Iranian Journal of Diabetes and Metabolism
Year:2006 | Volume:5 | Issue:4|Papers Count:15

Medicine and ethics have increasingly more links caused by considerable progresses in biotechnology in different fields of medical diagnosis, treatment and prevention. The issue of research ethics is one of the most important subjects which have been emphasized by international and regional organizations, policy-makers, medical and religious professions, scientists and researchers in different countries in recent decade. It is widely understood that research ethics committees typically play an important role in evaluating the ethical aspects of medical research. A ‘Research Ethics Committee’ (REC) is defined as a multidisciplinary, independent, body charged with reviewing research involving human participants to ensure that their dignity, rights and welfare are protected. Research ethics committees protect the welfare and rights of participants involved in research through reviewing research proposals, monitoring the conduct of research and dealing with complaints that arise from research.This manuscript will introduce you to the concepts underlying research ethics committees worldwide and in Iran. This paper will begin with a brief history of research ethics, continues with a concise overview of ethics committee situation and responsibilities, and ends with an outline of the national activities. We hope the manuscript could enhance awareness of biomedical researchers about status and duties of research ethics committees and consequently strengthen the RECs in our country.

Background: Insulin dependent diabetes is an autoimmune disease characterized as a T cell-mediated destruction of insulin-producing β cells. Dendritic cells (DCs) can either induce stimulating or regulatory functions of T cells depending on cytokines microenvironments. Methods: In this study DCs were generated from mouse bone marrow progenitors through culturing in the presence of granulocyte-macrophage colony stimulating factor (GM-CSF) and interleukin-4 (IL-4) for 7 days followed by two other day treatments with IL-10 or LPS. The DCs were then pulsed with insulin peptide B9-23 and their maturation markers and their ability to induce T cell responses and cytokine profiles were studied. Results: IL-10 treated DCs had an immature phenotype compared to LPS-treated DCs and expression of MHC-II in LPS-matured DCs was significantly higher than whom were treated with IL-10 (93% and 72% respectively, P<0.04). Although IL-10 like LPS-treated DCs were able to stimulate T cell proliferation, but the IFN-γ production was lower in IL-10 treated DCs (P<0.02).Conclusion: Using IL-10 treated DCs seems to be useful in prevention and treatment of autoimmune diabetes. However to clarify this hypothesis it needs to study these effects in animal models of insulin dependent diabetes.

Background: Regarding the adverse effect of stress on glycemic control in type 2 diabetic patients, the present study investigates the function of Glibenclamide on insulin release from β cells of rat pancreatic islets, subsequent to chronic psychological stress exposure. Methods: In this study 30 male Wistar rats were divided into equal groups of control and experiment (5 groups). Four different restraint stressors with random sequence were used 1h twice daily for 15 and 30 days. 24 hours after the last stress session, static insulin secretion from isolated pancreatic islets of each animal were evaluated in the presence of 5.6, 8.3 and 16.7 mM glucose. Also insulin release in response to 5.6 mM glucose in the presence of 10 μM Glibenclamide was evaluated.  Results: The insulin release from isolated islets of the stress experienced animals was significantly increased only on the 30th day as compared to the control animals. In the experiment group, insulin release from the islets in the presence of 5.6 mM glucose alone was significantly increased on the 15th and 30th days as compared to the first day. However, in the control group there was no significant increase in insulin release at the similar conditions. In contrast to the control group, insulin release in response to 5.6 mM glucose in the presence of 10 μM Glibenclamide revealed no significant difference in the experiment group on the 1st 15th and 30th days as compared to the insulin release in the presence of 5.6 mM glucose alone. Insulin release from the isolated islets exposed to 5.6 mM glucose in the presence of 10 μM Glibenclamide, on different experimental days was not significantly different between the control and experiment groups.Conclusion: According to the results of this study, it appears that chronic psychological stress decreases the responsiveness of pancreatic β cells to Glibenclamide, subsequently could prevent the augmentation of insulin release induced by the drug. This finding is worthy to consider in metabolic control of diabetic patients whom consume the agent.

Background: Experimental studies have shown that walnut (Juglans regia) intake decreases the risk of coronary heart disease (CHD). Walnut decreases the levels of atherogenic lipids such as TG, LDL-C and VLDL-C. Mainly the effect is induced via ω3- Poly Unsaturated Fatty Acids (ω3-PUFA). Walnuts are a rich source of these fatty acids, especially ω-Linolenic acid (C18:3; 9, 12, 15). Methods: We assigned 20 hypercholesterolemic male Rats (200-250 g) to four groups, and fed with four diet concentration of oil extract Persian walnuts(j. regia) (Lavasanate) (w/w) as complementary diet: control group (0% oil extract) and cases 5% (1g oil extract/1g weight/1 day) ,7.5% (1.5g oil extract/1g weight/1 day), 10% (1g oil extract/1g weight/1 day) for eight weeks.Results: Results revealed there is a positive effect on the decreasing of TG (14%),TC (7.8%), LDL-C (11%), VLDL-C (12%) serum concentrations, with increasing consumption of oil  extract Persian walnuts (5% ,7.5% and 10%).Conclusion: In view of the positive effect of oil extract Persian walnuts (J. regia) consumption on decrease serum concentration of TG, TC, LDL-C and VLDL-C known as atherogenic lipids and lipoproteins, it may be suggested as a CHD protective dietary supplement.

Background: Gestational diabetes mellitus is a common metabolic disorder in pregnancy. Low levels of sex hormone–binding globulin level (SHBG) are associated with increased insulin resistance and hyperinsulinemia. The aim of this study was comparison of SHBG levels between gestational diabetic pregnant women and normal ones. Methods: Serum SHBG concentration were measured in 38 women with gestational diabetes and in 143 women with normal pregnancy. The levels of Insulin, C-peptide and testosterone were measured and Insulin resistance was estimated via HOMA Index. Insulin sensitivity was estimated via QUIKE Index. Results: Serum SHBG concentrations was significantly lower in the diabetic group (P=0.015). In a logistic regression model after adjustment of age, body mass index (BMI) and number of gravid, lower than 25 percentile of SHBG was independently effective in prediction of gestational diabetes mellitus.Conclusion: SHBG concentrations are lower in gestational diabetic pregnant women and low levels account as a predictor of gestational diabetes mellitus.

Background: Microalbuminuria represents the earliest clinical of renal involvement and reflects the progression of diabetic nephropathy and increased risk of mortality in diabetic patients. The incidence of diabetic nephropathy in type 2 diabetes differs widely by race .The aim of this study was to determine the incidence of and risk factors for microalbuminuria in type 2 diabetic patients. Methods: As a cohort study 505 (22%male, mean age: 57.4±9.5 years and diabetes duration 10.2±4.7 years at initial registration) type 2 diabetic patients with initial normoalbuminuria were followed prospectively for 5 years in isfahan endocrine and metabolism research center. Patients were evaluated for BMI, HbA1c, blood pressure, lipid profile, serum creatinine and 24 hours urine albumin. Normoalbuminuria were defined as urine albumin excretion less than or equal to 30 mg/24 h and microalbuminuria as 31-299 mg/24 h. Logistic regression model were used to assess the associations.  Results: 176 revealed persistently elevated UAE during follow-up, giving an incidence of 82.3/1000 person-years (95%CI: 78/3-86/2). Incidence of microalbuminuria were significantly higher in men than women (104.4 and 66.2/1000 person-year, P<0.001).The mean values of HbA1c, duration of diabetes, systolic hypertension and serum creatinin during the follow-up period were significantly higher in the microalbuminuric than in the normoalbuminuric patients. Age, BMI, cholesterol and triglyceride were not significantly different in two groups. Logistic regression analysis revealed that duration of diabetes, HbA1c, high blood pressure and retinopathy during follow-up are independent variables that have a statistically significant influence on the development of microalbuminuria. Conclusion: These results revealed that microalbuminura in this population of type 2 diabetic patients were common and higher than of other studies. These findings suggest that urine excretion of albumin should be monitored routinely in these patients for detection early stages of nephropathy and effective treatment of microalbuminura and associated risk factors are very important.

Background: Atherosclerosis manifests earlier and more extensive in severity among diabetic patients. It seems Homocystein is one of the accelerating factors in development of atherosclerosis and serum levels Homocystein increase in patients with coronary artery involvement. The aim of this investigation was to compare Homocystein levels between diabetic and non-diabetic patients with coronary artery disease (CAD). Methods: As a case-control study via non-randomized sampling method we collected 33 diabetic CAD patient and 34 CAD patient with normal GTT test. All participants were matched in age, sex, family history of atherosclerosis, blood pressure, smoking, the level of triglyceride, total cholesterol, LDL-C and Body Mass Index (BMI). Fasting serum Homocystein was measured via ELISA technique and other selected variables also were assessed via conventional laboratory methods. The quantitative variables between two groups analyzed by student t-test, while the qualitative variables examined by X2. We used Pearson–spearman test for correlation analysis between two groups. Results: 33 diabetic and non-diabetic CAD/MI cases were participated. Among diabetic and non-diabetic subjects, mean age were 59.5±10.5 and 62.5±9.5 respectively. The mean duration of diabetes was 5.4±4.1 years. Comparison of the mean Homocystein levels between two groups revealed a significant differences, 16.2±4.8 mmol/L in diabetics vs. 10.6±4.8 mmol/L in non-diabetics (P<0.5). Correlation between Homocystein levels and blood glucose, uric acid, triglyceride were r≤0.69, r=0.46 and r=0.51, respectively.Conclusion: Fasting serum Homocystein in diabetic CAD subjects was higher than non-diabetic CAD cases. Our findings may suggest that the increased level of Homocystein is correlated to high prevalence and severity of atherosclerosis among diabetic individuals.

Background: Diabetes mellitus is an insidious disease which can affect different organs. One of the problems is resistant vaginitis, which is related to factors such as high blood glucose levels, allergy and atopia. One of the most common pathogens associated with this condition is Candida Albicans. Thus; most physicians begin anti-fungal therapy in first visit even without documented evidence of fungal origin. Methods: This descriptive analytical cross-sectional study was performed on 160 non-pregnant diabetic women in diabetes clinic of Shariati Hospital during a period of three years (2002-2005). Fasting and 2 hours postprandial blood glucose levels and HbA1C were measured and culture of vaginal discharge was performed. Fisher's exact test was used for statistical analysis. Results: 71% of women had clinical vaginitis (fungal or bacterial) and 12.5% were diagnosed with Candida vaginitis. Microscopic findings were positive in 1.3 % of patients who had Candida vaginitis (16.7% of all patients). Culture of vaginal discharge revealed that the Candida was responsible of 4.4% of Candida vaginitis. Overlay, the prevalence of Candida vaginitis based on positive culture was 8.8 % in this study. There was significant statistical relationship between mean FBS and infectious vaginal culture. However, the difference was not significant between positive culture of Candida and age, controlled blood glucose, history of allergy, genital hygiene, occupation, level of education, kind of treatment , and type or duration of diabetes.Conclusion: We suggest in the patients with positive signs of vaginitis, especially Candida vaginitis (even with positive smear); culture of vaginal discharge be carried out.

presence of three or more of the metabolic factors. Means and proportions, and multivariate odds ratios that quantify the association between metabolic syndrome and normal BMI quartiles, controlling for age, physical activity, smoking and education were presented. Results: The overall prevalence of the metabolic syndrome in normal weight men and women were 9.9% (CI 95%: 8.49-11.30) and 11.0% (CI 95%: 9.5-12.4, P=0.2), respectively. Men had slightly lower BMI than women (22.4±1.8 vs. 22.5±1.7 kg/m2, P<0.001), while their WC was higher (79.8±6.6 vs.79.3±7.7 cm, P<0.001). The prevalence of high WC and low HDL was higher in women, while high blood pressure, high triglyceride levels and having at least two metabolic risk factors were more prevalent in men. Individuals at the highest category of normal BMI had significantly higher odds for being at risk for metabolic syndrome compared to those at first category (OR; 5.21 for men and 2.15 for women). There was a significant increasing trend in odds for having all the metabolic syndrome components except for high FBS and high WC in men. Women revealed a similar increasing trend except for high FBS across normal BMI quartiles.Conclusion: Normal weights Iranians have excess cardiovascular risk. Therefore interventions for prevention of diabetes and cardiovascular disease could be considered in normal weight population. On the other hand, the cut-points of BMI, suggested by WHO, may be inappropriate for the Iranian adult population.

Background: The risk of cardiovascular diseases increase in diabetic patients. So, it is important for patients to achieve the optimal lipid levels. Nutrition including consumption of anthocyanins plays a primary role in reducing the risk of heart disease and hypertension. In this study, we assessed the effect of concentrated sour cherry juice (SCJ) consumption as a rich source of anthocyanins on lipid profile and blood pressure of type II diabetic patients. Methods: In this quasi-experimental study 16 type II diabetic women with fasting blood sugar ≥110 mg/dl and LDL-C ≥100 mg/dl were recruited and consumed 40 g/day of SCJ for 6 weeks. Measurements of weight, lipid profile and blood pressure were done in baseline and after completion of the study. A 2-day food records was completed by patients so. The Wilcoxon test was used for statistical analysis. Results: Mean (± SD) age, weight, total cholesterol, LDL-C, systolic and diastolic blood pressure were 53.6±8.8 years, 72.8±14.9 kg, 213.9±27/0 mg/dl, 118.4±14.7 mg/dl, 129.1±15.7 mmHg and 81.7±8.1 mmHg respectively in the beginning of the study. After consumption of SCJ, a significant decrease (P<0.05) in weight, total cholesterol, LDL-C, systolic and diastolic blood pressure was seen. Changes in serum triglyceride and HDL-C concentrations were not significant statistically.Conclusion: It is concluded that SCJ consumption may modify cardiovascular disease risk factors in diabetic type 2 patients.

Background: Diabetes is one of the chronic diseases need continual medical care and self care education, and nutritional therapy account as an integral part of dietary management. This study carried out to investigate the effect of diabetes dietary counseling on quality of life in type II diabetic patients. Methods: As a Randomized Clinical Trial, 144 patients with type II diabetes aged 35-65 years were recruited from patients referred to Imam Hossein Hospital dietary clinic and randomly assigned in case and control groups. A dietary schedule consisting 50-60% carbohydrate, 10-20% protein and less than 30% fat was prescribed at the first orally in a 30-minute counseling session then in written form for case group, while the control group was left without any intervention. The quality of life score was estimated in both groups via using the Short-form 36-Item (SF-36), before dietary counseling and one mouth after the dietary counseling, and the quality of life score between both groups were compared. The data were analyzed using SPSS software. Results: Average age was 52.1±10 years. Before dietary counseling, the quality of life among 46% of subjects was assessed to be poor and 52% claimed their health status poorer than the last year. Independent-Samples T-Test with P<0.05 revealed significant difference in weight, systolic blood pressure, diastolic blood pressure, blood sugar before and after breakfast, blood cholesterol and triglyceride, after dietary counseling in both groups. Also, this test with P<0.05 revealed significant difference in the quality of life score in general and in each dimensions, after dietary counseling in both groups. Paired-Samples T-Test revealed significant increase in the quality of life score in general and in each dimensions on pre and post dietary counseling in case group, but didn't observe in control group.Conclusion: According to the results, it was revealed that dietary counseling can promote the quality of life in patients with type II diabetes in all dimensions. So, it seems dietary counseling program is essential in prevention and decrease of type II diabetes complications.

Background: Assessing the trend of ischemic heart diseases and the process of acute coronary care is one of the most important tools in monitoring the programs dedicated to control of ischemic diseases. The current project was developed to assess the feasibility of using routine data registered in clinical records for coronary event registration according to the standards of WHO/MONICA project. Methods: Hospital records of 320 cases with primary diagnosis of acute coronary syndrome (80 cases from each quarter, July 2003-4) were evaluated according to sufficiency of data. Data were evaluated according to "internal consistency", "change in the proportion of missing data in the time periods" and "the proportion of insufficient data". Results: Available data of hospital records were not sufficient to determine the diagnosis in 0.7% of cases; In addition, they were resulted in a probable diagnosis in 11.2% of coronary events. Median percents of missing data regarding the prescribed drugs before event was more than 10% in both fatal and non-fatal coronary events (score 1 of 4). Median percents of missing data regarding the ECGs, cardiac enzymes and cardiac resuscitation was lower than 5% in non-fatal coronary events and lower than 2% in fatal cases (scores 2 and 3 of 4 relatively).Conclusion: The quality of available registered data in the evaluated clinical records was comparable with many reporting units of MONICA project. Using the available clinical records seems to be effective and feasible for systematic registration of cardiac events.

Background: Neuropathy is one of the most common and dangerous complications of diabetes. Diabetic neuropathy account as the most common cause of mortality among patients. Many studies suggest that neuropathy have a negative effect on quality of life. Although there are limited evidences about relationship between diabetic neuropathy and quality of life in Iran, so this study was conducted to investigate this interaction among a group of patients. Methods: As a descriptive-analytical study, 304 diabetic patients with neuropathy was selected via convenience sampling method. The data were collected through interview and physical examination. The tool of data collection was the information sheet of medical records and questionnaire that consisted of three parts, demographic and disease characteristics, list of neuropathic complications of diabetes and questions about dimensions of quality of life. The reliability evaluated via test-retest method and validity assessed via content validity method. Results: the results revealed that tingling (96.1%) and pain (92.1%) in the case of sensory neuropathy were the most common complains. Sexual dysfunction (72.4%) and gastrointestinal problems (70.4%) account the most common symptoms in view of autonomic neuropathy. The results revealed that quality of life among all patients was fairly desirable and there was a significant relationship between neuropathy and quality of life (P<0.001).Conclusion: According to the findings of this study, there is a significant relation between neuropathy and quality of life in diabetic patients. Our results suggest that nurses and educational supervisors should pay attention to promote different dimensions of quality of Life in diabetic patients with neuropathy.

Suppurative hidradenitis is a recurrent disease involving apocrine gland of skin with a predilection for intertriginous areas, including genital skin. It has a highly variable clinical course. Mild cases may present as recurrent isolated nodules, while severe instances of the disease with chronic inflammation may lead to abscesses, scarring, and rarely, squamous cell carcinoma. While genetic factors, hormones and infection play a role in disease expression, a comprehensive understanding of the pathogenesis remains to be elicited. Additionally, effective treatment is largely unknown. The mainstay of therapy had been surgery, and topical or systemic antimicrobial agents.We report a 65 years old diabetic man who had a long history of untreated suppurative hidradenitis with extensive gluteal area involvement. We search in pubmed and find 7 cases of suppurative hidradenitis with diabetes.