Iranian Journal of

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Objective: To compare the effect on insulin absorption intra-nasally of Acanthophyllum squarrosum (ASQ) compared with Acanthophyllum saponaria (ASA) and sodium cholate (NAC), which have proven pro-absorptive effects.
Methods: The formulation used in this study contained 2IU insulin (per rat), 1% carboxymethylcellulose (CMC) and a pro-absorptive agent at the same concentration. We assessed the hypoglycaemic effect of each formulation in 5 rats in the fasting state.
Results: There was no significant difference in the pro-absorptive effects of ASQ, ASA, and NAC. Blood glucose levels 2 hours after administration of insulin, given as a percentage of baseline glucose concentration, were as follows for the three formulations used: ASQ: 36.78±11.06%, ASA: 27.46±2.39%, and NAC: 39.94±14.93%. Conclusion: Acanthophyllum squarrosum has a significant pro-absorptive effect, comparable to that to Acanthophyllum saponaria.

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Background: Diabetes mellitus, the most common metabolic disorder of childhood, has important physical and emotional complications this urges the role of patient education and self-monitoring. Diabetes is costly since patients have to do several lab tests and spend a lot on treatment.
Methods: 150 patients with IDDM entered this cross-sectional study. The metabolic control and degree to which these patients were utilizing available facilities were determined and compared with same surveys from Germany, France, USA, Australia, and Saudi Arabia.
Results: 91.3% of patients had no glucometer thus were unable to do self-monitoring. HbA1C had been regularly determined in only 8.66%. Insulin therapy was improper or inadequate in 59.1%. The quality of metabolic control was significantly poorer than the other mentioned nations (P< 0.001).
Conclusion: The study advocates educational programs for diabetics. Complete insurance coverage and free weekly lab tests are also suggested.

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Celiac disease and typel diabetes mellirus have been linked to the same HLA markers and chromosomal loci, which may account for the concurrence of the two disorders in a significant number of patients. This study was designed to investigate the frequency of anti-gliadin antibodies, a marker for celiac disease, in diabetic patients.
Methods: In this study, 182 diabetic patients (52 with typel and 130 with type2 diabetes) were screened for anti-gliadin IgG by indirect immunofluorescence. Age range was 3-29.5 and 42-65 years for type 1 and type 2 diabetes groups.
Results: Anti-gliadin IgG was found in 1.9% and 1.5% of patients with type land type 2 diabetes. In Tehran, 0.02% of healthy blood donors have been reported to be seropositivitive for anti-gliadin IgG.
Conclusion: The prevalence of anti-gliadin seropositivity in type 1 and type 2 diabetics, was respectively 30 and 24 times higher than the general population of Tehran. This concurs with other reports indicating higher occurrence of celiac disease in diabetic populations. The rather low sensitivity and specificity (both around 80%) of the antigliadin antibody test has made it a suboptimal diagnostic test. However, it is quick and inexpensive and can be suitable for screening programs. We recommend the test in all at-risk populations including diabetics.

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Background: Diabetes mellitus is one of the chronic metabolic diseases with several organ damages that dearese life span. Prevalence of known diabetes appears to be increasing in most countries, presumably due to increasing the prevalence of risk factors such as obesity, lower physical activity and improved diagnosis. WHO expect the number of adults (20 years and older) with diabetes rises up to 300 millions in 2025. In view of the worldwide geographic differences in diabetes and lack of documented informations about prevalence of diabetes in Iran, we assigned this study.
Methods: The base of our study for assessment of prevalence of diabetes in Iran was results of ״Health and Disease Study in Iran, 1999״. We used epidemiologic model (DisMod) for estimating the incidence of diabetes in Iran. Results: The prevalence of diabetes in over 20 years of Iranian population in 2000, was 1.6 million or 4.67%. Also it is estimated up to 100000 persons have been affected by type II diabetes.
Conclusion: The true limitation of our study was limitations of documents about estimated of proportion of true prevalence to prevalence of known diabetes.

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Background: Fetal hyperinsulinemia correlated with large birth weight and impaired glucose tolerance test and obesity in second decades of life. In this study we compared the correlation between fetal insulin production (as estimated by amniotic fluid (AF) C-peptide concentration) and AF insulin with macrosomia (as estimated by neonatal birth weight 4000 gr).
Methods: Thirty eight neonates were studied. Ten infants were macrosom and 28 were normal (birth weight < 4000 gr). Amniontic fluid C-peptide and insulin concentration and mother and fetal blood C-peptide and insulin were measured during delivery with radioimmunoassay and mother and fetal glucose were measured at the same time and correlated with neonatal macrosomia within first hour of birth.
Results: There was a significant correlation between infant serum C-peptide level and macrosomia. Amniotic fluid insulin level was higher in the macrosom infants but this correlation was not significant. AF C-peptide was higher in the macrosom group. Also there was a significant correlation between maternal serum C-peptide and macrosomia. Infant and mother serum insulin was higher in the macrosom group.
Conclusion: Our results suggest that fetal insulin (as estimated by AF C- peptide) and mother insulin and C- peptide production, can influence fetal weight and induce fetal macrosomia.

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Background: Leptin is a peptide strongly correlated with adiposity and is a potential determinant of obesity and its complications. The aim of this study was to evaluate the correlation between serum leptin levels and different anthropometric indices among obese women.

Methods: This analytical descriptive study consisted of 106 women with different grade of obesity (BMI ³ 25 kg/m²) and 38 women with normal weight (BMI ≤ 25 kg/m²).serum leptin and glucose levels were measured via enzyme immunoassay and glucose oxidase methods respectively.

Results: The mean (± SE) serum leptin concentrations  in apparently healthy women with normal weight ,overweight, obese grade I, and obese grade II were 6.88 ± 0.56, 39.30 ± 1.73, 46.60 ±1.04, and 48.22± 3.31 ng/ml respectively. There was a dramatic increase in serum Leptin concentration when the BMI was increased. There was statistically significant differences between all groups in serum leptin concentration (P<0.001). There was a direct and significant correlation between serum leptin concentration and BMI in obese subjects (r= 0.736, P< 0.001). There was no significant correlation between leptin with age, and leptin with WHR neither in normal weight group nor in different grades of obesity groups.

 Conclusion: Our findings showed that the serum leptin levels continuously raised with increasing degree of obesity and among different anthropometric indices serum leptin concentration has significant correlation with BMI. 

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Background: Pump therapy (CSII) is offered as a safe and effective treatment for patients with type 1 Diabetes. We examined the efficacy and safety of continuous subcutaneous Insulin Infusion Therapy for six months as a before-after clinical trial study among type 1 diabetic patients. This is the first survey of this experience in Iranian patients.

Methods: We recruited, type 1 diabetic patients without chronic complications of diabetes (retinopathy, nephropathy and etc.) and followed them for six months as a before-after clinical study with use of the pump. The efficacy of this way was assessed with HbA₁C and fasting blood sugar measurements. Safety was estimated by frequency of clinical hypoglycemia episodes.

Results: Our patients were 7 men and 2 women aged 15 - 39 years with past history of diabetes by ranging from 0.1 to 15 years. Mean level of HbA₁C at the beginning of study and after six months follow-up were %8.6 and %7.1, respectively, with significant statistically difference between them (P= 0.02). During pump therapy the mean dose of insulin were decreased to 10 units with statistically significant difference to before investigation (P = 0.03). No case of hypoglycemia and weight loss was seen. One patient had 4 kg weight gain without any significant statistical effect.

Conclusion: It seems CSII Therapy in Iranian patients with type 1 Diabetes mellitus was effective and safe. We can not conclude about possible side effects of pump based on this study.

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Background: Balance dysfunction is one of the problems in diabetic patients so that peripheral neuropathy and decreased somatosensory sensitivity are the most important causes for it. One of the supposed theories for diabetic peripheral neuropathy is reduction in blood flow secondary to pathologies of peripheral neural arterioles. Intermittent Pneumatic Compression, regarding to its effect on vessels hemodynamics and perfusion improvements, has been considered in recent years. The aim of this study is to evaluate the effects of this method on improvement of neuropathy signs and symptoms improvement in patients with type 2 Diabetes and neuropathy. Also, regarding to the role of neuropathy on balance impairment, other aim of this study is to investigate the effect of this method on improvement of dynamic balance in diabetic patients. Methods: This study is a clinical trial study. 39 patients with diabetes type 2 and neuropathy divided into intervention (20 patients) and control (19 patients) groups. The intervention group underwent 10 sessions of IPC treatment, with 45 minutes for each session and one day interval between them. Neuropathy severity changes (by Valk and Michigan Questionnaires), Proprioceptive sensation (assessed by Diapason), and balance (by Biodex system), were evaluated in both groups in first and final sessions. Results: Anterior-Posterior Stability Index and Overall Stability Index obtained from Biodex system in level 6 showed significant changes. Vibration sensation, and Valk and Michigan neuropathy questionnaires also showed significant improvements (P<0.05). Conclusion: This study showed that IPC treatment method has positive effects on improvement of neuropathy severity, Vibration sensation and dynamic stability (Biodex).

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Background: A unique subset of Individuals with normal body mass index (BMI= 18.5-24.9 kg/m2) and high body fat percentage (above 30% in women and 23% in men) that are termed as normal weight obese, are at increased risk for development of the metabolic syndrome and chronic diseases because the adipose mass and the excess of fat mass are an important source of proinflammatory cytokines. The aim of the present study was based on this hypothesis that women with high body fat percentage and normal body mass index are at increased risk for the metabolic syndrome in compared to healthy non obese women. Methods: This was as case-control study in which 40 obese women with normal weight (BMI= 18.5-24.9 kg/m2) and body fat percentage above 30% (FM> 30%) and 30 non-normal weight obese women (BMI= 18.5-24.9 kg/m2) and fat percentage less than 25% (FM <25%) who were matched for age (mean age = 28 years) recruited for this study. The components of metabolic syndrome including Anthropometric variables, blood pressure and fasting plasma concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glucose and insulin were measured. Results: The anthropometric measurements including waist and hip circumferences in NWO was higher than non-NWO (respectively 74.78±4.81 vs. 70.76±2.91 and 99.12±4.32 versus 93.16±2/91, Pvalue<0.001), while the waist-to-hip ratio did not differ between the two groups (p=0.448).Also no significant differences were observed in concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, fasting plasma glucose, systolic and diastolic pressure between groups. Fasting serum insulin and insulin resistance was higher in NOW compared to non NWO (Pvalue<0.05) and insulin sensitivity in NWO was lower than non NWO (0.357 versus 0.374, pvalue = 0.043). Conclusion: Because of the higher serum insulin concentration and the lower insulin sensitivity, obese women with normal body mass index but high body fat percentage can be associated with a higher risk for metabolic dysregulation and metabolic syndrome compared to healthy women with the same body mass index and normal body fat percentage

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Background: The major cause of obesity is an imbalance between energy intake and energy expenditure and resting energy expenditure (REE) is the most important determining factor in metabolism because it can reduce obesity and body fat mass gain. Overt hypothyroidism is associated with a lower resting energy expenditure (REE). With treatment, the resting energy expenditure (REE) will be normal. But a group of patients with treatment and normal serum level of TSH and thyroid hormones, Continue to complain of the lack of improvement of Clinical signs of overt hypothyroidism. This study is designed whether patients that have Clinical signs of overt hypothyroidism in compared with patients without Clinical signs, resting metabolic rate, body composition and lipid profile are different or not.
Methods: This study is a descriptive and comparative study on 100 women with overt hypothyroidism are treated with levothyroxine. The patients were divided into 2 groups of 50 patients with and without clinical signs. All patients were matched for age and BMI and menstrual cycle. 2 groups regarding anthropometric measurements, resting energy expenditure (REE), body composition, thyroid hormones, lipid profile and diet were compared with each other.
Results: The average resting energy expenditure (REE) and adjusted of it for weight was significantly lower in the group with Clinical signs (Pvalue<0.03). But there was no significant difference between the 2 groups for the form of an adjustment for fat free mass (FMM) and FT3. The body fat mass (FM) was higher in the group with Clinical signs (Pvalue<0.005).But there was no significant difference between the 2 groups in the percentage of body fat mass and fat free mass (FMM). Serum levels of TSH, TF4, FT4, TT3, FT3, total cholesterol, HDL, LDL, there was no significant difference between the 2 groups. But the level of blood triglycerides (TG) in the group with Clinical signs was significantly higher than the group without Clinical signs (Pvalue<0.01).
Conclusion: Patients with Clinical signs, lower resting energy expenditure (REE) and fat mass (FM) and triglycerides blood (TG) is higher than in patients without Clinical signs.

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Background: Peripheral neuropathy is one of the most common problems in diabetic patients. The increased risk of Diabetic Foot Ulceration (DFU) and amputation would be a complication of diabetic neuropathy. The aim of this study was to compare the DFU healing in different severity classification of neuropathy.
Methods: This is a retrospective study that was conducted over a two-year period from April 2016 to March 2018 according to the information of patients records with Diabetes Mellitus (DM) referred to clinic of diabetes and metabolic disorders of Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences. Wound healing criteria including area, depth and healing duration were studied. Accordingly, changes in the area and depth of wounds were evaluated and reported during the first, third and sixth months after baseline. Data were analyzed using descriptive and inferential statistics using SPSS software version 16.
Results: The results of the study of patients with neuropathic ulcer showed that males and age group of 56 to 65 years had the highest frequencies. In addition, most of these patients suffered from type 2 DM (79%). The rate of wound healing, which was measured by area and depth of wound in three time periods, differed in different severity classification of neuropathy; at mild level of neuropathy the area and depth of wound decreased faster but in severe neuropathy, duration of wound healing in both mentioned criteria has increased. Regarding to the increase in the duration of DM, the healing time increased too. However the rate of wound healing decreased with increased age (p-value = 0.001).
Conclusion: Evidence suggests that early identification of neuropathy can reduce the incidence of DFU and amputation. Due to the slow healing of the size and depth of the wound in diabetic patients with severe neuropathy, it is necessary to prevent DFU by conducting preventive care and educational interventions.

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Background: Diabetic foot is one of the main complications of diabetes, which is caused by a significant proportion of patients with diabetes and which imposes costs on the family and the health system around the world. This review aims to summarize the latest findings in the field of diabetic foot based on clinical guidelines.
Methods: In this review study, in order to achieve the best clinical guide in the field of diabetic foot by determining the search strategy and inclusion criteria, all related clinical guides were searched in the databases and websites of clinical guidelines.  Clinical guidelines related to diabetic foot care were searched and retrieved from January 2000 to early 2019 and screened separately by two researchers to select the selected clinical guideline.
Results: Based on the study criteria, the clinical guide of the International Diabetic Foot Working Group was selected as the most complete guide in the field of diabetic foot. This summary is based on the International Working Group on the Diabetic Foot (IWGDF) Guidance 2015, consist of five documents including prevention of foot ulcers in at‐risk patients, footwear and offloading principles, diagnosis, prognosis and management of peripheral artery disease, foot infections in patients with diabetes and enhance healing of chronic ulcers of the foot in diabetes.
Conclusion: This Summary Guidance for Daily Practice is intended to overview of the main aspects of the prevention and treatment of foot problems in patients with diabetes. This summary guidance is adviced at healthcare providers and specialists in foot care throughout the world.

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Background: In this study, we investigated the diagnostic power of ultrasound in the diagnosis of malignancy in thyroid nodules in Iranian patients. For this purpose, we examined the relationship between ultrasound findings and pathology findings.
Methods: The present study is a retrospective study. The patients with a diagnosis of thyroid nodules who underwent ultrasound and FNA, were included in this study. To assess the relationship between the results of FNA and the ultrasound characteristics of nodules, we classified the results of FNA into malignant and benign groups and then compared ultrasound characteristics between the two groups. In cases which the FNA results were indeterminate (AUS/FLUS or FN/SFN), the postoperative pathology result was considered (if thyroid surgery was done and the result was available).
Results: In total, 201 nodules were included in this study. The results showed that hypoechogenicity, irregular/ill-defined margin, microcalcification, malignant flow pattern in Doppler sonography and concurrent cervical lymphadenopathy with suspicious features were significantly associated with malignant thyroid nodules. However, other ultrasound findings, such as the size and location of the nodule, presence of a cystic components within the nodule, the presence of a Halo sign, and the presence of a taller-than-wide shape, could not distinguish between benign and malignant nodules. Finally, the results of the present study showed that the accuracy of ultrasound in the diagnosis of malignancy in thyroid nodules is high.
Conclusion: This study suggests that the use of ultrasound can be very effective in diagnosing malignancy in thyroid nodules.

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Background: In Iran, with the advancement of technology and the development of registration statistics, the need to use data mining methods has attracted more attention from researchers. Regression and classification tree is one of the important methods in Big data modeling, which has attracted the attention of many researchers for community control and prediction. The purpose of this study is to determine the influencing variables on the occurrence of complications caused by diabetes.
Methods: This paper is a cross sectional-analytical study. In this research, all diabetic patients covered by Mashhad University of Medical Sciences in 2017 were extracted from the SINA system. The number of diabetics with complications was 5016 and diabetics without complications were 53613. The method of fitting the regression tree model and classification and measurement criteria of the model is the coefficient of determination and the area of the Rock curve and the Lift diagram.
Results: The rock curve for the fitted tree model is 73.8%, which shows the relatively high power of the model. Based on the Lift chart, the decision-making power of diabetes complications increases 3.5 times for the person who comes to visit.
Conclusion: The results of the regression model and tree classification showed that, in descending order, age, risk assessment factor, FBS, HbA1C, total activity time, cholesterol, FBS and HDL, cardiovascular disease, history of stroke, blood pressure, cholesterol Statin prescription, job with hard physical activity, living area, consumed oil, walking, consumption of vegetables and gender are more effective than other factors in the occurrence of diabetes complications.

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Background: Vitamin D (vitD) deficiency is common in Iran. Although there are several studies on therapeutic doses of vitD, the optimal dose is to be evolved. we compared the effects of high dose supplemental vitamin D versus its recommended dose on the serum level of 25(OH)D.
Methods: This clinical trial was performed at Endocrine & Metabolism Research Institute in Shariati Hospital, Tehran, Iran within 2008-2009. The subjects were osteopenic women older than 50 years who had been referred to Bone Densitometry laboratory. They were received either (group P) 50000u vitD3 weekly for 3 months then monthly for another 9 months, or (group M) 800u vitD3 daily for one year. 1000 mg calcium carbonate was given to both groups. Serum 25(OH)D, calcium, phosphorus, and PTH was checked at base, 3rd, 6th and 12th month. 24h Urine for calcium was collected before and at the end of trial.
Result: Serum 25(OH)D level was significantly higher in group P at 3rd month (P< 0.05), but it gradually declined and there was not statistically difference to group M. PTH decreased in both groups. Urine calcium to creatinine ratio did not rise in both groups.
Conclusion: vitD supplement at doses of 50000u weekly for 3 months then monthly for another 9 months as compare to 800u vitD3 daily for one year increases serum 25(OH)D at higher level without causing hypercalcemia and hypercalciuria, but it seems that more frequent doses in monthly period would be required to maintain the optimal 25(OH)D level.
 

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Blood glucose variability, defined as variations in blood glucose levels over time, is increasingly recognized as a significant factor in the pathology of diabetes complications. While chronic hyperglycemia has been linked to microvascular complications (retinopathy, nephropathy, and neuropathy) and macrovascular complications (coronary artery disease, stroke, and peripheral artery disease), emerging evidence suggests that glucose variability is an independent risk factor for these conditions. This review examined the relationship between blood glucose variability and the development of microvascular and macrovascular complications in diabetes, highlighting the underlying mechanisms, clinical implications, and therapeutic approaches.