Iranian Journal of Diabetes and Metabolism
Year:2002 | Volume:1 | Issue:1|Papers Count:15

Diabetes mellitus is a common disease and its incidence and prevalence are increasing in most populations. The trend is particularly worrying in developing countries. The number of diabetic patients in Iran is estimated at 1.5 million. The distribution of diabetes in Iran has been the subject of several surveys. Disease prevalence rates, for all forms of diabetes, of 7-17% have been variously reported in several adult urban populations. Geographical prevalence is not uniform, however, and the prevalence of type 2 diabetes mellitus has been reported at 3-5% in rural communities. A screening program conducted at different locations of Iran revealed that nearly 50% of people with type 2 diabetes were unaware of their condition. Not surprisingly, therefore, that the incidence of complications for diabetes is high in Iran. A battle is being waged on all fronts at present to control the socio-economic scourge that is diabetes mellitus. A national program has been designed for the primary, secondary, and tertiary prevention of diabetes. The major strategies that it puts forwards are screening, the identification of high-risk groups, public education, and the training of specialist care providers. This article reviews the epidemiological features of diabetes in Iran.

Diabetes during pregnancy is either concurrent diabetes, diagnosed before pregnancy, or gestational diabetes mellitus' (GDM), first diagnosed in pregnancy. GDM is the commonest metabolic disorder of pregnancy, with a prevalence of one to 14 percent, depending on the reporting team. The prevalence of GDM in Tehran is 4.7%. Diabetes concurrent with pregnancy is diagnosed according to the recently revised criteria of the National Diabetes Data Group (NDDG). GDM is diagnosed with a 100gram 3-hour glucose tolerance test (3hGTT 100), with at least two abnormally high readings being required for a definite diagnosis. Screening for GDM is still a matter of dispute. Universal or selective screening? Each has its supporters. The American Diabetes Association (ADA) recommended universal screening until 1997, and this is still recommended for areas with a high prevalence of GDM. Diabetes during pregnancy has multiple potential consequences for mother and fetus; fetal macrosomia being the commonest. The children of diabetic mothers are also more likely to become overweight and develop impaired glucose tolerance. ADA recommendations for glycemic control in diabetic mothers-to-be include maintaining their fasting blood glucose between 60 and 95 mg/dl, and their postprandial blood glucose between 80 and 120 mg/dl. Measurement of urinary ketones is recommended when the patient is on a calorie-restricted diet. Lifestyle changes are an integral part of management. Insulin requirements and calorie intake must be adjusted in line with weight gain as pregnancy progresses.

Background: Urtica dioica, or the stinging nettle, is recommended by ancient medical texts for the treatment of high blood sugar. Methods: We set up a perifusion system, in which an exact number of islets of Langerhans were exposed to an active component of the leaf extract of Urtica dioica, obtained by TLC. The active component was then injected into the peritoneum of both normal and diabetic rats to evaluate response in vivo. Results: There was a marked increase in insulin secretion in vitro, as determined by ELISA. In vivo, there was an increase in blood insulin content following intraperitoneal injection. The increase in serum insulin observed at 60 minutes was associated with a decrease in blood glucose, checked several times during the observation period. Maximum insulin release over 120 minutes was equal to five times the baseline value. The decrease in blood sugar correlated with both the timing and magnitude of insulin release. Conclusion: Notwithstanding the magnitude of the changes observed, the results obtained in normal and diabetic rats were similar.

Background: Estimation of cost effectiveness and cost benefit are intrinsic to the design and evaluation of healthcare systems. The aim of most studies of gestational diabetes screening has been to modulate screening parameters to reduce the eligible population and therefore costs. We analysed the findings of a cross-sectional study of gestational diabetes mellitus carried out in Tehran to determine the screening method best suited to the socio-economic profile of our population. Methods: 2416 pregnant women were universally screened in Tehran teaching hospitals. Each patient's risk factors and laboratory results were recorded. The 50gGCT was used to screen and the 100g0GTT to confirm a diagnosis of GDM. Results: Switching from the 130mg/dl to the l40mg/dl threshold, case-detection sensitivity declined by 12% (to 88%), with the per-pregnancy cost dropping from 30,410 to 25,641 Rials (from US$3.80 to 3.20) [-15.6%], and the cost per detected case from 644,488 to 619,500 Rials (from US$80.56 to 77.43) [-3.87%]. Conclusion: We recommend adoption of the universal screening approach in Iran for 4 reasons: (1) The high prevalence of gestational diabetes in the low-risk group; (2) The poor level of healthcare provided in Iran compared with societies that have opted for the selective approach; (3) The lower cost of screening and diagnostic tests in Iran compared with the aforementioned; and (4) The high cost of treating the complications of diabetes.

Background: Numerous studies have confirmed the association between type 1 diabetes mellitus (DMl) and polymorphisms of HLA genes on chromosome 6p21. Controlled DNA studies in Belgium recently have found a statistically significant association between DMl and certain HLA class II genes, especially DRB1Lys71+. Methods: 81 Danish families (each with at least 2 members with DMl) and 82 healthy controls were assessed for HLA polymorphisms. 54 of the 81 diabetic families were also assessed for polymorphisms at the HLA-B-DQBl, HLA-B-DQAl, and TNF-A and TNF-B loci. Affected sib-pair analysis was used to study correlation between DMl and DRBl alleles encoding Lys71+. Results: Homozygous expression of DRB1Lys71+ carried a relative risk (RR) of 103.5 for DMl. There was a very strong correlation (p<1×10-6) between DMl and DRBl alleles encoding Lys71+. Family-based association studies showed that DRB1Lys71+ was the most important determinant of DMl in carriers (haplotype relative risk=8.38). Haplotype analysis confirmed this. Conclusion: The DRB1Lys71+ allele confers genetic predisposition to DMl most strongly of all.

Objective: To evaluate the effect of hyperglycemia on the antinociceptive activity of baclofen, a GABAB agonist, in mice. Methods: We examined the antinociceptive effect of baclofen (2.5-7.5mg/kg injected intraperitoneally) in alloxan-induced mice using the hot-plate and tail-flick tests, both thermal tests. Results: Baclofen proquced a dose-dependent inhibition of hot-plate response in both normoglycemic and diabetic mice. The antinociceptive activity of baclofen was slightly reduced in diabetic mice. In comparison, the antinociceptive activity of morphine (10mg/kg), used as control, was significantly reduced in diabetic mice. Conclusion: Our results show that hyperglycemia reduces the antinociceptive action of baclofen less than it does that of morphine.

Background: Studies of the metabolic effects of Ram ad an fasting on patients with type 2 diabetes mellitus are inconclusive. Methods: Fifty-seven volunteers with type 2 diabetes underwent anthropometric and biochemical evaluation before and on the 14th and 28th days of Ramadan. Biochemical markers were measured by standard laboratory methods. Anthropometric measurements followed WHO criteria. Statistical analysis was by ANOVA for repeated measurements and Friedman's two-way ANOVA, using SPSSv6 software. Results: Daily cholesterol intake increased in all subjects (p<0.03). Body mass index increased (p<0.03) in women, but body mass index (BMI) and waist-to-hip ratio both decreased (p<0.01) in men. Blood pressure, fasting blood glucose and serum fructosamine did not change during the study. Plasma insulin (p<0.05), C-peptide (p<0.01) and insulin resistance (p<0.0l) decreased only in men. Total and LDL cholesterol increased significantly in all subjects during the study. Conclusion: Ramadan fasting does not alter carbohydrate metabolism or tissue insulin sensitivity in type 2 diabetes patients, given appropriate dietary education and rescheduling of oral hypoglycaemic medication. Lipid profile is unfavourably altered due to changes in both diet and biochemical response to starvation, Anthropometric indices improves in men but not women, possibly because of reduced physical activity in the latter.

Background: Oral glucose tolerance testing (OGTT) is the gold standard for the diagnosis of diabetes mellitus and impaired glucose tolerance (IGT), but is time consuming and difficult to perform. We investigated the value of glycosylated hemoglobin (HbAlc) in screening for diabetes mellitus and IGT. Methods: In a cross-sectional study, we measured the HBAlc levels of 497 people referred for OGTT. We calculated the sensitivity and specificity of HbAlc at 1, 2, 3 and 4 SD above the normal mean. We plotted receiver operating characteristic (ROC) curves after assigning our subjects to the diabetic, IGT, "diabetic+IGT", or normal group, based on WHO criteria for OGTT. Results: HbAlc levels (mean±SD) in the four groups were 9.2±l.5, 8.4±1.3, and 7.9±0.8 and 6.8±0.7 percent in the diabetic, diabetic+ IGT, IGT and normal groups, respectively. All differences were statistically significant (p<0.000l). ROC curve analysis showed that HbA1C levels above 7.5% (mean+1 SD) gave the best combination of sensitivity and specificity for the detection of diabetes (97.53% and 73.8%), IGT (66.37 and 69.44%), and diabetes+IGT (80.22% and 86.66%). Conclusions: An HbAlc level of >7.5% is an optimal cutoff point for diabetes screening programs.

Background: The American Heart Association used the findings of the Framingham Heart Study to design an equation that quantifies the risk of coronary heart disease (CHD). Methods: The variables in this equation are age, total cholesterol, HDL-cholesterol, systolic blood pressure, cigarette smoking, diabetes mellitus and evidence of left ventricular hypertrophy on electrocardiography. We calculated the CHD risk of 139 patients, with type 2 diabetes mellitus, who attended our diabetes clinic. We also assessed risk factors not taken into account by the Framingham equation, such as obesity (body mass index (BMI) or waist-hip ratio (WHR)), plasma triglyceride, LDL cholesterol (LDL-C), and diastolic blood pressure (DBP). We used the linear regression and one-way ANOVA functions on the SPSS.v6 software to analyze our data. Results: Ninety-one women and 48 men enrolled in the study. Men had a higher five and ten-year CHD risk than women. 36.4% of our subjects had plasma HDL-C<35mg/dl. The TC: HDL-C ratio was 6.18±1.76 in men and 5.97±2.21 in women. We found no significant correlation between two- and five-year CHD risk and WHR, BMI or triglyceride levels. There was a significant correlation between two- and five-year CHD risk and DBP (p=0.0006 and p=0.0001) and LDL-C (p=0.005 and p=0.001). Conclusion: Patients with diabetes mellitus have a higher, but smaller than expected, risk of CHD. The value of the Framingham equation in diabetic patients is equivocal, given the absence of correlation between obesity markers and CHD risk. Larger, prospective, studies are needed to clarify the matter.

Background: Diabetes mellitus is a common chronic disorder with multiple disabling long- and shorter-term complications, the majority of which can be controlled if not prevented. The management of diabetic patients is a major drain on both health budgets and time. Methods: We reviewed the records of 101 patients with diabetic foot ulcer, who had received treatment at either Doctor Shariati or Imam Khomeini hospital. Results: Out of 101 patients (56.4% male and 43.6% female) with diabetic foot ulcer, 34.7% had eventually undergone amputation. Conclusion: Our findings highlight the need for control and prevention programs aimed at reducing the risk factors for and complications of diabetic foot ulcer.