Iranian Journal of

---

Background: Oral glucose tolerance testing (OGTT) is the gold standard for the diagnosis of diabetes mellitus and impaired glucose tolerance (IGT), but is time-consuming and difficult to perform. We investigated the value of glycosylated hemoglobin (HbA1C) in screening for diabetes mellitus and IGT.
Methods: In a cross-sectional study, we measured the HBA1C levels of 497 people referred for OGTT. We calculated the sensitivity and specificity of HbA1C at 1, 2, 3 and 4 SD above the normal mean. We plotted receiver operating characteristic (ROC) curves after assigning our subjects to the diabetic, IGT, ‘diabetic+IGT’, or normal group, based on WHO criteria for OGTT.
Results: HbA1C levels (mean ± SD) in the four groups were 9.2±1.5, 8.4±1.3, 7.9±0.8 and 6.8±0.7 percent in the diabetic, diabetic+IGT, IGT and normal groups, respectively. All differences were statistically significant (p<0.0001). ROC curve analysis showed that HbA1C levels above 7.5% (mean + 1SD) gave the best combination of sensitivity and specificity for the detection of diabetes (97.53% and 73.8%), IGT (66.37 and 69.44%), and diabetes+IGT (80.22% and 86.66%).
Conclusions: An HbA1C level of >7.5% is an optimal cutoff point for diabetes screening programs.

---

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.

---

Background: Increased echogenicity of pancreas, due to hemosiderosis, is a frequent finding in  - thalassemic paitents. Hemosiderosis also leads to  - cell dysfunction. So diabetes and glucose intolerance are common consequences of hemosiderosis. The aim of this study was to investigate the association of increased pancreas echogenicity (IPE) with insulin sensitivity in  - thalassemic children aged 10-20 years.
Methods: After exclusion of thalassemic paitents with diabetes or familial history of diabetes, pancreas ultrasonography was performed in 42 -thalassemic children and they were divided into 2 groups with normal (21) and increased (21) pancreas echogenicity. Serum ferritin was measured, as well as serum insulin and glucose values, during an OGTT, at 0, 30, 60 and 120 minutes. A control group was selected randomly (n= 23). Insulin Sensitivity Index and Fasting Glucose/Insulin Ratio were calculated and the data were analysed using t-test and ANOVA statistical methods.
Results: Serum feritin differed significantly between 2 groups of thalassemic paitents (P<0.005), but the insulin and glucose values were not significantly different among studied population (P>0.05). Serum feritin was inversely correllated with ISI in patients IPE and 28.6% of them had IFG, as compared to patients with normal echogenicity (P<0.05).
Conclusion : Regarding the detection of all IFG cases among thalassemic paitents with IPE and the relation of feritin with ISI in this group, pancreas ultrasonography may be used to investigate the early stages of diabetes in these patients. however after conducting further studies with larger sample size and on older paitents are recommended.

---

Background: Constipation is the most common gastrointestinal complication in diabetic patients. Erythromycin mimics the effects of the gastrointestinal hormone Motilin in gastric contractile activity and insulin secretion. In this study, we compared the effects of Erythromycin and Metoclopramide on glycemic control and constipation in type 2 diabetic patients. Methods: As a clinical trial, thirty-nine type 2 diabetic patients with constipation were divided into two groups. Patients in group 1 (n=24) were treated with erythromycin (400 mg/day before sleep) and participants in the second group (n=15) received metoclopramide (10mg 3 times / day before each meal) for 3 months. FBS, 2hPP BS, HbA1c and the frequency of defecations during a week were measured and compared before and after the intervention. Results: In Erythromycin treated group, 2hPP BS decreased from 199.7 ± 47.0 before treatment to 174.0±46.3 after intervention (P=0.01) and a significant improvement in constipational symptoms was observed in both groups. Conclusion: It seems that Erythromycin not only can improve symptoms of constipation but may have a role in glycemic control in type 2 diabetic patients.

---

Background : Women with polycystic overy syndrome (PCOS) are sussceptible for developing type 2 diabetes (T2DM) and cardiovascular diseases. In view increased prevalence of T2DM in patients with PCOS and priority of prescription agents capable to decrease insulin resistances for them, It is important to diagnose PCOS in T2DM patients. The aim of this study was to evaluate the prevalence of PCOS in T2DM women.
Methods : Using ‘1990 National Institute of Child Health and Human Development Conference of PCOS’ criteria, 157 premenopausal women with T2DM were assigned into PCOS and non – PCOS groups after they were examined for the evidences of clinical PCOS. A questionnaire on reproductive history was completed and the waist circumference, weight, height and BP were measured for each participant. Biochemical tests were performed in both groups, but hormonal measurements were requested only for PCOS group.
Results : The prevalence of PCOS was high (about 8%) among subjects. Patients with PCOS had significantly lower age at the onset of diabetes, higher BMI and waist circumference. The differences in BP, serum TG, HDL, LDL, cholesterol and HbA1c were non – significant between 2 groups and insulin resistance is more.
Conclusion : PCOS is prevalent in diabetic women and Insulin resistance is more likely in those with both PCOS and T2DM resistant than whom with diabetes alone. Emphasis on reducing insulin resistance may be of benefit to achieve a better diabetes control in these patients.

---

Background: The aim of this study was to determine the prevalence of cardiovascular disease (CVD) risk factors among type 1 diabetic patients referring to Isfahan Endocrine & Metabolism Research Center.

Methods: In this cross-sectional study, the prevalence of CVD risk factors including dyslipidemia, smoking and hypertension was determined in type 1 diabetic patients aged 15-30 years.  Serum cholesterol <170 mg/dl, LDL<100 mg/dl , HDL>35 mg/dl , TG<150 mg/dl, systolic blood pressure<120 mmHg and diastolic blood pressure<80 mmHg were considered as optimal control levels.

Results: Among 219 studied diabetic patients (mean age=22.5±10.3, female/male=120/99), the mean cholesterol and HDL-C level was higher in women (176±34.9, 46.4±34.1) than men (162.9±32.4 vs. 41.5±10.1) (P<0.05). The prevalence of smoking, hypercholesterolemia, LDL>100 mg/dl, HDL<35 mg/dl, hypertriglyceridemia and hypertension was 6.9% (n=15), 47.4% (n=104), 53.5% (n=117), 22.8% (n=50), 18.3% (n=40) and 7.7% (n=17), respectively. HDL<35 mg/dl was more prevalent among men as compared with women but cholesterol> 170 was more frequently detected in women (P<0.05).

Conclusion: Considering the rather high prevalence of CVD risk factors in type 1 diabetic patients in Isfahan, and in view of modifiability of these risk factors, educating patients on appropriate glycemic control and increasing physical activity is necessary as well as close monitoring of these risk factors.

---

Background: Over the years type 2 diabetes, in addition to causing irreversible effects on various parts of the body, also causes liver dysfunction and increases the risk of heart failure, but due to the lack of physical symptoms, less attention has been paid. So, the aim of this study was to determine the effect of 8 weeks of endurance training on diabetic indexes and myocardial GLUT4 and liver enzymes of type 2 diabetic rats.
Methods: A total number of 24 rats (220±20) were divided randomly into three groups; 1-Non-diabetic Control group (NC, n=8). 2-Diabetic Control group (D, n=8) To induce type 2 diabetes, high-fat diets were given to rats for two weeks, then streptozotocin (Aldrich company) at a dose of 37 mg / kg in citrate buffer M0.1 (PH4.5) after 6 hours of intraperitoneal fasting was injected, For the healthy control group, the same amount of buffer was injected. Also, aerobic exercise groups ran 5 times a week and 8 weeks on a motorized treadmill. Diabetic index’s, myocardial GLUT4 (Western blotting) and liver enzymes (ELISA) of rats were measured.
Results: Endurance training significantly decreased fasting blood glucose, insulin resistance index (both P= 0.00). It also caused a significant increase in insulin (P= 0.01) and insulin sensitivity index (P= 0.00) compared to the diabetic control group. On the other hand, the amount of GLUT4 in the training group increased significantly (P= 0.01). The results also showed that in comparison with the diabetic control group, ALT and AST did not increase significantly in diabetics with endurance training (P= 0.30, P= 0.5, respectively).
Conclusion: Based on the results, it seems that endurance training significantly increases the level of GLUT4 in the heart and significantly decreased diabetic parameters such as fasting glucose, HOMA-IR index and liver enzymes.

---

Background: Type 2 diabetes is a common multifactorial disease that has been studied by researchers in this century. These studies show the importance and position of genetics in relation to diabetes. The purpose of this study is to investigate the prevalence of rs5219 and rs5215 polymorphisms in the familial type 2 diabetic population of Yazd province.
Methods: This study is a case-control study that was conducted on 200 people (100 type 2 diabetes patients with a positive family history of type 2 diabetes and 100 healthy people without a family history of diabetes). In this study, using the ARMS-PCR technique, the genotype of the patient group and the control group were examined, and dispersion indices and parametric statistical tests such as P-value and Chi-square were used to determine the significant relationship between diabetes and genetics.
Results: Statistical analysis showed that there is a significant difference between the allelic and genotypic frequencies in both patient and control groups in rs5215 polymorphism with P=0.0015 and in rs5219 polymorphism with P=0.0342.
Conclusion: The present study showed that rs5215 and rs5219 polymorphism of KCNJ11 gene can be related to type 2 diabetes in the population of Yazd province, although extensive studies are needed to confirm these results.

---

Background: Type 2 diabetes is a chronic metabolic disease and a complex disorder with several micro and macro vascular complications in different parts of the body, which is associated with cardiac fibrosis. On the other hand, endurance training seems to prevent the development of cardiac fibrosis in diabetes by reducing fasting glucose levels and increasing antioxidant indices.
Methods: 24 male Wistar rats were randomly divided into three groups: healthy control (NC, n=8), diabetes control (DC, n=8) and exercise diabetes (DT, n=8) after familiarization with the laboratory environment. Diabetes was induced to diabetic animals through streptozotocin injection. Training groups, performed 8 weeks of intermittent endurance training on a treadmill. Hematoxylin-eosin and Masson trichrome staining were used to check the level of fibrosis and cell disorder. Serum malondialdehyde (MDA) was measured by thiobarbituric acid spectrophotometry. Also, total serum antioxidants were measured by FRAP method.
Results: Compared to the diabetic control group, rats in the training group showed a decrease in fibrosis, fasting glucose, and also a decrease in triglyceride and total cholesterol (P<0.05).
Conclusion: Based on the results, it seems that Endurance training in diabetic Rats prevents the development of cardiac fibrosis caused by diabetes by reducing fasting blood sugar, lipid profile and increasing total antioxidants. However, more studies are needed.