in plasma homocysteine level. Increase in plasma homocysteine level was 7.54% in our study that is higher in comparing to the other studies. It can be explained by longer duration of Metformin therapy in our study. Rising in Homocysteine levels may have detrimental effect on vessels that need further study.

Background: Atherosclrosis is a process that initiated with hypercholestrolemia and fatty streak formation. Previous studies showed oxidative modification of LDL render immunogenic and autoantibodies to epitopes of oxidized LDL. Oxidized LDL (OX-LDL), has antigenic properties. Antibodies against oxidized LDL have been proposed to be independent predictors of atherosclerosis development. The main aims of the current study were to compare antibody titers to different types of oxidized LDL (Cu+2-LDL, Malondialdehyde-LDL) and Native-LDL between angiographically documented coronary patients, non-documented patients and healthy subjects. Correlation between autoantibodies against oxidized LDL and increased risks of cardiovascular diseases has been shown.Methods: As a case-control study, we evaluated angiographically documented coronary patients, non-documented patients and healthy subjects to measure anti-OX-LDL autoantibody levels. Enzyme-linked immunosorbent assay was used to measure anti-OX-LDL autoantibodies. ANOVA test used for statistical analysis. Results: Titers of anti-Malondialdehydo-LDL autoantibodies were 3.55±0.415, 0.361±0.20, 0.093±0.078 respectively in each group (P<0.005). There was not statistically meaningful difference, between native-LDL and Cu+2-LDL antibodies.Conclusion: It seems the titre of autoantibodies against OX-LDL considered as a predictor of progression of atherosclerosis. Our data provide further support for a role of oxidatively modified LDL in atherogenesis.