Iranian Journal of

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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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Background: Metformin is usually using for glycemic control in type 2 diabetes mellitus. The drug is the first line for obese patients without renal or liver failure. Different pharmaceutical types of Metformin are available. As a clinical trial, we compared effects of Aria Metformin (product of Aria pharmaceutical company, Iran) with Merck Metformin or Glucophage (product of Merck pharmaceutical company, France), in diabetic patients.
Methods: This double blind randomized clinical trial study performed with 60 non- pregnant diabetic patients, in order to comparison of therapeutic effects of combination therapy (Glibenclamide + Metformin "Aria or Merck") in a 12 weeks period. We evaluated FBS, BS 2hpp, HbA1c, lipid profile, liver function tests, weight, BMI and common or uncommon side effects.
Results: Not only each of two pharmaceutical types of Metformin had the same therapeutic effects for controlling of glycemia, lipid profile and weight, but also there were not difference between them in side effects. Distention was the most common side effects of two types products (33%). There is not significant difference between them in common side effects. 70% of patients were satisfied with each two kinds of Metformin.
Conclusion: It seems, in view of beneficial therapeutic effects of Aria Metformin, low rate of side effects, and finally low cost, Aria Metformin is a good choice.

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Background: Diabetic neuropathy is one of the most common complications of diabetes mellitus, which is associated with a decrease in the synthesis and transport of neurotrophins . The aim of present study was to investigate the effect of endurance training on gene expression of nerve growth factor (NGF) in the sensory spinal cord of rats with diabetic neuropathy. Methods: Twenty eight adult male Wistar rats in the body mass range of 326.3±8.4 gr, randomly assigned in to four groups: diabetic control, diabetic training, healthy control and healthy training. For inducing diabetic neuropathy, after twelve hours of food deprivation, intraperitoneal injection of STZ solution (45 mg/Kg) method was used. Two weeks after STZ injection, the endurance training protocol was performed for six weeks and Twenty four hours after the last training session, rats were sacrificed. Gene expression of NGF in rat spinal sensory segments were measured with Real time technique. In order to determine the significant differences between groups and Interaction independent variables two way anova and LSD post hoc test were used. Results: Endurance training, resulted in a significant increase in gene expression of NGF in the rats. Also, in compare with diabetic control, training led to significant decrease in blood glucose levels in diabetic training group. Conclusion: Increased physical activity and exercise can strongly affect pathological factors associated with diabetic neuropathy by increasing nerve growth factor. It is recommended that for prevention of neurological complications and treatment of diseases associated with diabets exercise training could be used as a non-pharmachological treatment.

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Background: Increased and decreased CDK5 gene expression regulation, as a protein kinase, is associated with launching death or survival pathways in the nervous system. According to the chronic effects of endurance training on growth Germination, Neuronal function and improvement of pathological conditions of neurodegenerative diseases, the aim of our study was to investigate the effect of 6 Weeks Endurance Training on Gene Expression of Cdk5 in spinal motor part of Male Wistar Rats with Diabetic Neuropathy. Methods: Twenty eight adult male Wistar rats ten year old in the weight range of 326.3±84gr, were randomly divided into four groups including healthy control (C), healthy training (HT), neuropathic control (N) and neuropathic training (NT). Diabetes was induced with one shut injection of STZ(45mg/Kg) and after confirmation of neuropathic condition with behavior tests, training groups performed 6 weeks endurance training(with moderate intensity and increasing) on the treadmill. CDK5 gene expression in Spinal motor segments forming the sciatic nerve was measured with Real time technique and calculated using the 2-ΔΔCT method. Results: After 6 weeks of endurance training, CDK5 gene expression in spinal motor part of (NT) group was significantly lower than the (NC) group, also, in comparison with neuropathy control, training led to significant decrease in blood glucose levels in neuropathic training group. Conclusion: According to the specific role of CDK5 in neuronal growth or death, our study showed the beneficial effects of Chronic endurance exercise on neural networks leading to reduced gene expression of CDK5 in a pathologic condition.

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Background: Glycogen synthase kinase 3 beta is a key regulator of many signaling pathways. It is reported that Inhibition of this kinase results neuronal survival. Accordingly in this study we investigated the effect of endurance training on the gene expression of GSK-3β in the sensory areas of the spinal cord of male Wistar rats with diabetic neuropathy.

Methods: we randomly assigned 16 male Wistar rats into four groups: healthy control, healthy trained, neuropathy control, neuropathy trained. Intraperitoneal injection of a STZ (streptozotocin) solution (45 mg/kg) was used to induce diabetes. At two weeks after STZ injections, the mechanical allodynia and thermal hyperalgesia tests demonstrated the presence of diabetic neuropathy. A moderate endurance training protocol was performed for a six- week period. At 24 hours after the final training session, the rats were sacrificed and the L4-L6 sensory neurons of the spinal cord tissue were removed. GSK-3β mRNA expression was performed using real time-PCR.

Results: Statistical analysis shows that neuropathy trained experiences a decrease in gene expression in comparison to neuropathy control (P=0.02). On the other there was significant difference between healthy control and neuropathy control (P=0.02). However, there was no significant difference between healthy control and neuropathy trained.

Conclusion: we claim that endurance training will effectively decrease the expression of GSK-3β in the sensory areas of spinal cord of male Wistar rats with diabetic neuropathy. Endurance training as a non- pharmacotherapy strategy can modulate and return GSK-3β to approximate normal levels.

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Background: Hemodialysis is the most common treatment in patients with end stage of renal disease (ESRD). Patients undergoing hemodialysis due to multiple drug treatments, special food programs and being able to cope with their illness need to self-care activities. Due to lack of information about the role of health literacy in effectiveness of self-care in these patients, this research aimed to determine the correlation between self-care and health literacy in patients undergoing hemodialysis in Valiasr Hospital of Arak in 2015.
Methods:  In this descriptive correlational study, 93 undergoing hemodialysis patients selected by objective sampling method. Data collecting instruments were "demographic questionnaire", "self-care questionnaire " and "Health Literacy for Iranian Adults questionnaire". The content and face validity of questionnaires was assessed. Reliability assessed through internal consistency (Cronbach's alpha) and Intra- Class Correlation Coefficient. Data were analyzed by SPSS, version 21, using, Kolmogorov–Smirnov test, Descriptive Statistics and Kolmogorov–Smirnov test. 
Results: The results showed that 79/6% of patients were male and 20/4% were female with an average age of 54/18 ± 13/9 year. The mean score of self-care and health literacy were 146/90± 45/46, 88/14± 36/42 and were at a moderate level. The lowest score of self-care and health education related to the field of fluid intake and decision-making and behavior. There was a significant positive correlation between self-care and health literacy (p<0/0001, r= 0/6).
Conclusion: The existence of a significant positive correlation between self-care and health literacy showed that the hospital managers and the nurses must pay more attention to what patients undergoing hemodialysis need. Considering the importance of health literacy in the care of patients undergoing hemodialysis, it seems necessary to nursing administrators and Politicians use educational programs tailored to the patient's health literacy level in order to promote their health and quality of life.
 

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Background: Diabetes causes nerve tissue damage and ultimately death of nerve cells, especially in important areas such as the hippocampus. It seems that exercise training and anti-inflammatory supplements can moderate this condition. Therefore, the aim of this study was to determine the effect of aerobic training exercise and L-carnitine consumption on the levels of hippocampus CNTF and CNTFR proteins in diabetic rat.
Methods: 45 Wistar rats between 250 to 300 gr were randomly divided into six groups, including healthy control groups, sham, diabetic control, diabetes + aerobic exercise, diabetes + L-carnitine supplementation and diabetes + aerobic exercise + L-carnitine supplementation. L-carnitine supplements were divided. Diabetic groups underwent subcutaneous injection of 55 mg / kg STZ. supplementary groups received 100 mg of L-carnitine per day orally. The aerobic exercise program was performed for 6 weeks and 5 days a week. The research variables were measured 24 hours after the last training session by the ELISA technics in the hippocampal tissue. The statistical method of one-way analysis of variance and Toki post –hoc test were used to analyze the data.
Results: The present study showed an significant increase in CNTF and CNTFR protein levels of hippocampal tissue after aerobic exercise and L-carnitine consumption (P = 0.001), which greater effect found in combination manner.
Conclusion: Due to the effect of aerobic exercise and L-carnitine supplementation alone and in interaction with each other on hippocampal tissue, the use of this method can be considered as maintaining neural tissue in diabetes.

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Background: Imbalanced production of adipokines as leptin and adiponectin in diabetic patients may lead to the development of metabolic complications. Therefore, the aim of this study was to determine the effects of 2-month of caffeine ingestion along with aerobic training on changes in serum leptin and adiponectin levels and leptin/adiponectin ratio (LAR) in type 2 diabetic men.
Methods: Thirty-two diabetic men participated in a quasi-experimental designs in the four groups for two-months period of a aerobic training (treadmill walking 3 times/week, 1.5 hour/session, 65-85% HRR) with and without caffeine ingestion (3 mg.kg^-1.day). Serum changes in leptin and adiponectin were measured during two phases (baseline and 24-hours after completing of the training program). Data were analyzed by one-way ANOVA and bonferroni's post-hoc test at level P≤0.05.
Results: Administration of two-months caffeine (CA) alone and combination with aerobic training (AT) were significantly could reduced and increased in leptin and adiponectin level, respectively (P=0.001). Thus, the combined group (AT+CA) effect were far more appropriate intervention in changing the studied indices (P=0.001). Also, the LAR method was notable reduced in all study groups, although these effects were more significantly in the combined group (AT+CA) (P=0.001).
Conclusion: It seems administration of caffeine supplementation and aerobic training for two-months have a positive effects on the improved relative of leptin and adiponectin levels as well as their ratio in diabetics, although the combination of these two variables has been shown to have far more dual effects.

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Background: Type 2 diabetes is a common chronic metabolic disease whose effective management requires attention to psychological and interpersonal factors. This study aimed to examine the relationship between the Perceived Spousal Sacrificial Behavior and self-efficacy with behavior management in patients with type2 diabetes.
Methods: This descriptive-correlational and cross-sectional study was conducted among married patients with type 2 diabetes who were referred to endocrinology and metabolism centers and primary health care units in Sari, Iran. Based on inclusion and exclusion criteria, 97 participants were selected using purposive sampling. The research instruments included the Perceived Spousal Sacrifice Scale (Harper & Figuerres, 2008), the Diabetes Self-Efficacy Scale (Fappa et al 2016), and the Behavioral Management Scale (Toobert et al., 2000). Data were analyzed using SPSS version 24 through descriptive statistics (mean, standard deviation) and inferential statistics (Pearson correlation coefficient and multiple regression analysis).
Results: Perception of the Perceived Spousal Sacrificial Behavior and self-efficacy showed a significant positive correlation with behavioral management among diabetic patients (p < 0.01). Together, these variables explained 30% of the variance in behavioral management, with Perceived Spousal Sacrificial Behavior making a greater contribution to prediction.
Conclusion: The findings highlight the significant role of Perceived Spousal Sacrificial Behavior and self-efficacy in improving behavioral management among patients with type 2 diabetes. Enhancing spousal support and strengthening patients’ self-efficacy through educational and psychological interventions may promote better self-care behaviors and disease control.