Iranian Journal of Diabetes and Metabolism
Year:2006 | Volume:6 | Issue:1|Papers Count:22

In the field of health care and medical practice, gain sharing plans should be carefully examined to be sure they reflect the codes of ethics. Ethical principles involved in gain sharing include informed consent and conflict of interest. Physicians must discharge their responsibilities to patients with loyalty, honesty and good faith, all the while avoiding conflict of interest. Conflict of interest rules usually focus on financial gain. This may raise some important issues, including kickbacks, fee-splitting and self-referral. These practices can potentially distort professional judgment. Some countries have rules of professional conduct governing these issues. In this article, we intend to describe importance of the issues of kickbacks, fee-splitting and self-referral in the field of clinical medicine and discuss some ethical issues that should be considered by physicians.

Background: Peroxisome Proliferators- Activated Receptor-Gamma2 (PPAR-g2) is a nuclear receptor that regulates adipocyte differentiation, lipid metabolism and insulin sensitivity. The aim of this study was to evaluate the association of the Pro12Ala polymorphism at the PPAR-g2 gene in Iranian population with obesity.Methods: The genomic DNAs of the 156 subjects including obese and healthy isolated from EDTA whole blood. Pro12Ala polymorphism detected by Polymerase Chain Reaction – Restriction Fragment Length polymorphism (PCR-RFLP).Results: In the obese group, one sample (1.3%) was as homozygote Ala/Ala genotype, 24 samples (30.8%) were Pro/Ala heterozygote and 53 samples (67.9%) as Pro/Pro genotype were identified. in the control group, one sample (1.3%) was as Ala/Ala genotype, 12 samples (15.4%) were Pro/Ala genotype and 65 samples (83.3%) were Pro/Pro genotype. allele frequencies of  Ala in obese subjects (qAla=%16.7)were significantly different from those in control subjects (qAla=%8.9).Conclusion: Our results revealed that Pro12Ala polymorphism in PPAR-g2 gene associated with obesity in the Iranian population and presence Ala allele cause to significantly higher BMI and lower fasting blood sugar.

Background: Sulfonylurea agents such as Glibenclamide (Glyburide) have been widely prescribe in treatment of type 2 diabetic patients for decades, but controversy remains about their precise mechanism of action. On the other hand, glucokinase serves as a glucose sensor in pancreatic b-cells and plays a key role in the regulation of insulin secretion and glucose homeostasis. The aim of the present study was to evaluate the effect of Glibenclamide on insulin secretion and glucokinase activity in the rat isolated pancreatic islets of Langerhans.Methods: The islets from normal and type 2 diabetic rats were isolated by collagenase digestion method. Glucokinase activity was measured via determination the rate of glucose-6-phosphate formation in the fluorometric assay. Insulin secretion from hand-picked islets was evaluated by static incubation technique. Insulin concentration was measured by rat insulin ELISA kit.Results: Our findings obtained from incubation of Glybenclamide with pancreatic islets revealed that this agent increases basal insulin secretion (at 2.8 mM glucose) in both normal and diabetic rats as compared it with control islet (without drug). However, the increase of insulin secretion in response to 16.7 mM glucose was not significant. On the other hand, Glybenclamide had no activating and/or inhibiting effect on pancreatic glucokinase activity in both diabetic and normal Rats. But reduced activity of this enzyme in diabetic rats was significant in comparison with normal.Conclusion: These data show that increasing effect of Glybenclamide on insulin secretion is through a mechanism other than affecting Glucose Mediated Insulin Release. Moreover, the regulation of pancreatic glucokinase does not depend on glybenclamid.

Background: Many researches have been conducted on islet cells' transplantation for a definitive treatment of diabetes mellitus type1. As the viability of the islets is the most important factor in predicting the transplantation prognosis, we have designed a study to isolate rat's islets. The aim of the study was to assess the viability of the islets at different stages and suggest the best transplantation time.Methods: Pancreatic islets were isolated from male rats (250-300gr) by standard surgical procurement followed by intraductal HBSS distension, chopping and digestion with collagenase (type V). After being centrifuged for 3 times, the islets were then hand-picked and incubated in 37oC with RPMI 1640 media for 6 days. Each well contained 35-45 islets. Viability of islets was assessed by 2 independent investigators, giving score 0-2 to the color of islets under florescent microscope after Propidium iodide/Acridine orange staining at 6 times: just after the incubation, 24h, 48h, 3rd day, 5th and 6th day.Results: The viability of the islet cells was gradually increased after the incubation as we had the most viability rate after the second day, while it decreased after this period and reached the least rate on the 5th and 6th day.Conclusion: The islets' viability increased following the cell culture after the isolation procedure, as they have the best condition for transplantation after 48 hours. As the islets’ viability is the most critical point in transplantation, further studies evaluating the effects of different interventions on viability is needed.

Background: Artichoke with the scientific name of Cynara scolymuse is a plant from compositae family. In this research, the effect of hydro alcoholic artichoke extract on serum glucose, lipids and lipoproteins and prevention of type 1 diabetes mellitus was investigated. Methods: Twenty mature male Rats with mean weight of 200-250 gr in four groups were arranged. Rats in the control group, received physiological serum. The Second group (diabetic) received 120 mg/kgbw Alloxan monohydrate. The Third group (diabetic + Glibenclamide) received 0.5 mg/kgbw Glibenclamide in addition of the similar treatment with second group. The Fourth group (Alloxan monohydrate + Cynara scolymus), received 120 mg/kgbw Alloxan monohydrate with 300 mg/kgbw of Cynara scolymus simultaneously. Prescribing materials in all groups was done as interaperitoneal injection(IP). Fourty eight hours after last IP, blood sample was taken from each animal via cardiac puncture to measure blood factors. Results: The results indicated significant reduction in glucose, cholesterol, triglyceride, VLDL and LDL levels in the treated group with extract and Alloxan monohydrate simultaneously as to compared diabetic group. Also, the result indicated significant increase in HDL level. Hydroalcoholic Artichoke extract could not reduce blood glucose level as compared with Glibenclamide, but had similar effects on other factors in comparison with Glibenclomide. Conclusion: Artichoke contains antioxidants compounds, that plays a protective role on beta cells against Alloxan. The results of this research indicate that hydro alcoholic extract of Cynara scolymus could effectively prevent type 1 diabetes mellitus.

Background: A high dietary lipid intake is an important mediator of cholesterolemia and cardiovascular disease. Oils such as Sesame oil are not thought to contribute to such complications although information on the subject seems to be spare and contradictory. Since the ground seed of Sesame or "Ardeh" is commonly used in certain parts of this country (Iran), so its effects on the serum lipid profile of the rats have been investigated.Methods: The study was performed on six groups of male Wistar albino rats (10 in each group) weighing 300-350 gr. Ardeh was prepared by grinding the seeds after they had been roasted at 60ºC. To prepare a high cholesterol diet, 1% cholesterol and 0.5% cholic acid was added. Group 1 consumed the ordinary diet; 2 the ordinary diet plus Ardeh (24%), 3 the ordinary diet plus sunflower oil (10%), group 4 the high cholesterol diet, 5 the high cholesterol diet plus Ardeh, and group 6 the high cholestrol diet plus sunflower oil, all for 30 days. Blood samples were obtained and sera were used to determine the lipid profile.Results: The results of the study revealed that addition of Ardeh to the ordinary diet decreased serum cholesterol level significantly (P<0.01) in group 2 (38.2±2.3 mg/dl) as compared to the group 1 (49.9±5.9). Ardeh and sunflower oil had a similar effect on the groups, which consumed the high cholesterol diet. Ardeh also reduced the triglyceride level significantly (P<0.01) in group 2 (65.1±7.6 mg/dl) as compared to group 1 (106.3±15.1). Presence of both Ardeh and sunflower in the diets failed to affect HDL, but VLDL levels in group 2 (13.0±1.5 mg/dl) were significantly (P<0.01) lowered as compared to group 1 (21.2±3.(Conclusion: From the results of this study it appears that Ardeh can have a beneficial effect on lipid profiles and its addition to the diet is recommended.

Background: Overweight is one of the most worldwide health problems particularly in industrial and developed communities. Obese subjects are at high risk for developing various disorders such as diabetes and especially cardiovascular diseases. It has been well established that life style modification plays an important role in reducing these complications, particularly weight reduction and caloric restriction (CR) as a non- pharmacological approach. In the present study the possible effects of caloric restriction on Nitric Oxide production and blood pressures in rat were investigated.Methods: Four groups of rats were selected as control(C), caloric restriction (CR), diabetic (D), and caloric restriction diabetic (CRD). Control animals fed freely with standard pellet but caloric restricted animals fed an every other day diet for 4 weeks. The systolic blood pressure (SBP) was measured in all groups using the tail-cuff method under the light general anesthesia induced by ether. Nitric oxide (NOx) concentrations were determined in serum using a colorimetric non- enzymatic NO assay kit.Results: In CR experimental groups (CR&CRD) SBP was significantly decreased as compared to control: (P<0.001) and diabetic (P<0.01) rats , while the serum NOx was significantly increased (P<0.01) in both groups as compared to control and diabetic rats.Conclusion: On the basis of obtained results, it could be concluded that caloric restriction may reduce blood pressure and increase nitric oxide in diabetic and non-diabetic rats. Increase nitric oxide is the likely mechanism for decreasing blood pressure.

Background: Few studies have investigated maternal leptin concentrations in women with pregnancies complicated by gestational diabetes mellitus (GDM), and these published results are conflicting. We examined the association between plasma leptin concentration and GDM risk.Methods: As a cross-sectional study 741 pregnant women that referred to five university hospital clinics were recruited. The universal screening was performed with a GCT-50g and those with plasma glucose level ≥130mg/dl, were diagnosed as GDM if they had an impaired GTT-100g based on Carpenter and Coustan criteria. The level of insulin was measured during OGTT-100g. Also maternal plasma leptin concentrations were measured.Results: GDM patients had higher age, parity, BMI, and serum leptin concentration as compare with normal pregnancies. In logistic regression model serum leptin levels were independent factor for GDM.Conclusion: Serum leptin concentrations can predict GDM.

Background: Detecting mothers with gestational diabetes mellitus (GDM) is not only important in prevention of prenatal morbidities but also has significant effect on neonatal and maternal long term outcomes. Today, there are screening tests for GDM but they are time-consuming and expensive, therefore it seems necessary to perform testes that are uses expensive but with higher sensitivity and specificity. The aim of this study was to determine a cut - off point of fasting plasma glucose (FPG) for screening of GDM. Methods: 200 pregnant women referring to the perinatal clinic of Imam Khomeini hospital, (Sari – Iran) were studied. All cases with age ≥25 years old, history of recurrent abortion, GDM, preeclampsia, macrosomia, still birth, diabetes mellitus(DM) in first degree family or pre gestational body mass index ≥25kg/m2 were selected. Those with pre gestational diabetes mellitus were excluded. All of participants underwent a 50 g glucose challenge test (GCT) between the 24th and 28th gestational week. If 1- hour plasma glucose was more than 130 mg/dl, a 3- hour 100g oral glucose tolerance test (OGTT) was performed. The diagnosis of GDM was made by ADA 2006 recommendation (Carpenter and Coustan diagnostic criteria). Referring to the Receiver Operative Characteristic Curve, level of FPG having highest sensitivity and specificity in diagnosis of GDM was determined. Results: From 200 participants, 65 women had positive GCT, of them 58 (response rate 89%) referred for 100g OGTT and 20 (10%) were diagnosed GDM. Using ROC curve and under curve area of 0.853; the FBG level of 91.5 mg/dl, showed the highest sensitivity and specificity, 80% and 92% respectively in diagnosis of GDM. Conclusion: FBG ≥ 91.5 mg/dl has good sensitivity and specificity in screening of GDM. Since this is simpler and cheaper than 50g GCT, is recommended as a screening method in diagnosis of GDM.

Background: Pregnancy is a condition that favors oxidative stress mostly because of the mitochondria-rich placenta. Transitional metals, especially Iron, which is particularly abundant in the placenta, are important in the production of free radicals. Also studies showed that free radicals has a role in GDM. This study was performed to compare Iron status between gestational diabetes mellitus (GDM) patients and control groups. Methods: As a case- control study 34 women with GDM were compared with 34 Healthy women matched for referred center, age, parity and BMI. Iron status measurements including ferritin, serum iron, total iron binding capacity (TIBC), hemoglobin, MCV and MCH at 24-28 weeks of pregnancy were assessed and compared between two groups. Results: In this study, concentration of serum ferritin, Iron, transferin saturation and hemoglobin, MCV and MCH were significantly higher in GDM group and TIBC was significantly lower in this group as compared with controls (P<0.05). No significant association was observed in other variables including familial history of diabetes and GDM.Conclusion: Our findings indicate an association between increased Iron status and GDM. The role of excess Iron from Iron supplementation in the pathogenesis of GDM needs to be examined.

Background: The aim of this study was to determine the level of agreement between the impaired fasting glucose (IFG) and abnormal glucose tolerance before and after application of the new IFG definition and to evaluate the impact of adding common clinical data on this agreement.Methods: A cross sectional population based study was carried out in an Iranian urban population which enrolled 8766 men and women over 20 years. Fasting and 2-hour plasma glucose were measured in all subjects excluding those with previously diagnosed diabetes and fasting plasma glucose ≥126 mg/dl. The diagnostic parameters and kappa coefficient between the previous and revised definitions of IFG for detecting impaired glucose tolerance (IGT) and dysglycemia (IGT and diabetes) were calculated. Logistic regression and ROC curve analysis were used to determine the independent clinical risk factors and their optimal cut-points associated with IGT and dysglycemia.Results: After using the new criteria, sensitivity of IFG for detecting IGT or dysglycemia increased but specificity and positive likelihood ratio (LR+) decreased and the κ slightly improved (0.16 to 0.29 for IGT and 0.24 to 0.35 for dysglycemia). Adding the clinical data to the revised criteria considerably improved the agreement between IFG with IGT and dysglycemia (κ increased from 0.286 to 0.470 for IGT and from 0.354 to 0.574 for dysglycemia). This also increased the LR+ from 3.86 to 14.5 and from 4.46 to 17.4 respectively for detecting IGT or dysglycemia.Conclusion: The new IFG definition in combination with common clinical risk factors most likely predicts IGT and dysglycemia.

Background: Combination of physical activity and pharmacotherapy in diabetes may augment the effects of the drug and may allow lower doses of medication that can minimize the side effects The goal of the study was to determine the effectiveness of aerobic training and Glibenclamide combination in type 2 diabetes. Methods: A total of 28 men with type 2 diabetes were divided to 3 groups randomly: Glibenclamide (5 mg daily) only, Glibenclamide (5 mg daily) plus aerobic training, Glibenclamide (2.5 mg daily) plus aerobic training Aerobic training protocol was performed for 12 week, 3 days (session) a week, 45 minutes in a session (ergo cycle program at 60-70 % heart rate reserve) Fasting glucose, HbA1c, fasting insulin, c-peptide, and insulin resistance were measured at pre, mid and post treatment periods Analysis of Variance test (ANOVA) were used to evaluate data. Results: HbA1c significantly decreased and c-peptide significantly increased in three groups (P<0.05).There were also no between-group differences for c-peptide and HbA1c (P>0.05) Fasting insulin concentration did not alter in three groups, however, insulin resistance decreased (no significant) after 12 weeks. Conclusion: In type 2 diabetic patients, Glibenclamide treatment alone or combination of aerobic training and Glibenclamide treatment, was effective in improving glycemic control in patients with type 2 diabetes .As a result, in patients with type 2 diabetes, the addition of aerobic training to Glibencelamide treatment allow lower doses of Glibenclamide to be used without impairment in glycemic control.

Background: The relationship between diabetes and periodontal diseases has already been proved, but the effect of non-surgical periodontal therapy on the control of diabetes is controversial. The aim of this study was to determine the effect of this type of treatment on the control of diabetes. Methods: In this randomized clinical trial 30 type 2 diabetic patients with moderate to severe periodontitis who were referred to the diabetes clinic of Imam Khomeini hospital during 2004-2005 were studied. The treatment procedure was explained for control group and an informed consent was taken. Scaling and root planning was randomly done for 15 patients, while control group were not treated for periodontal disease. The glycated hemoglobin (HbA1C) and clinical attachment loss was measured for all of the patients before and 2 months after treatment. Results: At the baseline the clinical attachment loss (CAL) was significantly different between two groups. There was no significant difference between baseline HbA1C in the control and the experimental group. After 2 months the HbA1C was reduced in the treated group which was not statistically significant.Conclusion: In this study non-surgical periodontal therapy had not effect on the control of type 2 diabetes.

Background: Cardiovascular Diseases are becoming increasingly prevalent due to urbanization and industrialization of our country. Therefore Screening of the Cardiovascular Risk Factors is one of the most important health system priorities. The aim of this study was to evaluate a screening method implementing family history for cardiovascular risk factors. Methods: We chose 10 Junior-high schools in the 6th district of Tehran using simple random sampling. Then a questionnaire asking about family history of cardiovascular disease in the first degree relatives (including grand parents) was distributed between them and was completed. with contribution of parents. Then high-risk and low-risk families were invited separately to Dr Shariati Hospital for further evaluation. SPSS software version 10 using student T-test, Chi-Square and descriptive tests were applied for data analysis. Results: Approximately 40% of families had positive family history (high risk). From this group, 72% participated for follow-up. From the low-risk group, only 34% participated. Total cholesterol and LDL-C levels were significantly higher in high risk (HR) group. FBS was also significantly higher in fathers and children of the HR group (P<0.05). High TC, LDL-C and FBS levels were more prevalent among the HR families (P<0.05). No significant differences were observed in age, BMI, BP, TG and HDL-C between the 2 groups. Conclusion: Families with a history of cardiovascular disease participated in greater numbers in the screening process and the prevalence of risk factors in this group was significantly higher. The findings confirm the usability of family history in screening programs.