Iranian Journal of Diabetes and Metabolism
Year:2007 | Volume:6 | Issue:4|Papers Count:15

It is estimated that there are 1.1–1.5 billion Muslims worldwide, and prevalence of diabetes is approximately 4.6%. Many patients with diabetes insist on fasting during Ramadan, thereby creates a medical challenge for themselves and their physicians. These patients are susceptible to diabetic complications such as hypoglycemia and hyperglycemia. It is therefore important that medical professionals be aware of potential risks that may be associated with fasting during Ramadan. Patients who insist on Ramadan fasting be assessed before Ramadan and receive appropriate education and instructions related to physical activity, meal planning, glucose monitoring, and dosage and timing of medications. In this article, management of diabetes in Ramadan is discussed.

Background: IFN-g is one of the most essential and fundamental player in initiation and development of T1DM. This mediator belongs to T Helper-1(Th1) class of cytokines and exerts stimulation and differentiation of naïve T cells towards Th1 cells and meanwhile inhibits differentiation and proliferation of Th2 cells. These effects are highly important in induction and progression of cell mediated immune responses that are aberrantly operative in development of T1DM. Due to such outstanding role, numerous studies including genetic manipulation have focused on the role of this pro-inflammatory cytokine in T1DM.Methods: In a genetic association study the influence of IFN-g gene variation in position +874*T/A on development of T1DM was analysed in 248 British Caucasian T1DM patients in comparison with 119 healthy matched controls. ARMS-PCR procedure was designed for detection of the variants at allele/genotype level.Results: No significant association between IFN-g gene polymorphism and T1DM was apparent (P³0.05). The distribution of these polymorphic variants was in Hardy-Weinberg equilibrium.Conclusion: While some studies have shown an association between the examined polymorphism of IFN-g and T1DM, our data do not support that. According to present study the selected polymorphic marker (+874*T/A) is not among the polymorphisms that governs in part genetic susceptibility to T1DM. That irreproducibility or controversial results is a common observation in genetic studies of complex traits such as T1DM, reflecting a fragile correlation between genotype and phenotype. This study also underlines the importance of replication of association studies to confirm the previous results/interpretations.

Background: Atherosclerosis is the leading cause of mortality in the developed and some developing countries. Some people believe that opium abuse has beneficial effects for reducing blood lipids and atherosclerosis prevention. In this study, the effect of oral opium addiction on lipid profile and atherogenesis in normal and hypercholesterolemic rabbits was studied.Methods: Thirty two male Newzeland White rabbits were used in this study. They were divided into four groups including control, hypercholesterolemic, addicted, and hypercholesterolemic addicted and were studied for three months. The blood samples were obtained and lipid profile was determined at the beginning of the study and at the end of every month thereafter. After 90 days aorta was removed to assess for lesion formation.Results: The levels of cholesterol, triglyceride (TG), high density lipoprotein-cholesterol (HDL-C), low density lipoprotein-cholesterol (LDL-C), and atherogenic index (total cholesterol/HDL-C) in the hypercholesterolemic and hypercholesterolemic addicted rabbits were increased significantly (P<0.001). These increases in lipids and aorta lesion areas were higher in hypercholesterolemic addicted group than hypercholesterolemic group.Conclusion: These findings suggest that oral opium abuse affects cholesterol metabolism and depending on the dietary condition can have an aggravating effect on atherosclerosis. The protective effect of mrphine on cardiac disease is not probably through the modulation of lipid metabolism.

Background: Several studies were pointed to oxidized LDL (OX-LDL) as one of the main immunogenic agents which have important roles in primary lesions of atherosclerosis. In this study, via immunization against OX-LDL with two different antigens in an animal model (rabbit); we tried to clear relation between immune system and atherosclerosis.Methods: LDL was isolated from healthy human plasma and oxidized with MDA or Cu ++. Rabbits were divided to three groups and after 2 weeks (under basic diet) immunized with MDA-LDL or Cu- LDL. In control group Phosphate-buffered saline (PBS) was used. Immunization was repeated with these materials again the weeks of 2, 4, 6, and 8 and concentration of OX-LDL antibody was measured in each stage. At the end of 8th week, rabbits fed normal or high cholesterol regimens. Biochemical factors were measured at the beginning and end of study, also Fatty streaks in aorta and left and right coronary arteries was evaluated.Results: Immunization with h Cu 2+ -LDL and MDA-LDL induced adequate antibody formation (IgG) at the end of 8th weeks. Immunization with MDA-LDL significantly decreased the level of cholesterol, LDL-cholesterol and fasting blood sugar (FBS) (P= 0.04). Also a significant decrease in fatty streak lesions was detected in aorta and right and left coronary arteries as compared with non-immunized high-cholesterol group (P= 0.04). Immunization with Cu 2+ -LDL significantly decreased Triglyceride, FBS and cholesterol as compared with non-immunized high cholesterol. No differences were detected in the fatty streak lesions in this group as compared with non-immunized high-cholesterol diet cu+2- LDL immunized group, shown significant decrease in CRP as compared with both non-immunized group and high cholesterol diet.Conclusion: We conclude the protective effects of immune responses on atherosclerosis depend to what kind of antibody, so MDA-LDL and CU-LDL prevent atherosclerosis with different mechanism.

Background: Children with Type 1 diabetes were present one of the greatest challenges in the worldwide. Health-care providers must be sufficiently aware of diabetes so that such children make utmost benefit of their educational opportunities. The aim of the present study was to compare the effect of three educational methods in raising the level of knowledge of school health-care providers.Therefore the best method would be applied for this purpose.Methods: In this interventional study 132 samples were randomly chosen from the list of school health care providers of Tehran and divided to the three groups (educated by posters, booklets, and group education). A questionnaire was completed for all the three groups before and after the education. Questionnaire consisted of two parts: -demographic information and 16 questions about diabetes information. Scores were analyzed by descriptive and inferential methods (T-test, ANOVA).Results: The level of knowledge of school health-care providers was weak in 23.5% of the case, average in 59.8% of cases, and good in 16.7% of cases. The level of knowledge in the groups educated by booklets and group education increased meaningfully, while no obvious increase was observed in the group trained via posters.Conclusion: From the three aforementioned training methods, group education and education by booklets have the most effect on raising the level of knowledge of health-care providers.

Background: Chronic diabetes is substantially associated with circulatory disorders in lower limbs. Vacuum-Compression Therapy (VCT) has been commonly used in treatment of peripheral circulatory disorders. VCT is based on intermittent alteration of Positive- Negative pressure phases. The purpose of this study was to determine effects of VCT on diabetic subjects' peripheral blood flow.Methods: In this Before-After and case-series study, 18 type 2 diabetic subjects with diabetic neuropathy and/or peripheral vascular disease (PVD) completed the study. Subjects received 45 min of VCT for 10 sessions three times weekly. Blood flow (calf+foot) was measured via venous occlusion plethysmography.Results: Among Variables of "Arterial Inflow", "Venous Outflow", "Venous Capacity", "Postischemic Reactive Hyperemia" and "Peak Flow of Reactive Hyperemia", only "Venous Outflow" significantly improved after 10 sessions treatment via VCT (P<0.05).Conclusions: Arterial blood inflow, which was the most important determinant evaluated in this study, was not increased via VCT. Additional studies are required to investigate the effective VCT parameters and duration of each session and number of sessions, considering progressive and deteriorative natural history of diabetes.

Background: The prevalence of Diabetes mellitus as the most common metabolic disorder of human is progressively increasing. Dyslipidemia is common among diabetic patients characterized by elevated plasma TG, LDL-C and reduced HDL-C levels; which increase risk of cardiovascular events.Fish oil supplement which contains omega-3 has been proposed to correct the atherogenic lipid profile associated with diabetes mellitus. Doubt remain whether the net effect of fish oil supplement on lipid profiles are beneficial in diabetes. We therefore performed this randomized double-blind clinical trial to investigate this.Methods: Ninety six patients with type 2 diabetes mellitus were randomized assigned to take 3 times daily supplementation (capsule) with either fish oil or corn oil for 8 weeks (48 patients in each group).At begining also end of study we measured laboratory variables (FBS, TG, Total cholesterol, LDL and HDL) in both groups.Results: At begining of the study demographic and laboratory measurements were similar in both groups (P>0.05). At 8th weeks there were no statistically significant differences in variables measured except for LDL and HDL in fish oil group that leads to increase and decrease respectively.Although both groups show improvement in LDL / HDL and Total cholesterol / HDL ratios but mean charges were statistically significant in fish oil as compared with corn oil group. (P=0.001, P=0.005 respectively).Conclusion: Fish oil supplement showed statistically significant improvement in LDL/HDL, Total cholesterol/HDL ratios as compared with corn oil. This may leads to decrease cardiovascular events.

Background: Different criteria have been proposed for the diagnosis of the metabolic syndrome (MES). In April 2005, the International Diabetes Federation (IDF) has formulated a new worldwide definition of the metabolic syndrome in a global consensus statement built on earlier WHO, the ATPIII definitions. The aim of this study was to estimate the prevalence of this syndrome using the IDF definition among Iranian adults and to compare it with the prevalence estimated using the two other definitions.Methods: The prevalence of the MES was determined according to the three different definitions in 10368 men and women aged³20 years participated in the cross-sectional phase of the Tehran Lipid and Glucose Study (TLGS). To assess the degree of agreement between different MES definitions, the k test was used.Results: The prevalence of MES (95% confidence interval) was 32.1% (31.2-33.0) by the IDF definition, 33.2% (32.3-34.1) by the ATPIII and 18.4% (17.6-19.2) according to the WHO definition.The sensitivity, specificity and concordance of the IDF definition for detecting MES were 91%, 89% for the ATPIII definitions and 73%, 77% for the WHO definition, respectively. The k statistics for the agreement of the IDF definition was 66.3±0.01 with the ATPIII and 39.5±0 with the WHO definition.Conclusion: In the Iranian population, the IDF definition for MES has a good concordance with the ATP III definition and a low concordance with the WHO definition.

Background: Only limited data are available on the benefits of fruits and vegetable consumption on CVD risk factors. The aim of this study was to examine whether and to what extent intake of fruits and vegetables are inversely associated with cardiovascular (CVD) risk factors in adults.Methods: In this population-based cross-sectional study a representative sample of 840 Tehranian adults (361 men and 479 women) aged 18-74 years were randomly selected in 1998. Usual dietary intake was assessed with the use of food frequency questionnaire. Portion sizes of consumed foods were converted from household measures to grams and analyzed by using Nutritionist III software designed for Iranian foods. Subjects were categorized based on category cut-points. : 0-1.9, 2-2.9, 3.0- 3.9, and>=4 servings/d.Results: In multivariate logistic regression after adjusting for confounders, dietary fruits and vegetable were found to be significantly and inversely associated with CVD risk factors. Adjusted odds ratio for high LDL concentrations were 1.00, 0.88, 0.81, 0.75(P for trend < 0.01) in first model which was adjusted for age, body mass index (BMI), energy intake, smoking status, dietary cholesterol, and prevalence of diabetes mellitus and coronary artery disease, a trend which was not appreciably altered by additional adjustment for education, physical activity, and saturated, polyunsaturated, total fat, Potassium and vitamin C intakes. This association was observed across categories of smoking status, physical activity, and tertiles of the Keys score.Conclusion: Consumption of fruits and vegetables more than 4 servings a day is associated with lower concentrations of total cholesterol and LDL-C and with decrease in the risk of cardiovascular diseases.

Background: Recently on the metabolic syndrome is considered as an inflammatory disease. So factors affecting inflammation are important in this condition.Methods: This randomized cross-over clinical trial was undertaken on 42 postmenopausal women with metabolic syndrome. Participants were randomly assigned to consume a control diet (Dietary Approaches to Stop Hypertension= DASH), soy protein diet, or soy nut diet, each for eight weeks. Inflammatory markers were measured by ELISA.Results: The difference from the control diet for E-selectin (an inflammatory markers which shows the endothelial function) was –11.4% (P<0.01) on the soy nut consumption and –4.7% (p=0.19) on the soy protein diets. Soy nut consumption reduced interleukin-18 compared to the control diet (difference from the control diet: –9.2%, p<0.01). For C-reactive protein the difference from the control diet was – 8.9% (P<0.01) on the soy nut diet and –1.6% (P<0.01) on the soy protein diet.Conclusion: Short-term soy nut consumption reduced some markers of inflammation and increased plasma nitric oxide levels in postmenopausal women with the metabolic syndrome.

It is estimated that up to 40-70% of obesities is attributable to genetic factors. Monogenic forms of obesity are uncommon. We present the first such reported case in Iran. The patient presented with a history of severe hyperphagia, rapid weight gain and recurrent infections. He was born after a normal pregnancy in a highly consanguineous marriage. His birth weight had been normal. At age of 18 months he weighted 28 kg. Apart from obesity and syndactyly of second/third digits in both feet there were no other abnormalities on physical examination. His fasting serum leptin was 45 ng/ml.Genotyping revealed 66-bp deletion in codon 514 of leptin receptor gene. Unfortunately he developed another respiratory infection which was unresponsive to intensive treatment and died following a cardiorespiratory arrest. Genetic assessment is recommended in morbid obese patients especially those with a childhood onset. Leptin receptor mutations can be associated with immune system deficiency and recurrent infections.

Background: Pump therapy (CSII) is offered as a safe and effective treatment for patients with type 1 Diabetes. We examined the efficacy and safety of continuous subcutaneous Insulin Infusion Therapy for six months as a before-after clinical trial study among type 1 diabetic patients. This is the first survey of this experience in Iranian patients.Methods: We recruited, type 1 diabetic patients without chronic complications of diabetes (retinopathy, nephropathy and etc.) and followed them for six months as a before-after clinical study with use of the pump. The efficacy of this way was assessed with HbA1C and fasting blood sugar measurements. Safety was estimated by frequency of clinical hypoglycemia episodes.Results: Our patients were 7 men and 2 women aged 15 – 39 years with past history of diabetes by ranging from 0.1 to 15 years. Mean level of HbA1C at the beginning of study and after six months follow-up were %8.6 and %7.1, respectively, with significant statistically difference between them (P= 0.02). During pump therapy the mean dose of insulin were decreased to 10 units with statistically significant difference to before investigation (P = 0.03). No case of hypoglycemia and weight loss was seen. One patient had 4 kg weight gain without any significant statistical effect.Conclusion: It seems CSII Therapy in Iranian patients with type 1 Diabetes mellitus was effective and safe. We can not conclude about possible side effects of pump based on this study.