Iranian Journal of

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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 100-gram 3-hour glucose tolerance test (3hGTT100), 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 95mg/dl, and their postprandial blood glucose between 80 and 120mg/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.

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The incidence and prevalence of type2 diabetes mellitus is increasing worldwide. Many believe that type 2 diabetes mellitus is a disease that can be prevented by appropriate interventions in individuals at high risk for the disease. A number of studies have therefore looked at primary prevention during the past decade. Iran’s diabetic population of approximately 2 million people and the warning by the World Health Organisation that diabetes is on the rise in developing countries make the primary prevention of diabetes mellitus in Iran doubly important. Researchers have been increasingly focusing on identifying the risk factors for type 2 diabetes and, through these, appropriate strategies to prevent the rapidly growing incidence of this disease in the population at risk. Genetic predisposition (a positive family history), insulin resistance, obesity, impaired glucose tolerance, a history of gestational diabetes mellitus, physical inactivity and an unsuitable diet are among the most important recognised risk factors for type 2 diabetes other factors have also been found to contribute. Most of the available research has evaluated the effect of behavioural or lifestyle modification, in the form usually of dietary education and increased physical activity, in the primary prevention of type 2 diabetes. The second most common approach has been pharmacological manipulation. The information available indicates that type 2 diabetes will come to be considered as a preventable disease within the next decade. The weight of research behind this problem will undoubtedly discover even more effective methods of preventing type 2 diabetes in the near future than behavioural/lifestyle modification.

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There are more than 140 million people with diabetes in the world. Iran’s share is estimated at 1.5 million people. The increasing prevalence of diabetes and the longer life expectancy of diabetic patients mean that an increasing number of patients with diabetes are undergoing surgery, and not just for diabetes and its complications, such as end-stage renal disease, retinopathy, peripheral vascular disease, and diabetic foot ulcers. The metabolic stress caused by general anaesthesia and the operation itself makes blood glucose control even more difficult. Stricter pre- and intra-operative glycaemic control reduces the risk of sepsis, cardiovascular events, disability and death, accelerates wound healing and decreases hospital stay. Improved outcome requires pre-operative ascertainment of the type of diabetes, quality of metabolic control, and detection of complications, as well as optimal metabolic and haemodynamic management during the operation. Local anaesthesia is the preferred option in this group of patients because it least interferes with metabolic control. The diet recommended to achieve normoglycaemia will depend on the type of diabetes, pre-operative glycaemic control, and the extent of the planned procedure. In all type 1 diabetic patients and type 2 diabetic patients on insulin or oral hypoglycaemic agents who are to undergo surgery under general anaesthesia, the glucose-insulin-potassium (GIK) regimen is the one recommended by most authors to achieve tight intra-operative blood glucose control, conditional upon blood glucose measurements being available every one or, at most, two hours. Intra-operative blood glucose levels in the 120-180mg/dl ranges are considered satisfactory. Failing this, it is recommended that 50% of the daily NPH requirement be given subcutaneously on the morning of the operation, together with an intravenous glucose infusion intra-operatively. Type 2 diabetic patients with unsatisfactory metabolic control, time permitting, should be admitted several days before the operation and switched to and stabilised on insulin.

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In this article, we review animal models of types 1 and 2 diabetes mellitus. Models of type 1 diabetes are discussed in two parts, genetic and chemical. Models of type 2 diabetes are discussed in four parts – rat and mouse models, dietary induction, and selective breeding. Models are assessed regarding metabolic disturbances, the condition of the pancreas, long-term complications, and research benefits.

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Insulin resistant states are emerging rapidly and lots of efforts have gone into understanding their pathogenesis and major metabolic consequences. Hypertriglyceridemia, a major complication of this metabolic syndrome, seems to be caused by overproduction of lipoproteins (LPs) containing apo B that are rich in triglycerides. Some in vitro and in vivo models have been introduced so as to understand mechanisms governing lipid metabolism in insulin resistance states. Human and animal studies have suggested a key role for overproduction of VLDL in hypertriglyceridemia and dyslipidemic states. Recently, we have employed a diet-induced animal model of insulin resistance (hamster fed with fructose) in our laboratory in order to examine the relationship among development of insulin resistant state, impaired metabolism of LPs and overproduction of LPs containing apo B. These experiments have indicated that insulin resistant states occur along with overproduction of VLDL containing apoB105 from liver and enteral LPs rich in apo B 48. In insulin resistant states, decreased metabolic signaling to liver and intestine seems to play a critical role in overproduction of LPs. We have also been recognized a number of intracellular factors which may regulate VLDL production. This article reviews recent advances in the area the hypothesis indicating that a complex interaction exist between increased free fatty acids flow from peripheral tissues to the liver and intestine (caused by hyperinsulinemia) and prolonged lipogenesis has also been expounded.

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Increasing of the aging population in most of the developed countries should be more attention to the health issues of this aged group. In Iran, the ageing program has been launched and some institutes or organizations have been in charge of this program. The coordination of health policies and activities in elderly care programs and ageing networks could be helped to improve of elderly life span. This paper discusses the performance of different organizations and or other relevant entities regarding an ageing program in Iran and also comparing those activities to the other developed countries.

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Assessing of outcomes and risk factors in the form of qualitative variables is common in the most of medical studies and the research objectives are defined as the relationship between these variables. This paper introduces the concepts and basic and applied statistical tests to examine the relationship between these variables in these studies, including chi-square tests. Principles and method of calculating the statistics and hypothesis testing to assess the relationship between qualitative variables (or difference in proportions between groups), were presented taking into account relevant considerations. The method of reporting findings were introduced in the context of contingency tables, for all types of chi-square tests. To investigate the relationship between two binary or multi-category qualitative variables, Pearson chi-square test (in the case of establishing Cochran conditions), Yates continuity correction for small samples, in the case of not establishing Cochran conditions exact P-Value calculated on the basis of exact tests, trend chi-square test for ordinal qualitative variables and McNemar chi-square test for related samples should be used. In addition for tables larger than 2 × 2, when the overall relationship was significant, post hoc tests with appropriate correction is required. In each of these situations, examples based on research, calculations of tests were performed and their results were presented. To investigate the relationship between a set of risk factors and nominal or ordinal qualitative variables, the introduced analyses are recommended considering the situation and purpose of the proposed study.

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In medical studies, measures are required to reveal the effect of exposures and interventions and also the precision of measurements. This paper aimed to introduce the measures of effect and agreement and inferences about them in these studies. Principles and method of calculating measures of effect and agreement and inference about them were presented for all types of medical studies taking into account the relevant considerations. To assess the effect of risk factors on outcomes in case-control and cohort studies, and to determine the relevant effect, the attributable risk and fraction in the exposed group and population were used along with their confidence intervals. Also the relative risk reduction, absolute risk reduction and number needed to treat were applied as the measures of effect of intervention in the interventional studies especially in trails. The sensitivity, specificity and related measures along with their confidence intervals were computed for diagnostic accuracy and screening studies. In addition it is needed to evaluate the precision of measurements using standard error of measurements, ICC, Altman and Bland’s limits of agreement and Lin’s concordance correlation coefficient for quantitative variables and using kappa and weighted kappa for nominal and ordinal variables. In each of these situations the results of research based examples were presented along with the methods of their calculations.To assess the measures of effect and agreement, the mentioned analyses are recommended considering the situation and purpose of the study.

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There are situations in medical studies, wherein it is impossible to use the methods based on normal distribution (parametric methods). This paper objects to introduce common nonparametric methods and the inferences based on the methods in medical studies. Principles and method of calculations along with the software codes for common nonparametric methods and inference based on them were presented taking into account the considerations relevant to choose the nonparametric methods and their relative efficiency with examples in medical studies. In the situation where the assumptions are not satisfied, the nonparametric methods should be used without caution to lose the efficiency or even with higher efficiency of these methods. To compare a non-normal or ordinal variable between two groups Mann-Whitney test, to compare a non-normal or ordinal variable among more than two groups Kruskal-Wallis test, to compare a non-normal variable between two related situations or matched groups Wilcoxon test and to compare an ordinal variable between two related situations or matched groups Sign test should be used. In each of these tests the results of research based examples were presented along with the methods of their calculations. To assess the relation or difference in all types of medical studies, these tests are recommended considering the situation and purpose of study.

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Background: The prevalence of non-communicable disorders such as metabolic syndrome (MetS) is high in developing countries. Metabolic syndrome is a disorder of energy utilization and storage, diagnosed by a co-occurrence of three out of five of the following medical conditions: abdominal (central) obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and low high-density cholesterol (HDL) levels. The present review aims to discover the genetic variant reported in association with MetS. Methods: The database for genotypes and phenotypes (dbGaP) and the database for genetic associations and human genome (HuGE navigator) were utilized in order to search for genes and their corresponding polymorphisms related to MetS. Additionally, an electronic literature search for other Iranian studies and the genetic aspect of TLGS was completed using PubMed. Results: For phenotype selection in PheGenI, 30 traits were chosen and after the analysis, 21 of them were in common results with MetS. After finding the common variation between traits and MetS, omitting the repeated SNPs, 173 variations were remained. Finally, results distinguished six of the most important genetic regions found to have strong association with MetS. Conclusion: Identifying major genes that are responsible for the metabolic syndrome may improve the medical care for treating individuals with metabolic syndrome, and eventually may lead to personalized medicine in which treatment is tailored genetically to the patient’s needs. The present candidate regions is a respectable start to replicate genetic studies in large affected Iranian individual which we hope leads us to improve our medical care in this field.

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Background: Existing studies show that a poor diet has an effect on the progression of non-alcoholic fatty liver disease (NAFLD). The aim of the present study was to systematically summarize the results of studies on the relationship between dietary intakes and NAFLD. Methods: A review of Scopus, PubMed, Cochrane Library, Magiran, Medlib and SID databases and theses in the National Library of the Islamic Republic of Iran was conducted to identify epidemiological studies concerning NAFLD, food groups and dietary patterns. Cross-sectional, case-control and cohort studies with documented in English were selected for this systematic review. Duplication, topic, type of study, study population, variables examined and quality of data reporting of articles were evaluated. Results: Of 2128 articles found in the initial search, 33 were reviewed in full-text of these 6 articles were included in the systematic review. The literature review showed patients with NAFLD consumed more red meat, fats and sweets and less whole grains, fruits and vegetables. The Western dietary pattern was positively associated with the risk of NAFLD and adherence to the Mediterranean diet was negatively correlated to hepatic steatosis. Conclusion: The results of the systematic review indicate that different dietary intakes may be associated with development of NAFLD and its related factors. Due to limited research documented on this topic, further prospective studies are recommended.

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Background: In the last few years several polymorphisms variants with significant association to power and sprint performance of elite athletes have been verified. Meantime, the IL-6 gene was introduced as a proper candidate to imply a person alteration into an elite athlete. Therefore, the goal of the present study is to examine the association between IL6 gene polymorphism and power sport using meta-analysis to gather further evidence compared to individual reports.

Methods: Science direct, Google Scholar and Pub Med databases have been searched until March 2015. Articles were studied based on key word IL6 accompanied with polymorphism, mutation, variant and power sport were studied.  Statistical software STATA was used to analyze the data.

Results: Ten articles included into the final meta-analysis and Systematic review. The survey of the obtained data from the articles revealed that 292 persons were as an entire group of athletes and 559 people were as a control group. For the allele G vs. C 1.43odds ratio (95% confidence interval: 1.03 -1.99), for the allele GG vs. GC 1.74odds ratio (95% confidence interval: 1.28- 2.36), for the allele GG vs. GC + CC 1.71 odds ratio (95% confidence interval: 1.24 -2.36) and GG + GC vs. CC allele model 0.96 odds (95% confidence interval: 0.77-1.20) was revealed. The relationship between the polymorphism 1800795GG genotype and exercise can be statistically significant (P<0.05).

Conclusion: Generally, the result of the present study indicates that the IL6-174 G/C polymorphism is associated with better performance of elite athletes in power sports. The findings suggest that the genetic profiles might influence human physical performance. Therefore, it is recommended that researcher use IL6-174G/C polymorphism as one of the selected factor for Sports talent.

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Background: The clustering of cardiovascular risk factors , known as the metabolic syndrome , greatly increases the risk of developing diabetes and cardiovascular disease .individuals with the metabolic syndrome are also at increased risk for premature death from cardiovascular disease or all–cause mortality . Although is a particular importance, its epidemiology in Iran has not been studied systematically. Aim of this review of published data was to describe epidemiology of metabolic syndrome in Iran.

Methods: We searched MEDLINE, sid, magiran, iranmedex, and irandoc databases through 2014, and examined the reference lists of pertinent articles, limited to studies in humans.

Results: Total 45 studies were eligible (25 English and 20 Farsi). The findings show the high prevalence of metabolic syndrome in both sexes according to three criteria. The prevalence of metabolic syndrome was more in women than men. We found that differences in screening programs and diagnostic criteria or various ethnic groups make it difficult to compare frequencies of metabolic syndrome among various populations. Nevertheless, factors that increase risk of metabolic syndrome were age, sex, body mass index, low HDL and high triglyceride.

Conclusion: High prevalence of metabolic syndrome and relevant risk factors suggest the identification of the risk factors should be attempted to prevent syndrome acquisition.

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Background: Several studies have evaluated the effects of coenzyme Q10 on glycemic control, but there are large discrepancies between studies.

Objective: This meta-analysis of randomized controlled trials aimed to summarize the effect of Co-Q10 on diabetes’ biomarkers.

Methods: This systematic review and meta-analysis was conducted on studies published from 1998 until December 2015. We searched Pub med, EMBASE, Science direct, ISI web of science and Google Scholar to find relevant studies. Totally, our search resulted in 16 articles reporting the effects of Co-Q10 on fasting blood glucose, fasting insulin and HbA1c. Mean ± standard deviations (SD) were used for calculating mean differences. 95% confidence interval was considered between intervention and control treatments.

Results: The present meta-analysis revealed that Co-Q10 decreased fasting blood glucose (-0.20mg/dl, 95%: -0.38,-0.02). However, Co-Q10 supplementation could not effectively reduce HbA1c (0.05%; 95%: -0.22, 0.12) and fasting insulin (0.12pmol/l; 95%: -0.21, 0.44).

Conclusion: Co-Q10supplementation didn’t result in reduction in HbA1c and fasting insulin. However, it had a significant lowering effect on fasting blood glucose. It should be noted that significant changes in fasting blood glucose reported in this study was due to the extended sample size and this is not clinically significant in the present study.