Iranian Journal of

---

Background: Diabetes is a hidden epidemic and the most common metabolic disorder in the world. Immune dysfunction (cellular and humoural) is one of the consequences of diabetes, including defects of phagocyte function, notably in chemotaxis, phagocytosis, and killing. Results of studies on phagocyte respiratory burst activity, however, have been contradictory. We studied the respiratory burst of peripheral blood neutrophils and monocytes separately in response to formyl-met-leu-phe (fmlp) and phorbol-12,13-myristate acetate (PMA).
Methods: 36 patients with type 2 diabetes (mean age 53±7 years) and 20 healthy controls (mean age 50±5 years) each provided a 15ml blood sample. Peripheral blood neutrophils and monocytes were separated and purified (>95%) using specific density gradients and short-term culture. We then separately assessed respiratory burst activity in response to fmlp and PMA by the semi-quantitative nitroblue tetrazolium (NBT) test.
Results: Following stimulation with PMA, diabetic neutrophils showed reduced respiratory burst activity compared with normal neutrophils (p=0.097). Following stimulation with fmlp, too, diabetic neutrophils showed reduced respiratory burst activity compared with normal neutrophils, which this time was statistically significant (p=0.027). There was no difference between diabetic and normal subjects with regards to monocyte response to either fmlp or PMA.
Conclusion: It appears that the diminished response and reduced effectiveness of the phagocyte system in people with diabetes can facilitate the onset, exacerbation, and persistence of infection.

---

Patients with type 2 diabetes have a higher risk of coronary heart disease and a worse prognosis compared with patients without diabetes. In this study, the prevalence of cardiovascular risk factors have been investigated in type 2 diabetic patients.
Methods: A Cross Sectional study with a target population of known type 2 diabetic subjects was conducted in 2002 in Isfahan. From registered patients, 1150 were selected and evaluated for age. sex.duration of diabetes, BMI, hypertension, lipid profile, proteinuria, fasting blood glucose. HbAlc and smoking using convenience sampling methods.
Results: Mean fasting blood glucose and HbAl were 165.16 x 53.4 mg/dl and 9.2+ 3.5 percent respectively. The number of women with 3 cardiovascular risk factors was significantly greater than men (50.7% VS 33.5% PO.001). 19.5% of men and 50.2% of wjomen had high serum cholesterol level (>230 mg/dl). The prevalence of obesity (BMI >30Kg/m2) was 13.6% for men and 30.8% for women. 56.6% were hypertensive and 29.3% had proteinuria (P<0.001).
Conclusion: Cardiovascular risk factors are present in a considerable proportion of studied type 2 diabetic patients. Control of risk factors and life style modifications should be tightly considered in order to decrease the prevalence ofTHD in the up -coming years of their life.

---

Background: Diabetic nephropathy is a leading cause of end-stage renal disease (ESRD) in developed countries. This study was designed to determine the proportion of the diabetic patients among under-hemodialysis patients in ten hemodialysis centers of Tehran. Methods: This descriptive, cross-sectional study was done on all under-hemodialysis patients of ten hemodialysis centers (620 patients) during 2001-2002. Data were collected by taking history of the patients and reviewing their medical records. The data were analyzed to find out the frequency of the diabetes and the risk factors associated with diabetic nephropathy such as age, sex, type and duration of diabetes, smoking, hypertension, dyslipidemia, ischemic heart disease and the family history of diabetes and hypertension. Results: Diabetes was the cause of ESRD in 25% of patients aged 32 to 89 years old. The most frequent age group was 7th decade. 9% of diabetic patients suffered from type 1 and 91% of them suffered from type 2 diabetes. Patients with the diabetes duration of 15-19 years had the most frequency. 40% of patients were female and 60% of them were male. History of hyperglycemia, hypertension, dyslipidemia, ischemic heart diseases and smoking were positive in 48%, 82.5%, 46%, 41%, and 21% of patients, respectively. Conclusion: The results of this study are in agreement with other studies in this field. Diabetic patients compose a remarkable percentage of under-hemodialysis-patients. High frequency of risk factors in these patients should promote controlling them to prevention ESRD.

---

Background: The liver plays a main role in the production and metabolism of lipoproteins, and then impaired lipid metabolism is often seen in patients with liver cirrhosis and chronic hepatitis (CH). As a result, plasma lipid levels could be as useful indicators of liver function and patient's prognosis especially in liver cirrhosis.
Methods: We measured the lipoprotein levels in 77 consecutive patients with liver cirrhosis and CH. 47 men (61%) and 30 women (39%) with mean age 43years (SD=16.4) and mean BMI 26(SD=4.2) have been recruited as patients group. Child score and MELD scale was determined in patients group. The control group was age and sex matched with patients group.
Results: In case group, the levels of HDL LDL, TG, and total cholesterol were significantly lower than control group (p <0.0001). In patients with cirrhosis, the levels of LDL, HDL and total cholesterol were progressively lower when comparing patients in Child class A with patients in class C (p<0.0001).This difference was more significant in LDL and total cholesterol and between upper Child scores ,similarly decreasing in LDL, HDL ,and total cholesterol level was observed when MELD score increased (P<0.0001).
Conclusion: There is a correlation between plasma lipid levels and liver function, so it may be mentioned as an accessible and reliable indicator of liver function in cirrhotic and CH patients.

---

Background: Retinopathy is one of the microvascular complications of diabetes which is strongly related to the glycemic control and duration of the disease. According to results of other studies, the prevalence of retinopathy has been reported 5-30% in newly diagnosed patients whit type 2 diabetes (T2DM). The aim of this study was to determine the prevalence of idabeteic retinopathy among newly diagnosed T2DM patients in Isfahan, Iran.
Methods: From july 2001 to March 2004, 710 newly diagnosed patients with T2DM were recruited in this study. Patients with duration of diabetes less than 1 year were considered as newly diagnosed ones. Along with physical examination and laboratory measurment for FBS, HbA1c, lipid profile, urea, Creatinin, and 24 houre urin examniation for albumin, retinoscopy was performed by an experienced ophttalmologist.
Results: In this study, 286 men and 424 women were investigated. The mean age of patients at presentation and the mean duration time of diabetes were 48.8 ±9.8 years (range 31-72years) and 8.6±5.4 months respectively. The prevalence of retinopathy was 9 % (9/8% in males and 8.5% in females). Logistic regression analysis revealed that BMI, diastolic blood pressure and 24 hour urine albumin, were independent risk factors for developing retinopathy.
Conclusion: Nevertheless of relatively moderate prevalence of diabetic retinopathy in our study as compared with other studies, it is necessary to perform retinal examination in newly diagnosed T2DM patients in order to prevent the sight-threatening outcomes of diabetic retinopathy.

---

Background: Microalbuminuria represents the earliest clinical of renal involvement and reflects the progression of diabetic nephropathy and increased risk of mortality in diabetic patients. The incidence of diabetic nephropathy in type 2 diabetes differs widely by race .The aim of this study was to determine the incidence of and risk factors for microalbuminuria in type 2 diabetic patients.
Methods: As a cohort study 505 (22%male, mean age: 57.4±9.5 years and diabetes duration 10.2±4.7 years at initial registration) type 2 diabetic patients with initial normoalbuminuria were followed prospectively for 5 years in isfahan endocrine and metabolism research center. Patients were evaluated for BMI ,HbA1c, blood pressure, lipid profile, serum creatinine and 24 hours urine albumin. Normoalbuminuria were defined as urine albumin excretion less than or equal to 30 mg/24 h and microalbuminuria as 31-299 mg/24 h. Logistic regression model were used to assess the associations.
Results:176 revealed persistently elevated UAE during follow-up, giving an incidence of 82.3/1000 person-years(95%CI:78/3-86/2). Incidence of microalbuminuria were significantly higher in men than wemen(104.4 and 66.2/1000 person-year, P<0.001).The mean values of HbA1c, duration of diabetes, systolic hypertension and serum creatinin during the follow-up period were significantly higher in the microalbuminuric than in the normoalbuminuric patients. Age, BMI, cholesterol and triglyceride were not significantly different in two groups. Logistic regression analysis revealed that duration of diabetes, HbA1c, high blood pressure and retinopathy during follow-up are independent variables that have a statistically significant influence on the development of microalbuminuria.
Conclusion: These result revealed that microalbuminura in this population of type 2 diabetic patients were common and higher than of other studies. These findings suggest that urine excretion of albumin should be monitored routinely in this patients for detection early stages of nephropathy and effective treatment of microalbuminura and associated risk factors are very important.

---

Background: Overweight is one of the most worldwide health problems particularly in industrial and developed communities. Obese subjects are at high risk for developing various disorders such as diabetes and especially cardiovascular diseases. It has been well established that life style modification plays an important role in reducing these complications, particularly weight reduction and caloric restriction (CR) as a non- pharmacological approach. In the present study the possible effects of caloric restriction on Nitric Oxide production and blood pressures in rat were investigated.
Methods: Four groups of rats were selected as control(C), caloric restriction (CR), diabetic (D), and caloric restriction diabetic (CRD). Control animals fed freely with standard pellet but caloric restricted animals fed an every other day diet for 4 weeks. The systolic blood pressure (SBP) was measured in all groups using the tail-cuff method under the light general anesthesia induced by ether. Nitric oxide (NO x) concentrations were determined in serum using a colorimetric non- enzymatic NO assay kit .
Results: In CR experimental groups (CR&CRD) SBP was significantly decreased as compared to control: (P<0.001) and diabetic (P<0.01) rats , while the serum NO x was significantly increased (P<0.01) in both groups as compared to control and diabetic rats.
Conclusion: On the basis of obtained results, it could be concluded that caloric restriction may reduce blood pressure and increase nitric oxide in diabetic and non-diabetic rats. Increase nitric oxide is the likely mechanism for decreasing blood pressure .

---

Background: Type 2 diabetic patients have higher risk for death from coronary heart diseases than non-diabetic patients. Studies have revealed showed intensive treatment of hyperglycemia only have a small effect on CVD risk. Other risk factors such as Lipid abnormality play a leading role in the increased CVD risk associated with diabetes. The aim of this study was to assess the quality of lipid control and treatment in type 2 diabetic patient with dyslipidemia. 

Methods: We studied Data from 602 type 2 diabetic patients who had at least four regular clinic visits every year for medical care in outpatient clinics of Isfahan Endocrinology and Metabolism Research Center, 1999-2003. Patients for Classified in three groups according to lipid levels as low, moderate and high risk. ADA )American Diabetes Association) standard criteria were used for appropriate lipid control.

Results: The mean age, duration of diabetes, HbA1c and BMI were 52.2±9.5 years, 6.8±4.6 years, 9.2±1.7% and 29.4±4.2 Kg/m2 respectively at initial registration. Eighty four percent of patient had LDL cholesterol above 100 mg/dl and 71% had triglyceride level >150 mg/dl, of these patients 47.8% and 41.6% had high risk levels and only 12.4% taking statins and 21.5% taking fibrate for treatment  at end of study. Among hyperlipidemic patients levels of LDL-C decreased from 170.8±35.6 mg/dl to119±30.20 (p < .001), triglyceride decreased from 273.8±126 to225.2±97 mg/dl (P<0.004) and HDL-C increased from 43.3±10.6 to 48.4±14.1mg/dl ((P<0.6). Percentage change of lipid level was -35.8%, -17.7% and +7.3% respectively. At the end of fallow-up 50.4% of patients treated with statins and 14.7% with fibrate. Finally, overall control of cholesterol and triglyceride in patients with dyslipidemia was 30% and 37% respectively.

Conclusion: Our findings showed that many of type 2 diabetic patients with dyslipidemia have inadequate control of lipid and lipoprotein. The prevalence of cardiovascular events due to hyperlipidemia in type 2 diabetic patients is high. This fact demonstrates the importance of early interventions for control and treatment these risk factors for prevention of cardiovascular complication in this patients.

---

Background: The prevalence of depression in diabetic patients is 2-3 times more than general population. The quality of life (QOL) and glycemic control are two important outcome measures of diabetes management. The aim of this research is to study the relationship between depression, glycemic control and QOL in a sample of Iranian diabetic patients.

Methods: One hundred diabetic patients who were referred to diabetes clinic of Dr. Shariati Hospital were included in the study consecutively. The depression subscale of Hospital Anxiety and Depression Scale (HADS-D) were used to determine depression. The World Health Organization Quality of life brief version questionnaire (WHOQOL-BREF) was used to measure QOL. The status of glycemic control was evaluated through measuring HbA1c. Other measured variables included:  demographic variables, smoking, diabetes type, body mass index, duration and complications of diabetes and previous history of depression. The linear regression method was implemented to analyze the data.

Results: Depression was observed in 28% of the patients. Glycemic control had a reverse significant correlation with diabetes complications. No significant relationship was found between HbA1c and scores of HADS-D. WHOQOL-BREF subscales scores had no significant relationship with glycemic control. There was a significant relation between scores of HADS-D and WHOQOL-BREF subscales.

Conclusion: Improving quality of life (QOL) is one of the main outcomes in the management of diabetes. According to the result of this study, depression had a prominent relationship with QOL. Thus, careful management of depression may be necessary to improve QOL of diabetic patients.

---

Background: Adiponectin and omentin-1 are adipokines with insulin-sensitizing properties. The aim of this study was to investigate the effect of resistance training on serum levels of adiponectin and omentin-1 in Streptozotocin-induced diabetic rats. Methods: Twenty four male Wister rats (12-14 weeks’ old) were randomly divided into three groups: non-diabetic control, diabetic control, and diabetic training. The rats in diabetic training group were subjected to a resistance training program (3 days/wk, for 4 wk) consisted of climbing a ladder carrying a load suspended from the tail. Following four weeks resistance training serum glucose, insulin, lipid profile, adiponectin, and omentin-1 concentrations were measured. Results: Serum levels of omentin-1 and adiponectin were significantly lower in diabetic control group compare with non-diabetic control group (P<0.001). After 4 weeks of resistance training serum adiponectin levels was significantly higher in diabetic trained group compared with diabetic control group (P= 0.028), but we did not find any significant difference in omentin-1 levels between two diabetic groups. Morever, we did not find any significant difference in serum lipid profile among all groups. Four weeks resistance training did not change serum glucose and insulin concentrations in diabetic rats. Conclusion: This study indicated that resistance training could increase serum adiponectin levels in diabetic rats without significant changes in lipid profile, glucose, insulin, and omentin-1 concentrations. It seems low intensity and short term duration of resistance training had important roles in failure of significant changes of omentin-1, glucose, and insulin concentrations.

---

Background: kallikrein 7 (KLK7), a serine protease with a chymotrypsin-like specificity, is able to cleave human insulin in the A- and B-chain. The aim of this study was to investigate the effects of aerobic exercise training on plasma KLK7 concentration and insulin resistance index (HOMA-IR) in normal and overweight sedentary women.

Methods: Twenty-eight sedentary women, aged 24-60 years, voluntary participated in this study and according to body mass index status divided into normal (n=15) and overweight (n=13) groups. All subjects completed an 8-week progressive aerobic exercise training program (running with 40- 80% Heart rate reserve). Metabolic and Anthropometric (body weight, BMI, body fat percentage) parameters in addition to plasma KLK7 concentrations were measured at baseline and end of training program.

Results: Body fat percentage significantly decreased (P<0.05) and maximum oxygen consumption increased (P<0.05) by this training program in both training groups. At baseline, plasma KLK7 concentration in overweight women was significantly higher compared with normal weight group (P<0.05). Plasma KLK7 concentrations significantly increased after 8-week aerobic exercise training only in normal weight group (P<0.05). Changes in plasma KLK7 concentrations were not correlated with changes in insulin concentration and insulin resistance index (P<0.05).

Conclusion: Aerobic exercise training could be an effective factor to increase plasma KLK7 concentration in sedentary women. These data do not support a role of plasma KLK7 in insulin resistance alterations.

---

Background: Visfatin is an adipokine secreted from visceral adipose tissue and involved in glucose homeostasis. The aim of the present study was to investigate the effect of eight-week resistance training on plasma visfatin levels and its relation to insulin resistance in insulin-resistant male rats.

Methods: In this experimental study twenty-four Wistar male rats­ (220±20 gr) were acclimatized with lab condition then were randomly divided into three groups: Control (C), Insulin-Resistant control (IRC) and Insulin-resistant Training (T) groups. Insulin-resistance status induced by %10 fructose solution during 5 weeks. Resistance training group subjected to a three-day per week resistance training program for 8 weeks. Plasma visfatin, insulin, glucose levels, and insulin resistance index were assessed 48 hours after experimental period. Data were analyzed using one-way ANOVA and statistical significance was set at P<0/05

Results: The results showed that insulin resistance induction significantly increased plasma visfatin, glucose, insulin levels and insulin resistance index (P<0.05). On the other hand, resistance training significantly decreased plasma visfatin, glucose, and insulin levels (P<0.05) but visfatin was not altered significantly (P<0.05).

Conclusion: Based on the findings, visfatin increases in diabetes and insulin resistance and is correlated with insulin resistance. The change in plasma visfatin levels was not significant following resistance training and it was not correlated with insulin resistance index. Therefore, visfatin may not have a role in metabolic improvement induced by exercise training.

---

Background: Diabetes mellitus is one of the most common chronic diseases and the patient's quality of life plays an important role in controlling the disease. The purpose of this study was to investigate the mediating role of quality of life in the relationship between depression, stress and anxiety, with severity of diabetes.
Methods: 108 patients with type 2 diabetes (57 women, 51 males) participated in this study. The participants completed the 21st-DASS Questionnaire, a quality of life questionnaire (SF-36), and a demographic questionnaire.
Results: The results of the study showed that the severity of the disease was negatively correlated with quality of life and positively correlated with anxiety, depression and stress (P <0.01). The results of path analysis also indicated the mediating role of quality of life in the relationship between depression and anxiety and the severity of type 2 diabetes.
Conclusion: Based on the results, it is necessary to consider psychological interventions in order to reduce depression and anxiety and improve the quality of life of patients in the field of diabetes management.