Iranian Journal of

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Introduction: Urbanization, establishment of sedentary life style and unhealthy diet in association with environmental stress has led the cardiovascular risk factors to prevail in the metropolitan city of Tehran. Survey of lifestyle related cardiovascular risk factors is one of the priorities of Tehran university population laboratory in the 17th zone of Tehran.
Methods:1573 inhabitants of 17th zone of Tehran were recruited by one stage cluster random sampling according to the model of WHO MONICA project.
Results: 58.6% of men and 64% of women had BMI ≥ 25 kg/m2. 41.7% of men and 37.6% of women had hypertension. 8.9% of men and 12.2% of women had diabetes. 34.4% of men and 44.6% of women had total cholesterol ≥ 200 mg/dl. 34.1% of men and 32.6% of women had triglyceride ≥ 200 mg/dl. 34.7% of men and 4.2% of women were regular smokers. 21% of participants had positive family history of cardiovascular disorders.
Conclusion: The prevalence of hypertension in this region is high, that of dyslipidemia relatively lower than the other studies performed in Iran. The prevalence of Diabetes and overweight /obesity is high and comparable to other Iranian studies. It seems that the population of this zone is at high risk for stroke and then coronary heart disease. This fact must be considered in the future interventional programs to control cardiovascular risk factors in the region.

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Background: Myocardial infarction is the most important cause of mortality all over the world. Complications may increase with some risk factors including stress hyperglycemia. The aim of this study was to evaluate the correlation and importance of hyperglycemia in acute intrahospital complications after AMI.
Methods: Prevalence of stress hyperglycemia among 160 patients with acute myocardial infarction (Q wave MI) was determined. These patients were divided into normoglycemic and stress hyperglycemic groups. These were compared according to complications such as heart failure, cardiogenic shock and mortality.
Results: 61% were normoglycemic and 7.5% had stress hyperglycemia. 25% had history of diabetes and 4.4% were not aware of diabetes. Among 18 patients with stress hyperglycemia, 6 patient (50%) and among 101 normoglycemic patients 18 (17.8%) were affiliated with cardiac failure that the difference were significant (P=0.02 and χ 2= 6.25). There were no cases of cardiogenic shock in both groups. Three patients died during first hours of admission (2.97%). They hadn't have history of diabetes. We could not assign them to normoglycemic or stress hyperglycemic groups since blood sampling had not been done yet.
Conclusion: Stress hyperglycemia can increase complications of AMI, significantly stress hyperglycemia caused increased incidence of heart failure in this study.

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Background: The aim of this study was to determine the best Anthropometric indices for prediction of the risk of type 2 Diabetes in lower and higher 60 years old population in Tehran.
Methods: As a prospective study among 4479 non-diabetic men and women over 20 years from the participants of Tehran Lipid and Glucose Study (TLGS) who had complete data of blood pressure, plasma glucose in the fasting state and 2 hours after ingestion of 75 g glucose (2-hPG) as well as fasting serum lipids, anthropometric measurement including body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR) and demographic data at baseline and were followed for a mean duration of 3.6 years. Subjects reevaluated for measurement of fasting Glucose and 2-hPG at follow-up. Diabetes and its associated risk factors were defined according to the ADA criteria. Different measurements of general and central obesity were defined based on the WHO criteria. Logistic regression analysis with stepwise conditional method was used to estimate the Odds Ratio (OR) with 95% CI. Results: A total of 166 new cases of type 2 diabetes (3.7%) were diagnosed during 3.6 years of follow-up, with an approximately one percent per year incidence rate (men=3.7% and women =3.7%, P= 0.95). Diabetic subjects of follow-up were significantly more obese than nondiabetics considering their BMI, WC and WHR. In subjects aged< 60 years high WC was a predictor of diabetes only in model 1 and 2, while general obesity and high WHR predicted diabetes risk in all the 3 models. In these 3 models the OR of general obesity were 5.3(2.9-9.5), 3.4(1.8-6.3), 2.4(1.1-5.1) and the OR of high WHR were 3.5(2.1-5.8), 3.4(1.4-5.8) and 2.6(1.3-4.9), respectively. In subjects aged≥ 60 years general obesity predicted diabetes only in models 1 and 2, while high WHR was a predictor of diabetes risk only in model 1. In this age group, high WC predicted diabetes in all models 1, 2, 3 with the OR of 4.6 (2.3-4.1), 4.5 (2.3-8.9) and 3.8 (1.8-7.7), respectively.
Conclusion: General obesity and high WHR in young Iranian subjects (< 60years) and high WC in older ones (≥ 60 years) are the important anthropometric indices for prediction of type 2 diabetes. Age should be considered when using different anthropometric indices for predicting the risk of type 2 diabetes.

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Background: The risk of metabolic risk factors increases in Middle-Eastern adults within the normal limits of BMI. There is a report that 30.1% of the Iranian population had metabolic syndrome but no reports on the prevalence of this syndrome among individuals within the various BMI categories are available. The present study estimates the prevalence of metabolic syndrome in adult population with normal levels of BMI (18.5-24.9 kg/m2). Methods: In this population-based cross-sectional study, a representative sample of 3444 subjects (1737 males and 1707 females) aged≥20 years with normal body mass index (BMI= 18.5-24.9 kg/m2 for both genders) were included. Demographic data were collected anthropometric indices and blood pressure were measured according to standard protocol. Biochemical analysis was conducted on fasting blood samples. The metabolic syndrome was defined according to the ATP Ш guidelines as the 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.

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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.

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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.

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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.

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In April 2005, the International Diabetes Federation (IDF) has formulated a new worldwide definition of the metabolic syndrome in a global consensus statement built on earlier WHO, the ATPIII definitions. The aim of this study was to estimate the prevalence of this syndrome using the IDF definition among Iranian adults and to compare it with the prevalence estimated using the two other definitions. 

Methods: The prevalence of the MES was determined according to the three different definitions in 10368 men and women aged≥20 years participated in the cross-sectional phase of the Tehran Lipid and Glucose Study (TLGS). To assess the degree of agreement between different MES definitions, the k test was used. 

Results: The prevalence of MES (95% confidence interval) was 32.1% (31.2-33.0) by the IDF definition, 33.2% (32.3-34.1) by the ATPIII and 18.4% (17.6-19.2) according to the WHO definition. The sensitivity, specificity and concordance of the IDF definition for detecting MES were 91%, 89% for the ATPIII definitions and 73%, 77% for the WHO definition, respectively. The k statistics for the agreement of the IDF definition was 66.3±0.01 with the ATPIII and 39.5±0 with the WHO definition.

Conclusion: In the Iranian population, the IDF definition for MES has a good concordance with the ATP III definition and a low concordance with the WHO definition.

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Background: The aim of this study was to examine the prevalence of the metabolic syndrome (MetS) and its association with coronary heart disease (CHD) in Iranian older individuals.

Methods: In this cross-sectional study, the prevalence of the MetS was determined according to the Third Adult Treatment Panel (ATPIII), the World Health Organization (WHO) and the International Diabetes Federation (IDF) definitions in 720 men and women aged≥65 years. Logistic regression analysis was used to estimate the Odds Ratio (OR) of developing CHD in model 1 an age adjusted model, in model 2 adjusted for age, smoking status, premature history of CHD and LDL cholesterol and in model 3 adjusted for mentioned variables in model 2 plus the components of the MetS according to each definition.

Results: The prevalence of MetS was 50.8%, 41.9% and 41.8% by ATPIII, IDF and the WHO definitions, respectively. IDF had high agreement with the ATPIII definition. In model 2, the ATPIII and the WHO definitions of MetS were associated with CHD by the odds ratio of 1.6 (1.1-2.2) and 1.7 (1.9-2.4), respectively. In model 3, obesity (WHO definition) and high blood pressure (ATPIII and WHO definitions) were associated with CHD.

Conclusion: As defined by the ATPIII and WHO definitions, the MetS was associated with CHD even after adjustment for the conventional CHD risks, but after further adjustment for their components none of these definitions showed association with CHD.

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Background: Fortification of corn with folic acid has beneficial effects on hyperhomocysteinemia and heart disease. Folate fortification was contributed to an increase in average folate status and a reduction in serum homocysteine concentration.

Methods: In this randomized clinical trial 17 men and women aged 61±5 years old with hyperhomocysteinemia with mean homocysteine concentration of 15/32±6/13 µmol/L were recruited. Subjects received fortified bread which contained 100µg folic acid daily for 8 weeks. Three-day food record, food frequency questionnaire and BMI (Body Mass Index) data at baseline and week 8 were completed. Plasma homocysteine and serum folate at baseline and week 8 were measured. All dietary and statistical analyses were undertaken using Nutritionist III and SPSS release 15.0 software with paired t-test.

Results: Mean plasma homocysteine concentration decreased significantly in hyperhomocysteinemic subjects after daily consumption of folate fortified bread for 8 weeks (P<0.001).After 8 weeks serum folate concentration increased %26 (P=0.06). Mean BMI, energy and other components of dietary intake did not change significantly. Dietary vitamin C decreased significantly (P<0.001).

Conclusion: Daily consumption of folic acid fortified bread, with 100 µg folic acid, in hyperhomocysteinemic subjects for 8 weeks led to significant decrease in plasma homocysteine and an increase in serum folate.

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Background: The flexible structure of proteins is one important factor in the formation of ordered aggregates (amyloid fibril). This is a major problem for therapeutic proteins such as insulin. Study on the induction and inhibition of insulin fibrillation process with specific compounds such as aromatic derivatives may provide useful information about means of stabilization of protein structures. Methods: To induce fibrillation, regular insulin was incubated in phosphate buffer (pH=7.4) during 24 hours. Amyloid formation was investigated by using Congo red absorbance and transmission electron microscopy (TEM). Then nodular amyloidosis was observed in mice upon amyloid fibril injection, after which the excised nodule was studied by Congo red staining and polarized light microscopy. Then, some aromatic compounds effect was investigated on the fibrillation process. Results: Regular insulin form mature amyloid fibrils at pH=7.4, 37°C after 24 hours. Silibinin had the highest inhibitory effect on that process. Furthermore, Amyloid fibril injection in mice caused nodular amyloidosis. Conclusion: Regular insulin has a high potential to undergo amyloid aggregation. Nodular amyloidosis confirms fibril formation by insulin under in vitro condition. Silibinin could be considered as a potential compound capable to increase protein structure stability.

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  Background : PCOS (Polycystic Ovary Syndrome = PCOS) is a relatively common disease in women of childbearing age. Bisphenol s are chemical groups that are composed of two functional hydroxyl group and most of them are based on methane. In this study, the effects of phenolic compounds, (bisphenol A and AP) in polycystic ovary syndrome were investigated.

  Methods : mature Wister rats were classified in six groups . Healthy controls ( healthy rats that received Grape seed Oil as solvent ), PCOS Group ( disease induced by testosterone propionate ) experimental groups 1.2.3.4 , respectively. after induction of PCOS,they received bisphenol- A and AP in doses of25 mg / kg, 50mg/kg, by gavage . Blood samples were taken and the hormones LH, FSH was measured . Ovaries were also to be studied histologically .

  Results : The results showed that the amount of LH to FSH ratio increases after induction with bisphenol-A and bisphenols AP,. Furthermore the number of follicles and growing follicles were reduced significantly, and these concequences causing negative effects on polycystic ovary syndrome.

 

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Background: Alpha-amylase is the most important enzyme in the digestion of starch. Activators of this enzyme could be potentially used as digestive aids and its inhibitors block the absorption of starch compounds and result in the control of blood sugar levels. This study aimed at the investigation of aromatic compounds on bovine serum alpha-amylase. Methods: Effect of carvacrol, cumyl phenol, tryptamine, tryptophan, N-acetyl-L-tryptophan, Bis phenol A, 2-benzyloxy phenol, 2,6 diisopropyl phenol and 4-chloro-2-isopropyl-5-methyl phenol was investigated on bovine serum alpha-amylase with use of artificial substrate (laboratory kit). Results: Most of tested aromatic compounds showed a similar pattern. All these compounds had 5-30% inhibitory effect on the tested serum with the exception of tryptamine which showed a 20% increase in the enzyme activity. The best inhibitory effect was obtained from cumyl phenol in the range of 30%. Conclusion: This study showed that aromatic compounds with one and two cycles have moderate inhibitory effect on bovine serum alpha-amylase and tryptamine showed a slight activator effect. With regard to these results, indolic and phenolic structures may be effective on alpha-amylase, and in the next step, investigation of these compounds derivatives is suggested.

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Background: Health locus of control is an important variable in diabetes. The aims of the present study were to investigate the role of health locus of control in predicting psychosocial adjustment to illness and compare psychosocial adjustment to illness and dimensions of health locus of control among male and female type 2 diabetic patients.

Methods: One hundred and eighteen patients were recruited via convenience sampling method from type 2 diabetic patients who were referred to the Shahid Motahari diabetes clinic in Shiraz. The participants filled Multidimensional Health Locus of Control (MHLC) and Psychosocial Adjustment to Illness Scale (PAIS).

Results: The results indicated that there were significant positive correlations between psychosocial adjustment to illness and internal health locus of control (r= .30,   P &le .001) and God health locus of control (r= .18,   P &le .05). Internal health locus of control (&beta= .28,   P &le .01) significantly predicted psychosocial adjustment to illness. There were significant differences between male and female diabetic patients on the basis of chance health locus of control. Female patients got higher scores on chance health locus of control. Moreover, there were no significant differences between male and female diabetic patients on the basis of psychosocial adjustment to illness.

Conclusion: The findings highlighted that internal health locus of control and God health locus of control play significant role in psychosocial adjustment to illness. Therefore, it is recommended that psychologists and clinicians take the dimensions of health locus of control into considerations in the treatment of psychological problems of diabetic patients.

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Background: A key aspect of Scientific collaboration increases scientific productivity. This study aimed to draw up a scientific collaboration network of the Endocrinology and Metabolism Research Institute (EMRI) at Tehran University of Medical Sciences.
Methods: A Descriptive Cross-Sectional Study was conducted by the Scientometrics method. Data collection from the Scopus and Web of Science Core collection databases between 2002 until 30 October 2020. MS-Excel, HistCite, VOSviewer, and ScientoPy were used for descriptive statistics and data analysis.
Results: A total of 4190 records with the affiliation of the EMRI are indexed in two international databases. All of the records received a sum of 89480 citations. The EMRI Researchers were published in 1118 journals. The annual growth rate of publication and citation of the scientific output of the EMRI was 20.3% and 22.7%, respectively. A total of 17662 authors from 186 countries participated in the publication. The co-authorship pattern shows. The next section of the Study was classified and visualized based on authorship (institutes and country of affiliation), keywords (co-occurrence and trend).
Conclusion: Overall, these results indicate that the pattern of collaborations in the authorships' articles increases the flow of knowledge among the institute's researchers as a result of international collaborations, interaction with leading countries, and interdisciplinary collaborations. To develop a full picture of co-authorship, additional studies will need a comprehensive picture of network cooperation to analyze the situation with other social network analysis indicators.

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Background: The purpose of this study is to identify patterns of information sharing in the field of evidence-based medicine to determine the main areas of evidence dissemination, including co-authorship patterns and citation networks, and to provide a scientific horizon for improving evidence-based medical research in Iran. Accordingly, evidence-based medicine related research at the Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences is suggested.
Methods: This study is a bibliographic study using scientometric methods. In this regard, the network of co-authorship and analysis of scientific articles indexed with the subject of evidence-based medicine in the Scopus database from 2004 to 2019 were analyzed.
Results: The status of scientific production of evidence-based medicine of Endocrinology and Metabolism research Institute has been increasing in recent years. The Journal of Diabetes and Metabolic Disorders contains a great collection of information about evidence-based medicine in this field and its contents have been widely cited in many Iranian journals. In lexical analysis, the most widespread evidence was osteoporosis.
Conclusion: The results indicated that evidence-based medical research topics are widely focused on other medical fields such as osteoporosis and obesity and have shifted from evidence-based clinical practice to evidence-based clinical management.

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Background: Coronary heart disease is a viral infection that has become a pandemic disease. Given the comprehensive impact that this disease has on the lifestyle of individuals, the economic situation of the country, imported drugs; the present study aims to investigate the self-care status of patients with type 2 diabetes during the Covid epidemic.
Methods: The study population in the present study was people with diabetes in Bushehr. The sampling method in the present study was purposeful and available sampling and the sample size was 13 people (7 men and 6 women). The research information was collected through a semi-structured interview for 40 to 60 minutes using open-ended questions. After the interview process, the answers were interpreted and coded using the content analysis method.
Results: According to the results of the present study, in general, patients with type 2 diabetes during the period of Covid-19 epidemic did not have a favorable self-care status and many problems in the field of self-care behavior (medication, nutrition and exercise and mobility) and in other Fields have experienced.
Conclusion: Diabetics have experienced many problems during the Quaid 19 epidemic, which further reduces their quality of life; therefore, the government, the media, the patient's family, the patient himself, doctors, psychologists and counselors can be used to reduce these problems.

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Background: Type 2 diabetes is the most common metabolic disease, a chronic and progressive disorder that causes permanent complications and increased cardiovascular, cerebrovascular, peripheral vascular disease, nephropathy, retinopathy, neuropathy, diabetic foot, amputation and death in patients.The aim of the present study was to examine the predictor role of negative repeating thoughts, emotion regulation strategies and self-care in remedial acceptance and adherence of patients with type 2 diabetes.
Methods: The method of the present study was descriptive, correlation type, and the population was from all the patients with type 2 diabetes who were members of Diabetes Association in Chahar-Mahal-o Bakhtiyari. Among this group, using the convenience sampling method, and on the basis of Morganʼs table, 300 patients with type 2 diabetes were recruitment. Using MackEuy and othersʼ negative repeating thoughts questionnaire (2014), Mans & Malouf emotion regulation­ strategies questionnaire (2009), Toobert & Glasgow self-care questionnaire (2000) & Modanloo acceptance and treatment follow-up questionnaire (2014), the experiment group was investigated. The data were analyzed by SPSS software.
Results: Our findings have shown that negative repeating thoughts, emotion regulation strategies and self-care predict the remedial acceptance and adherence of patients with type 2 diabetes significantly.
Conclusion: With pay attention to identify of the predictor role of negative repeating thoughts, emotion regulation strategies and self-care in remedial acceptance and adherence of patients with type 2 diabetes, and high prevalence of this disease too, it seems that psychological intermediations, with pay attention to role of mentioned variables to decrease of psychological problems and increase of adherence in them, pay attention to role of negative repeating thoughts too, compatible and incompatible strategies of emotion regulation and adhere to self-care could be taken as prevention of deterioration type 2 diabetes and better controlling.

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Background: Insulin resistance plays a fundamental role in disorders such as obesity, diabetes, cardiovascular diseases, and metabolic syndrome. Regular physical activity and the use of medicinal plants are important strategies for its reduction and management. Ginger has attracted research attention due to its phytochemical compounds that influence insulin signaling pathways. Despite numerous studies, a bibliometric analysis examining the effects of exercise and ginger supplementation on insulin resistance has not yet been conducted. Therefore, the present study aimed to analyze the trends in Iranian research in this field.
Methods: In a bibliometric review, the keywords “training,” “ginger supplementation,” and “insulin resistance” were searched in the Magiran database. According to the entry criteria, 13 eligible articles were selected and data extracted from them, including writing pattern, collaboration, prolific authors and institutions, selected journals and study trends, and common keywords were extracted from the database of recipients and analyzed using VOSviewer software.
Results: The results indicated that 36 authors had an average of 3.23 ± 0.89 cooperation in writing articles. Fifty-four percent of the articles were published by public university faculty and 46% by independent universities. The most frequent keywords included "ginger", "insulin resistance", "obesity", "diabetes mellitus", "irisin" and "lipid peroxidation".
Conclusion: The results of this bibliometric study showed that exercise with ginger supplement reduced insulin resistance. In particular, 84% of the articles showed the positive effect of combined exercises (resistance and aerobic exercises) along with ginger supplements on the reduction of insulin resistance. Compared to other types of exercise, these exercises have had the greatest effect on improving the glycemic profile and body composition. In addition, high intensity interval training (HIIT) has also shown positive effects on reducing insulin resistance, but is not as effective as combined training. Also, due to the relationship between insulin resistance and various diseases, it is felt to conduct more studies on diverse statistical populations and people suffering from various diseases.

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Background: Recurrent diabetic ketoacidosis is one of the serious and life-threatening complications of diabetes that can lead to repeated hospitalizations and significant complications. This study was conducted with the aim of investigating the prevalence, risk factors, and clinical outcomes of recurrent diabetic ketoacidosis in southeast Iran.
Methods: In this retrospective descriptive-cross-sectional study, the medical records of 560 patients with diabetic ketoacidosis during the years 2017-2020 at Afzalipour Hospital in Kerman were reviewed. Patients with at least two admissions due to diabetic ketoacidosis were included in the study. Demographic, clinical, and laboratory data were collected and analyzed using a checklist. The collected data were analyzed using SPSS software version 25 with chi-square and independent t-tests at a significance level of 0.05.
Results: Of 560 patients, 40 patients (7.16%) had recurrent diabetic ketoacidosis. The mean age of patients was 28.36 ± 15.04 years, and 60% were women. 70% of patients had type 1 diabetes. The most common underlying causes included irregular consumption or discontinuation of insulin (72.5%) and presence of infection (55%). Substance abuse was reported in 25% of patients. The mean serum levels of urea, creatinine, and potassium were 55.23 ± 37.73 mg/dL, 0.98 ± 0.67 mg/dL, and 4.38 ± 0.64 mEq/L, respectively.
Conclusion: This study showed that patients with type 1 diabetes are at higher risk of recurrent diabetic ketoacidosis. Non-adherence to insulin therapy and infections were the most important identified risk factors. These findings emphasize the importance of patient education regarding regular insulin consumption and prevention of infections.