Iranian Journal of

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Background: Studies of the metabolic effects of Ramadan fasting on patients with type 2 diabetes mellitus are inconclusive.
Methods: Fifty-seven volunteers with type 2 diabetes underwent anthropometric and biochemical evaluation before and on the 14th and 28th days of Ramadan. Biochemical markers were measured by standard laboratory methods. Anthropometric measurements followed WHO criteria. Statistical analysis was by ANOVA for repeated measurements and Friedman’s two-way ANOVA, using SPSSv6 software.
Results: Daily cholesterol intake increased in all subjects (p<0.03). Body mass index increased (p<0.03) in women, but body mass index (BMI) and waist-to-hip ratio both decreased (p<0.01) in men. Blood pressure, fasting blood glucose and serum fructosamine did not change during the study. Plasma insulin (p<0.05), C-peptide (p<0.01) and insulin resistance (p<0.01) decreased only in men. Total and LDL cholesterol increased significantly in all subjects during the study.
Conclusion: Ramadan fasting does not alter carbohydrate metabolism or tissue insulin sensitivity in type 2 diabetes patients, given appropriate dietary education and rescheduling of oral hypoglycaemic medication. Lipid profile is unfavourably altered due to changes in both diet and biochemical response to starvation. Anthropometric indices improve in men but not women, possibly because of reduced physical activity in the latter.

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Background: Diabetes mellitus is a common chronic disorder with multiple disabling long- and shorter-term complications, the majority of which can be controlled if not prevented. The management of diabetic patients is a major drain on both health budgets and time.
Methods: We reviewed the records of 101 patients with diabetic foot ulcer, who had received treatment at either Doctor Shariati or Imam Khomeini hospital.
Results: Out of 101 patients (56.4% male and 43.6% female) with diabetic foot ulcer, 34.7% had eventually undergone amputation.
Conclusion: Our findings highlight the need for control and prevention programmes aimed at reducing the risk factors for and complications of diabetic foot ulcer.

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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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Introduction: In this study, we compared the level of glycosylated haemoglobin in patients with essential hypertension and healthy controls.
Method: 70 non-diabetic patients with essential hypertension were recruited into the study along with 140 controls without any significant medical history. Persons with a history of metabolic disease, anaemia, renal disease, splenectomy, pregnancy, or on medication were excluded from the study. A blood sample was taken from each participant and immediately sent to the EEMRC laboratory, where fasting blood sugar and glycosylated haemoglobin levels were measured by the glucose oxidase and thiobarbituric acid (colorimetry) method, respectively. The unpaired t-test was used to compare means. A p-value of less than 0.05 was considered significant.
Results: Mean fasting blood glucose was 103.1±16.1mg/dl in the hypertensive group and 92±7mg/dl in controls (p<0.05). Mean glycosylated haemoglobin levels were 7.38±0.78% in the hypertensive group and 6.5±0.85% in controls (p<0.05). Conclusion: People with essential hypertension have a higher level of glycosylated haemoglobin than healthy controls.

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Introduction: In patients with type 2 diabetes, triglyceride (TG) is usually increased, HDL decreased, and LDL normal. This pattern is associated with an increased risk of coronary heart disease. More recently, dense-particle LDL has been identified as an important risk factor for coronary heart disease.
Methods: 298 patients with type 2 diabetes attending the diabetes clinic at Doctor Shariati University Hospital underwent anthropometric and biochemical assessment. Anthropometric measurements followed WHO criteria. Biochemical indices (apoB100, TG, cholesterol, LDL, LDL particle size, HDL, and apoA1) were measured using standard laboratory methods. One-way ANOVA was used to analyse data with SPSSv6 software.
Results: Mean patient age was 55±13.2 years. Mean duration of diabetes was 9.5±6.1 years. The majority of patients were moderate to severely overweight. 73.2% of patients had some form of hyperlipidaemia. 20.7% had isolated hypertriglyceridaemia, 21% isolated hypercholesterolaemia, and 31.5% mixed hyperlipidaemia. Mean apoA1 concentration was higher than normal in this group, and mean apoB100 concentration lower. LDL particle size generally followed a small and dense pattern.
Conclusion: This study shows that LDL particles in both men and women with type 2 diabetes undergo both qualitative and quantitative changes. 35.5% of patients had smaller, denser LDL particles than normal. It appears that dyslipidaemia and B-pattern LDL particles are important risk factors for atherosclerosis in this group.

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Introduction: There is as yet no consensus as to the effect of Ramadan fasting on fasting blood glucose. We carried out a study to help clarify the situation.
Methods: This was a semi-experimental (pre- and post-) study of 115 healthy volunteers (67 men and 48 women), who fasted for at least 25 days during Ramadan. Blood samples were taken 7 days before Ramadan (at 7am after a 8-hour overnight fast), and on the 14th and 28th days of Ramadan (1 hour before sundown). The mean duration of daily fasting was 11.5±0.5 hours. Plasma glucose was measured by an enzymatic assay. Statistical analysis was by the paired-t and ANOVA functions on SPSS10.0 software.
Results: Fasting plasma glucose in the group as a whole decreased from 88.4±9.0mg/dl pre-Ramadan to 75.4±15.3mg/dl on day 14 and 62.9±7.7mg/dl on day 28 (p<0.001). Both men [87.5±8.8mgdl (pre-Ramadan)  60.8±6.4mg/dl (day 28)] and women [89.7±9.3mgdl (pre-Ramadan)  65.7±8.4mg/dl (day 28)] experienced a significant decrease in fasting plasma glucose levels (p<0.001 in both). There was a reduction in calorie intake during Ramadan in every volunteer (p<0.001), and there was a direct correlation between reduction in calorie intake and fasting plasma glucose (p<0.01).
Conclusion: Fasting plasma glucose decreases with Ramadan fasting and is associated with a reduction in calorie intake. The decrease in plasma glucose does not seem to be accompanied by any serious adverse effects in healthy volunteers, however.

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Background: The non-enzymatic glycosylation (NEG) of proteins in diabetes damages both the structure and function of these proteins. In vivo and in vitro studies have shown that NEG of proteins and advanced glycosylation end-products (AGE) contribute to the pathogenesis of both macrovascular, such as atherosclerosis, and microvascular complications, such as retinopathy and nephropathy, in diabetes.
Methods: We studied the electrophoretic mobility, fluorescence at isoelectric pH, and time-dependent AGE formation of glycosylated albumin. For the first time, we have used isoelectric focusing to study serum glycosylated albumin in diabetic patients and healthy controls. Results: After 10 weeks incubation with glucose, the electrophoretic mobility of glycosylated albumin increased 21.3% compared with normal albumin. The isoelectric pH of albumin decreased from 4.6 on day 1 to 4.1 on day 7. The increase in electrophoretic mobility was accompanied by the drop in pH during the first week of incubation. These changes correlated well with those observed by fluorescence. The glucose content of the albumin samples decreased during the first week of incubation, but gradually increased thereafter. Fluorescence readings agreed with these observations. Using isoelectric focusing, there was a significant difference between the serum albumin of diabetic and normal individuals (p<0.001).
Conclusion: Increased electrophoretic mobility during the first week with a simultaneous decline in isoelectric pH shows that AGE formation begins after the first week. The reduction in glucose concentration during the first week and its subsequent increase during the second week may be attributed to the formation and hydrolysis of AGE. This method may be used to determine the stability or progress of diabetes.

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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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Background: We estimated the prevalence of angina pectoris (AP) and myocardial infarction (MI) in the hyperlipidaemic population of Bushehr using the ROSE questionnaire and ECG changes using the Minnesota code.
Methods: 1036 residents of Bushehr (in southern Iran), aged 30-64 years, were enrolled as part of a 2-year cross-sectional prevalence study of diabetes mellitus and other risk factors for coronary heart disease. All participants completed a ROSE questionnaire and underwent 12-lead electrocardiography. ECG strips were interpreted according to the Minnesota code. The criteria for diagnosing AP was grade 1 or 2 on the angina pectoris diagnostic scale, and for MI, code 1.1 of the Minnesota code or a history of myocardial infarction. Results: The crude prevalence of hypercholesterolaemia was 47.6%, and its age-adjusted prevalence 50.3% in women and 43.9% in men. Mean serum cholesterol was 204.2±49.5mg/dl in women and 195.0±46.1 in men (p=0.003). The prevalence of AP was 4.9%, which, after adjustment for age, came to 5.6% in men and 4.6% in women. The prevalence of AP was 6.3% in subjects with high cholesterol and 3.6% in subjects with normal cholesterol levels (p<0.05). There was a strong association between AP and hypercholesterolaemia in men (p<0.0005). The crude prevalence of MI was 4.1% in subjects with hypercholesterolaemia and 0.9% in subjects with normal cholesterol (p<0.05). In multivariate analysis, MI was correlated with hypercholesterolaemia in both sexes (p<0.05). Similarly, MI in both men and women was associated with diabetes, and in men alone with hypertension (p<0.05). Conclusion: It is imperative to reduce the average cholesterol level of the population of Bushehr in order to decrease the incidence of AP and, ultimately, MI. Interventions to improve people s lifestyle are of one of the effective measures that may be used in this regard.

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Background: A controversy exists on the prevalence of hearing impairment in diabetic patients. Previous studies have reported figures ranging from 0 to 93%.
Methods: 80 diabetic patients (mean age: 49.0816 range: 16-65 years) were evaluated with regards to their hearing thresholds, using pure tone and speech audiometry. The results were compared with 78 healthy controls. None of the patients or controls reported histories on exposures that might affect their hearing power.
Results: For all frequencies, lower hearing thresholds were registered in diabetic patients (on average 5.741.8 dB) compared to the controls. In sum, 53.7% of diabetics showed hearing thresholds lower than controls. Diabetics had poorer speech discrimination function but equal speech reception as compared to the controls. Age seemed to influence the mode of hearing impairment in the diabetic patients. To say, high frequencies disturbances were more commonly affected in older diabetics the reverse was true for the younger ones. Genders, duration of diabetes and positive family history for diabetes were not related to the degree of hearing impairment. Patients with retinopathy had poorer hearing threshold.
Conclusion: Hearing loss seems to be a frequent feature of diabetes mellitus.

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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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There are controversies on the effects of diabetes and lifestyle of affected patients on their bone mineral densities (BMDs). This study has investigated the effects of lifestyle of type 2 diabetics on BMD at the lumbar spine and proximal femur in pre and postmenopausal women.
Methods: In a historical cohort study, 20 pre-menopausal type 2 diabetics and 57 non-diabetics and 126 type 2 Diabetics and 315 non-diabetics postmenopausal women, were recruited. BMD measurements were also made to the spine and proximal femur (Neck, Wards, and Shaft) by dual energy X-ray absorptiometry (DXA) technique. Exclusion criteria were endocrine, rheumatologic or chronic diseases. Type 2 diabetic cases and non-diabetics were matched for age and body mass index (BMI) in both pre menopausal or postmenopausal groups.
Results: A total of 146 type 2 Diabetic patients without any other endocrine disorder and 372 non-diabetic women, aged 40-81 years were enrolled. No significant differences were found between diabetics and healthy controls in terms of BMD values of spine and femur regions in the pre‌menopausal women. Postmenopausal diabetics, however, had higher BMD at the lumbar spine compared with the healthy postmenopausal controls. An age-related decrease in BMD values (lumbar and femur) was observable in all groups and a significant correlation between BMI and BMD was found. Adjusting for age and BMI, the effect of lifestyle on BMD at all sites was investigated. Occupation was associated with BMD in postmenopausal, but not in premenopausal women. Among the investigated dietary items, milk, yogurt and cheese were all associated with increased BMD in at least one region in diabetic patients. Smoking was not associated with BMD.
Conclusion: Type 2 Diabetes does not seem to be complicated by bone loss and osteoporosis. Physical activity and milk consumption in postmenopausal diabetic women can be a protective factor against bone loss.

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Increased prevalence of Helicobacter Pylori (HP) infection is a common feature in diabetics, which is attributable to the presence of diverse predisposing factors. In this study, the prevalence of HP infection has been investigated in type 1 diabetic children.
Methods: In a cross-sectional study, anti-HP antibody (IgG) was measured in 75 type 1 diabetics (aged 2-18 years) and the results were compared with 75 healthy children who were matched for age, sex and socio-economic status. In seropositive diabetic patients with gastrointestinal (GI) symptoms, gastroduodenoscopy was performed to establish the diagnosis.
Results: Sera were positive for anti-HP in 22.7% of diabetics versus 17.3% in controls (P>0.05). No significant difference was observable between seropositive and seronegative diabetic groups as regard to age, sex, age at onset of diabetes, number of outpatient visits during the last 6 months, HbAlc and insulin requirements. Gastrointestinal symptoms were more common in diabetics than the healthy controls the prevalence of these symptoms, however, did not differ significantly between seropositive and seronegative diabetics.
Conclusion: The study indicated that type 1 diabetes is not associated with increased risk of HP infection. Further studies are required to investigate the impact of HP infection treatment on the glycemic control in diabetic children.

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At least 2 million people are affected by type II diabetes mellitus in Iran. Neuropathy is one of the commonest complications of diabetes affecting the quality of life of patients and can result in foot ulcer and amputation. The current study aimed to examine possible factors that could alter development of diabetic neuropathy.
Methods: In this case-control study, 110 diabetic patients were selected from Shariati hospital diabetes clinic. Michigan Neuropathic Diabetic Scoring (MNDS) was used to distinguish cases from controls. The neuropathic status of patients was confirmed with EMG-NCV. Multiple factors were compared between the two groups including ACE-I consumption, blood pressure, serum lipid level, sex, smoking, method of diabetes control and its quality.
Results: Statistically significant relations were found between neuropathy and age, gender, quality of glycemic control and duration of diabetes (P values: 0.04, 0.04, 0.000 and 0.005, respectively). No correlation existed between atherosclerotic risk factors (high BP, hyperlipidemia, cigarette smoking) and diabetic neuropathy.
Conclusion: In this study, hyperglycemia was the only modifiable risk factor for diabetic neuropathy. Glycemic control can decrease the incidence of neuropathy and delay its progression leading to improvement in the quality of life in diabetics. Aged and male diabetic patients and those with poor diabetes control are groups in most need of regular foot exam and more practical educations.

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Diabetes is one of the most common metabolic diseases. The prevalence of diabetes, which is around 4.5 - 6% in Iran, reaches as high as 14.2% in population of age 30 years and over in Yazd. Microalbuminuria is diagnosable before development of nephropathy and could be detected at an early stage when effective therapy can still be carried out. In this stage near normalization of blood glucose, strict blood pressure control and administration of ACE inhibitors can prevent nephropathic complications.
This study was aimed to determine the correlation among microalbuminuria, age, duration of diabetes, body mass Index, serum triglyceride, serum cholesterol and blood pressure in type 2 diabetic inhabitants of Yazd diabetes research center.
Methods: This cross-sectional study was carried out during November 2002-July 2003 to investigate the correlation between microalbuminuria and assumed risk factors. Two hundred and eighty eight type 2 diabetic patients (141 males and 147 females) were selected through consecutive sampling. Results: Overall prevalence of microalbuminuria was 14.2%. Chi-square analysis revealed the association between microalbuminuria and high diastolic blood pressure (P-value=0.003) and duration of diabetes (P-value = 0.001). No statistically significant correlation was found between microalbuminuria and body mass index, serum triglyceride, serum cholesterol and systolic blood pressure.
Conclusion: Determination of urine albumin/creatinin ratio is an easy method for screening microalbuminuria which is recommended for all diabetics especially those with hypertension and a long term history of diabetes.

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Neuropathy is a common complication of diabetes mellitus. Meticulous neurological examination and electrodiagnosis are valuable tools in early diagnosis of neuropathy and prevention of its sequels.
Methods: A hundred and three randomly selected diabetic patients were recruited from the endocrine clinic. Mean age of patients was 52.6 ±14 years. 29.4% had type 1 and 70.6% had type 2 diabetes.
Medical history was taken from patients and neurological examination was done. Electroneurographic examination included nerve conduction velocity, action potential amplitude, distal latency and H reflex measurements.
Results: Neuropathy was found in 79.4% of patients. The prevalence of neuropathy had a direct relation with duration of the disease. The most common complaints were tingling and numbness of extremities (72%) and burning sensation of the feet (36%). The most common physical findings were abnormal ankle jerk (92%), and decreased vibration perception (76%) in feet. Abnormal H reflex
(92.5%) and decreased amplitude of action potentials (79%) were the most common electroneurographic findings. There was a strong correlation between clinical and electroneurographic findings.
Conclusion: Neuropathy was quite common in diabetic patients. Neurologic examination is, therefore, recommended to prevent unnecessary workups and prevent complications.

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Background: Type 1A Diabetes Mellitus (T1DM) is a chronic and progressive auto- immune disorder resulting from immune mediated destruction of Langerhans islet beta cells. The etiology of T1DM like the other autoimmune diseases is unknown and many factors are involved, Both humoral and cell-mediated immunity have a critical role in T1DM pathogenesis. The cytokines, the immunomodulatory peptides, are responsible for the immune cell recruitment and producing auto-antibodies by the immune effector cells. To evaluate the role of cytokines in sensitivity or resistance to T1DM, we have employed IFN gamma to determine their gene polymorphisms and their association with T1DM.
Methods: 30 patient suffering from T1DM and 40 normal control were studied simultaneously .PCR technique was used to characterize the polymorphisms of cytokine. Salting out method was performed for DNA isolation .The polymorphosime of IFN gamma gene was determined on position UTR+5664`5.The PCR products were evaluated by Gel Electerophoresis Technique.
Results: There was a significant difference between patient and control group in TT allele IFN gamma gene: p<0.05, RR: 0.39(0.22

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Background: Diabetic Neuropathy is the most common and troublesome complication of Diabetes Mellitus, leading to the greatest morbidity and mortality and resulting in a huge economic burden for diabetes care. Early diagnosis of distal symmetric sensorimotor polyneuropathy, a common complication of diabetes, may decrease morbidity by allowing potential therapeutic interventions.
Methods: In 68 diabetic patients after neuropathy screening by U.K and Michigan scores, Bilateral sural nerve conduction parameters as nerve conduction velocity, latency and amplitude were determined and analysed.
Results: 54.4% of patients had Rt sural abnormal response, 50% had abnormality in left side and 39.7% had bilateral abnormality. There was significant statistical correlation between Michigan physical score and electrophysiologic finding (P-value < 0.003) but no correlation with U.K score (P-value > 0.3). The most prevalent abnormal electrophysiologic finding was amplitude decrement of sural response. Conclusion: Sural nerve response is one of the simplest and most sensitive peripheral sensory nerves for electrophysiologic study of diabetic neuropathy and its evaluation is recommended in all diabetic patients in spite of normal physical examination and history for detection of subclinical neuropathic cases. For increment of sensitivity, amplitude measurement of sensory response is highly recommended.

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Background: Diabetic Neuropathy is the most common and troublesome complication of Diabetes Mellitus, leading to the greatest morbidity and mortality and resulting in a huge economic burden for diabetes care. Early diagnosis of distal symmetric sensorimotor polyneuropathy, a common complication of diabetes, may decrease morbidity by allowing potential therapeutic interventions.
Methods: In 68 diabetic patients after neuropathy screening by U.K and Michigan scores, Bilateral sural nerve conduction parameters as nerve conduction velocity, latency and amplitude were determined and analysed.
Results: 54.4% of patients had Rt sural abnormal response, 50% had abnormality in left side and 39.7% had bilateral abnormality. There was significant statistical correlation between Michigan physical score and electrophysiologic finding (P-value < 0.003) but no correlation with U.K score (P-value > 0.3). The most prevalent abnormal electrophysiologic finding was amplitude decrement of sural response.
Conclusion: Sural nerve response is one of the simplest and most sensitive peripheral sensory nerves for electrophysiologic study of diabetic neuropathy and its evaluation is recommended in all diabetic patients in spite of normal physical examination and history for detection of subclinical neuropathic cases. For increment of sensitivity, amplitude measurement of sensory response is highly recommended.