Iranian Journal of

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Background: Chronic complications of diabetes causes substantial mortality and morbidity. The incidence and rate of progression of these complications depends on ethnic factors. The aim of this study was to investigate the incidence of late complications of diabetes and its relation to blood glucose control in a group of diabetic patients from South of Iran.
Methods: In this retrospective study, medical records of all diabetic patients who were followed regularly during a 12 year period at outpatient clinics of Shiraz University of Medical Sciences were investigated. Information regarding age, sex, type of diabetes, duration of disease , mean fasting and postprandial blood sugar, complications (eye, kidneys, peripheral nerves, foot, cardiovascular, cerebrovascular), and timing of complications with regard to duration of disease were collected.
Results: The study population included 392 patients (205 males and 186 females), 300 patients had type 2 and 92 had type 1 diabetes. The mean age at diagnosis was 20.412.8 years for type 1 and 47.510.4 years for type 2 patients. 95% of patients developed at least one chronic complication during the follow-up period. The incidence rates of eye , renal, and peripheral nerve complications were 51.5, 44.7, and 68.8 percent respectively. Diabetic foot problems occurred in 16.8 percent of cases and it led to amputation in 8.4 percent (33 cases) of patients. The incidence rates of cardiovascular and cerebrovascular complications were 49.7 and 15.3 percent respectively. The development of eye, renal, and peripheral nerve complications was related to blood sugar control.
Conclusion: Our diabetic patients developed chronic complications early and at a higher than expected rates. Future studies and more emphasis on prevention methods are recommended.

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Background: This study was performed to evaluate the prevalence and risk factors of asymptomatic bacteriuria (ASB) in women with type 2 diabetes mellitus in Iranian population.
Methods: Between March 2003 and December 2003, 202 nonpregnant women with diabetes type 2 who were between 31 to 78 years old and had no abnormalities of the urinary tract system were included. We defined ASB as the presence of at least 105 colony-forming units/ml of 1 or 2 bacterial species, in two separated cultures of clean-voided midstream urine. All the participants were free from any symptoms of urinary tract infection (UTI). Risk factors for developing bacteriuria was assessed and compared in participants with and without bacteriuria.
Results: In this study, the prevalence of ASB was 10.9% among diabetic women. E.coli was the most prevalent microorganism responsible for positive urine culture. Most of the isolated microorganisms were resistant to Co-trimoxazole, Nalidixic acid and Ciprofloxacin. Pyuria (P<0.001) and glucosuria (P<0.05) had meaningful relation with bacteriuria but no association was evident between age (P<0.45), duration of diabetes (P<0.09), macroalbuminuria (P<0.10) and HbA1c level (P<0.75), and the presence of ASB.
Conclusion: The prevalence of ASB is more prevalent in women with type 2 diabetes, which pyuria and glucosuria can be considered as risk factors in this regard. Routine urine culture can be recommended for diabetic women even when there is not any urinary symptom.

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Background: All contemporary methods of insulin administration are non-physiological. Insulin is not absorbed from the gastrointestinal tract because of its peptide nature. The aim of the present study was to examine the absorption of oral insulin from gastrointestinal tract, using novel oral formulation- adding a delivery agent superporouse hydrogel (SPH) and SPH composite (SPHC) in combination with insulin.
Methods: Capsules containing insulin and SPH &SPHC were administered orally, to 15 non-diabetic subjects in order to assess its biological effects and safety. Plasma glucose, insulin and c – peptide serum levels were determined, at timed intervals up to 4 h.
Results: In the present study, we showed that AUC of exogenous insulin in polymer -insulin group was higher than sub-cutaneous regular insulin group. It means that addition of SPHC polymer caused increase in insulin absorbtion.In addition, Insulin Tmax in polymer group was longer than sub-cotaneaus insulin group. Blood glucose AUC in sub-cotaneaus group was higher than polymer group.AUC C-peptide serum level in polymer group was higher than sub-cutaneous group.
Conclusions: Insulin in combination with a novel delivery agent, SPH and SPHC, given orally is absorbed through the GI tract in a biologically active form. This was demonstrated by suppression of endogenous insulin secretion.

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Background: Obese patients are usually thought to have an increased risk for complications in coronary artery bypass grafting surgery (CABG). Several studies have been unclear about the relationship between obesity and the risk of adverse outcomes. The aim of this study was to assess the relationship between Body Mass Index (BMI) and in-hospital mortality following CABG.
Methods: Between December 2003 and February 2005, 1258 patients who underwent isolated CABG at Tehran Heart Center were included in this study. Patients were divided into three groups according to their BMI. Patients in group I had BMI<30 (non obese patients). In group II patients had (obese patients). Patients in group III had (very obese patients). Patients in each group were followed for in-hospital death and variables were compared to find any statistically meaningful relationship.
Results: No significant difference was found between non obese and obese patients (group I & II), but hypertension was more prominent in very obese patients (group III) and female sex was more prevalent in this group comparing two other groups. Mortality was more in the 3rd group as well. In non obese diabetic patients, the rate of mortality was higher than other patients. Logistic regression showed that BMI can not be considered as an independent factor to predict the risk of death in post CABG in-hospital mortality. Conclusion: It seems, in coronary artery bypass grafting, BMI is not an independent factor for predicting in-hospital mortality.

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Background: All contemporary methods of insulin administration are non-physiological. The euglycemia that is achieved in at the expense of the adverse effects of systemic hyper-insulinemia, emphasize the importance of devising methods to deliver insulin physiologically and directly into the portal circulation. The aim of the present study was to evaluate the oral absorption of insulin from gastrointestinal tract, using novel oral drug delivery system delivery based on superporouse hydrogel (SPH) and SPH composite (SPHC) in combination with insulin.
Methods: This study has been done based on interventional clinical trial in healthy volunteers. Capsules containing insulin and SPH &SPHC in various combination were administered orally, to 15 non-diabetics subjects in order to assess this biological effects and safety. Serum glucose, insulin and C - peptide levels were determined, at predetermined timed intervals up to 4 h.
Results: An increase in serum insulin level was demonstrated in all subjects that used polymer plus insulin. The nadir of serum glucose level appeared after 60 - 120 min following the ingestion of polymer plus insulin. Serum C - peptide levels were suppressed while exogenous insulin was absorbed at the same time. No adverse effects were detected during the trial and several weeks following the trial using SPH based drug delivery system.
Conclusions: Insulin in combination with novel delivery agents, SPH & SPHC, given orally was partially absorbed through the GI tract in a biologically active form. This was demonstrated by serum glucose lowering effect of the delivery system as well as a suppression of plasma C-peptide which also represented a decrease in endogenous insulin secretion.

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Background: In many studies, Serum lipoprotein(a) [Lp(a)] levels considered as an independent risk factor for atherosclerosis. The aim of this study was to assess the association between Lp(a) and cervical carotid artery stenosis in one sample the Iranian population.
Methods: As a cross sectional study, between June 2004 and January 2005, at Tehran Heart Center, 1189 candidates for any kind of open heart surgery, were recruited into this study. Carotid Dopplers ultrasonography was performed for all participants. Serum levels of Lp(a), total cholesterol, triglyceride and blood sugar and quantitative CRP were measured in fasting state and their correlations with carotid atherosclerosis were assessed.
Results: Among 1189 participants, 837 (70.5%) were male and 352 (29.4%) were female. Their mean age was 60±9.3 years (range between 35 to 88). There was not significant relation between Lp(a) serum levels and carotid artery stenosis (P=0.46). The relationship between Lp(a) levels and carotid artery stenosis in both ≤55 years and >55 years patients was not significant too (P=0.25). Also gender has no relationship in this regard (P=0.15). Significant relationship was found between Lp(a) level & hypoecho plaques (vulnerable lesions) (P=0.001).
Conclusion: In our study, we found no significant correlation between serum Lp(a) and carotid stenosis. Lp(a) was found to have positive relationship with hypoecho plaques (vulnerable lesions) which predispose patients for CVA. Further investigations suggest for better evaluations.

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Background: The relationship between diabetes and periodontal diseases has already been proved, but the effect of non-surgical periodontal therapy on the control of diabetes is controversial. The aim of this study was to determine the effect of this type of treatment on the control of diabetes.
Methods: In this randomized clinical trial 30 type 2 diabetic patients with moderate to severe periodontitis who were referred to the diabetes clinic of Imam Khomeini hospital during 2004-2005 were studied. The treatment procedure was explained for control group and an informed consent was taken. Scaling and root planning was randomly done for 15 patients, while control group were not treated for periodontal disease. The glycated hemoglobin (HbA1C) and clinical attachment loss was measured for all of the patients before and 2 months after treatment.
Results: At the baseline the clinical attachment loss (CAL) was significantly different between two groups. There was no significant difference between baseline HbA1C in the control and the experimental group. After 2 months the HbA1C was reduced in the treated group which was not statistically significant.
Conclusion: In this study non-surgical periodontal therapy had not effect on the control of type 2 diabetes.

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Diabetes among Eastern Mediterranean (EM) population above age of 20 years is around 10.5% and is ranked among the leading causes of blindness, renal failure and lower limb amputation. While 50% of EM people with diabetes will die of cardiovascular diseases. This means that in our region, there are pandemic trends in prevalence of diabetes and associated complications. Globally, people with diabetes are 25 times more likely to have a leg amputated than those without the condition, and up to 70% of all leg amputations happen to people with diabetes. Somewhere in the world, a leg is lost to diabetes every 30 seconds. Foot ulcer is the most common single precursor to lower extremity amputations among diabetics. Hyperglycemia, impaired immunologic responses, neuropathy, and peripheral arterial disease are the major predisposing factors leading to limb-threatening diabetic foot infections. Diabetic foot represents a health problem and economic burden among majority of EM Countries. Infection in a diabetic foot is limb-threatening and must be treated empirically and aggressively. Treatment of infected foot wounds is the most common reason for diabetes- related hospitalization. The good news is that up to 85 percent of diabetic amputations can be prevented. As to above challenge, the best approach for EMR is education, community awareness and prevention of diabetic foot. The public approach and education that emphasize on proper footwear and foot care are best preventive and cost-effective modalities that can be easily implemented among EM Countries. EM Countries need to strengthen national health services that promote the concept of prevention and tight control of diabetes in order to prevention diabetes complications. This also necessitates building/strengthening diabetes registry and complications.

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Background: Use of medicinal plants for attenuation of hyperglycemia and restoration of lipids to normal levels is very important. The effect of oral administration of Vaccinium myrtillus (VM) on serum glucose and lipids in diabetic rats was investigated.
Methods: Female Wistar rats were divided into 4 groups: control, VM-treated control, diabetic, and VM-treated diabetic groups. The treatment groups received oral administration of plant-mixed food (6.25%) for 4 weeks. Serum glucose, triglyceride, total cholesterol, LDL- and HDL- cholesterol levels were determined before the study, and at 2nd and 4th weeks after the study.
Results: Serum glucose level in diabetic group increased 2 and 4 weeks after the experiment as compared to data one week before the study (P<0.001) and VM treatment of diabetic rats did have a significant hypoglycemic effect (P<0.01). In addition, triglyceride level in diabetic group increased 4 weeks after the experiment in comparison with related data one week before the study (P<0.05) and there was a significant lower level of triglyceride in VM-treated diabetic rats (P<0.05). Furthermore, there was no significant changes regarding serum total cholesterol, HDL- and LDL- cholesterol levels in treated diabetic group as compared to untreated diabetic group.
Conclusion: Oral administration of VM has a significant hypoglycemic effects and leads to an appropriate changes only in triglyceride level.

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Background: Type 2 diabetes mellitus is the most common type of diabetes which is triggered by various factors such as obesity, hyperlipidemia, hypertension, dietary habits and inheritance. With respect to geographic variation of diabetes prevalence, it is important to know the risk factors regionally.

Methods: As a case-control study, we looked for important risk factors of diabetes in our region. This study consisted of 400 individuals in case group and 400 individuals in control group. All these anthropometric measurements were calculated by standard methods. Blood samples taken from two groups were studied for TG, FBS, Cholesterol and HbA1c. Data are reported as the Mean±SD. P<0.05 was considered as statistically significant.

Results: There was no significant difference between two groups about mean age and sex ratio. Statistically significant difference were found for central obesity, hyperlipidemia, hypertension, polycystic ovarian syndrome (PCOS) and positive family history of diabetes in both groups (P<0.05).

Conclusion: The results showed that central obesity, hyperlipidemia, hypertension, PCOS and positive family history of diabetes are important risk factors of diabetes mellitus in Shiraz. In concordance with the results of this study, screening programme for that risk factor of diabetes in this region is suggested.

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Background: The relationship between diabetes and serum insulin and Zinc (Zn) levels is complex with no clear cause and effect relationships. Since Zn plays a clear role in the synthesis, storage and secretion of insulin as well as conformational integrity of insulin in the hexametric form, the decreased Zn, which affects the ability of the islet cell to produce and secrete insulin, might then compound the problem, particularly in type 2 diabetes. The aim of this study was to determine the changes of plasma Zn in patients with type 2 diabetes mellitus and healthy control in Shiraz city.
Methods: As a case-control study, we determined the serum Zn levels by atomic absorption spectrophotometer, blood HbA1c levels with columnar chromatographic method and Glucose, by enzymatic colorimetric method in auto analyzer. Data are reported as the Mean±SD and P<0.05 was considered as statistically significant Results: Results of this study revealed that levels of Zn in serum of diabetic patients is lower than in the healthy control in Shiraz city (P<0.05).
Conclusion: With respect to the result of this study, dietary educations about consuming enriched Zn foods such as sea foods and corn in diabetic patients is necessitated.

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Background: Food insecurity refers to the inability to afford enough food for an active, healthy life. The metabolic syndrome, otherwise known as syndrome X or the insulin resistance syndrome, is a collection of cardiovascular risk factors including hypertriglyceridemia, lowered HDL-cholesterol, glucose intolerance, abdominal obesity and hypertension. Recent studies indicate widespread prevalence of food insecurity and metabolic syndrome in various regions of Iran. No studies have been conducted so far to investigate the relationship between food insecurity and the metabolic syndrome in Iran. This study was conducted to investigate the relationship between food insecurity and metabolic syndrome in women. Methods: In this study, 130 women 30 to 60 years old with metabolic syndrome as cases and 130 women without metabolic syndrome as controls referred to clinics affiliated to Shiraz University of Medical Sciences were selected. The USDA household food security questionnaire was used to assess food insecurity status. The metabolic syndrome was defined according to the criteria of the Adult Treatment Pane l II (ATP III). Results: The prevalence of food insecurity was 69.2% in cases and 45.4% in controls (P< 0.001). After multiple logistic regression and removal of potential confounders, food insecurity was significantly associated with metabolic syndrome (OR3.2&CI 95%: 1.9-5.6)(P<0.05). Conclusion: Given that food insecurity is an important risk factors for metabolic syndrome, Planners should reduce food insecurity in society, especially women through measures to improve the economic situation and dietary patterns of households.

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Background: There are no available reports indicating the effects of Dietary Approaches to Stop Hypertension (DASH) eating plan on insulin resistance, inflammation and oxidative stress among pregnant women with gestational diabetes mellitus (GDM) We aimed to investigate the effects of DASH diet on insulin resistance, serum hs-CRP and biomarkers of oxidative stress among pregnant women with GDM. Methods: This randomized controlled clinical trial was performed among 32 pregnant women diagnosed with GDM at 24-28 weeks' gestation. Subjects were randomly assigned to consume either the control (n=16) or DASH diet (n=16) for 4 weeks. The DASH diet was rich in fruits, vegetables, whole grains, and low-fat dairy products and low in saturated fats, total fats, cholesterol, refined grains, and sweets, with a total of 2400 mg/d sodium. The control diet contained 40-55% of its energy as carbohydrates, 10-20% as proteins and 25-30% as total fats. Fasting blood samples were taken at baseline and after 4 weeks of intervention to measure fasting plasma glucose (FPG), serum insulin and hs-CRP, HOMA-IR, plasma total antioxidant capacity (TAC) and total glutathione levels (GSH). Results: Consumption of DASH diet, compared to the control diet, resulted in decreased FPG (-7.62 vs. 3.68 mg/dL P=0.02), serum insulin levels (-2.62 vs. 4.32 µIU/ml, P=0.03) and HOMA-IR score (-0.8 vs. 1.1 P=0.03). Increased concentrations of plasma TAC (45.2 vs. -159.2 mmol/L P<0.0001) and GSH (108.1 vs. -150.9 µmol/L P<0.0001) were also seen in the DASH group compared with control group. We failed to find a significant difference in mean changes of serum hs-CRP levels between the two diets. Within-group comparisons revealed a significant reduction in plasma TAC and GSH levels in the control diet, while a significant rise in these biomarkers in the DASH diet. Conclusion: In summary, consumption of DASH diet in pregnant women with GDM had beneficial effects on FPG, serum insulin levels, HOMA-IR score, plasma TAC and total GSH levels. The effects of this dietary pattern on pregnancy outcomes need to be investigated in future studies.

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Background: Diabetes is a chronic disease that is increasing in the world that has a different outbreak in different societies. 90% to 95% of all types of diabetes include type 2 diabetes. This disease is spreading due to the Industrial life and urbanization .The Nationwide Program for Prevention and Control of Diabetes is already under way for controlling the disease and its side-effects. This study is intended to probe into the effects of the program in the country.
Methods: This study used a cross-sectional pre- and post-test design involving 100 elderly patients newly introduced to be suffering from diabetes who were selected by convenience sampling in Isfahan. The data collection methods were a questionnaire on demography and health, and another one on patients’ levels of fasting blood sugar (FBS) and hemoglobin glycosides (HbA1c(The data was gathered before and three months after the patients’ entrance into the program.
Results: The mean and standard deviation of the fasting blood sugar before the program were 172.73 and 71.68 and after the program 143.02 and 51.19, respectively (P<.001; t=5.30). And finally, glycated hemoglobin mean and standard deviation before the program were 8.24 and 1.9 and after the program 7.44 and 1.66, respectively (P<.001; t=4.79).
Conclusion: The results indicate the importance of the program for the prevention and control of the elderly patients’ diabetes by controlling their fasting blood sugar and glycated hemoglobin.It is recommended that this program be implemented in all health centers of the country.

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Background: Prevalence of obesity and overweight in women increases the possibility of metabolic syndrome and diabetes. Based on the variety of the effects of different type of exercise and the differences in the upper and lower body muscle volume involved in the exercise, the effects of high intensity interval exercise with arm and leg ergometer on metabolism and insulin resistance might be different. The aim of this study was to compare the effect of upper and lower body interval exercise on carbohydrate metabolism and insulin resistance in obese women.
Methods: Twelve obese and overweight women (body mass index, 31.1±5.5 kg/m²) performed two interval exercise trials of 30-min on arm and leg ergometer with one week intervening. Interval exercise included 5 sets of 6 min in which 2- min activity at 85% VO_2max and 4 min active rest at 45% VO_2max was performed. Two blood samples were taken before and immediately after exercise for measuring glucose and insulin. VO₂ and VCO_2m were collected during exercise and used to calculate the amount of carbohydrate oxidation.
Result: Although interval exercise reduced the insulin concentration, responses of insulin to upper and lower body exercises were not significantly different (P>0.05). Glucose level reduced following interval exercise, and this reduction was significantly (P<0.05) higher following lower body interval exercise than upper body exercise. Similarly the reductions in HOMA-IR were significantly (P<0.05) higher following lower body interval exercise than upper body exercise. Interval exercise resulted in increases in oxidation of carbohydrate, though; responses to upper and lower exercises were not significantly different.
Conclusion: It could be concluded that interval exercise in obese women leads to changes in carbohydrate metabolism and insulin resistance, and that the changes in insulin resistance are related to type of exercise (upper and lower body), though carbohydrate oxidation is not.
 

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consumption of medicinal plants, especially when conventional treatments are not able to control diabetes, and the patient needs insulin administration, is remarkable. The aim of this paper is the attitude and social behaviors of Bandar Abbas 's people to consume of herbal medicine in treatment of DM.

Methods: This descriptive cross-sectional study was conducted in 2017. In this study, 300 individuals aged 20 to 65 years were selected randomly from 10 locations in Bandar Abbas. The research instrument was a two-part questionnaire that evaluated demographic information and attitude. Data were analyzed by SPSS-24 software using descriptive statistics (mean, standard deviation and frequency), ANOVA, T-test Independent and Chi-Square tests.
Results: The mean and standard deviation of people's attitude toward using herbal drugs in the treatment of diabetes was 47.15±3.23. The mean score of attitude with gender variables (P = 0.002), age (P = 0.04) and education (P = 0.02) was statistically significant. The majority of people had their information on herbal medicines through their parents and relatives, and this difference was statistically significant in distributing the frequency of information sources in individuals. (P = 0.001)

Conclusion: According to the results of this research, people's attitude towards the use of herbal medicines in the treatment of diabetes was at a relatively good level, which can play a constructive role in the scientific and executive planning of the health and medical professions.

 

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Background: Due to the progress of diabetes and the use of alternative herbal medicines, In this study, the effects of oral administration of the mucilage extracted from pods of Abelmoschus esculentus (Ae) fruits on serum levels of glucose, lipids and morphology of Langerhans islets in diabetic rats was investigated.
Methods: In this experimental study, 24 female wistar rats were randomly allocated into four groups (n=6): normal control (NC), diabetic control (DC) and 2 diabetic groups that received (oral) 300 and 500 mg/kg/body weight of Abelmoschus esculentus. After preparing and confirming the type of, mucilage extraction from the fruit’s green okra was done by evaporation device in vacuum. Diabetes mellitus was induced by single dose intraperitoneal injection of streptozotocin 60mg/kg/body weight in diabetic groups. After 4 weeks, the serum levels of glucose and lipid profile of all groups were analyzed. Also morphology of Langerhans islets in the 4 groups was evaluated using H&E staining method. The data analyzed by SPSS software using ANOVA and Tukey tests.
Results: The results indicate a significant increase (P<0/05) in glucose, cholesterol, triglyceride, LDL and significant decrease (P<0.05) in HDL in diabetic rats compared to normal control. The use of the mucilage extracted from A. esculentus caused a significant decrease in serum levels of glucose, cholesterol, triglyceride, LDL and significant increase in serum level of HDL comparison with diabetic group.
Conclusion: according to the results of this study, the mucilage extracted from A. esculentus could be effective on control hyperlipidemia and hyperglycemia caused by diabetes mellitus.

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Background: Although a positive association between type 2 diabetes and breast cancer has been reported, an association with gestational diabetes mellitus (GDM) is less clear. This study aimed to assess the relationship between the history of GDM and the incidence of BC a long term population based study.
Methods: To conduct this research, 4076 women aged 20-50 years who participated in the first phase of Tehran-Lipid-and-Glucose-Study, who had at-least one pregnancy were included. Each participants were asked about the history of GDM every 3 years. They was evaluated about the occurrence of breast cancer (BC). Cox-survival analysis was used to measure the Hazard-ratio (HR) for both groups with and without history of GDM
Results: The study population included 886 women with prior GDM and 3,909 women without history of GDM. The median duration of follow-up among women with and without the history of GDM were 12.12 and 11.62 years, respectively. The incidence of BC was 0.64 per 1,000 year-olds with confidence=interval of 95% (0.44-0.91). Among them, 4 cases were reported in women with GDM and 26 cases in women without GDM. (Incidence of 0.36 per 1000 person-years with confidence=interval 95% (0.11-0.99) in women with prior GDM and 0.73 per 1,000 person-years with confidence=interval 95% (0.49-1.1) in women without a history of GDM.
Conclusion: Our study showed that the history of GDM is not an independent risk factor for breast cancer.

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Background: Diabetes is the most common glandular disease in the world. The aim of this study was to compare the effect of three types of endurance, resistance and combination training on inflammation and insulin resistance in visceral adipose tissue of type 2 diabetic rats. 

Methods: For this purpose, among eight-week-old male Wistar rats, 48 ​​rats were selected and randomly divided into 6 groups (diabetic endurance training, diabetic resistance training, diabetic combination training, healthy combined training, healthy control and diabetic control). The rats became diabetic by injecting 95 mg of nicotinamide and after 15 minutes of STZ injection at the rate of 55 mg/kg body weight. 4 days after injection, rats with serum glucose above 300 mg/dL were considered diabetic. Then, the endurance training group trained for 6 weeks, 3 sessions per week with moderate intensity (50-60% of maximum oxygen consumption). The initial load to start resistance training was 50% of the rat's body weight. Each session added 15% of body weight to the weights. The combined exercise group also performed resistance and endurance exercises in a row. 48 hours after the last session, the rats were anesthetized and visceral adipose tissue was removed to examine the variables. 

Results: The results showed that there was a significant difference between the effect of six weeks of endurance, resistance and combined exercise on inflammation and insulin resistance in the visceral adipose tissue of male diabetic mice. 

Conclusion: The results confirm the effect of three training methods on the mechanisms involved in diabetes.

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