Iranian Journal of

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Background: Metformin is usually using for glycemic control in type 2 diabetes mellitus. The drug is the first line for obese patients without renal or liver failure. Different pharmaceutical types of Metformin are available. As a clinical trial, we compared effects of Aria Metformin (product of Aria pharmaceutical company, Iran) with Merck Metformin or Glucophage (product of Merck pharmaceutical company, France), in diabetic patients.
Methods: This double blind randomized clinical trial study performed with 60 non- pregnant diabetic patients, in order to comparison of therapeutic effects of combination therapy (Glibenclamide + Metformin "Aria or Merck") in a 12 weeks period. We evaluated FBS, BS 2hpp, HbA1c, lipid profile, liver function tests, weight, BMI and common or uncommon side effects.
Results: Not only each of two pharmaceutical types of Metformin had the same therapeutic effects for controlling of glycemia, lipid profile and weight, but also there were not difference between them in side effects. Distention was the most common side effects of two types products (33%). There is not significant difference between them in common side effects. 70% of patients were satisfied with each two kinds of Metformin.
Conclusion: It seems, in view of beneficial therapeutic effects of Aria Metformin, low rate of side effects, and finally low cost, Aria Metformin is a good choice.

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Background: It is well recognized that an increased body weight is often associated with increased blood pressure. Moreover, leptin an adipocyte-derived hormone is strongly suggested to have an important role in pathogenesis of the obesity. We aimed to evaluate the levels of serum leptin in association with obesity and hypertension in a sample of Iranian obese children.
Methods: Children from all the primary schools of a distinct of Tehran were screened for obesity. Children with a waist circumference equal to or above 90th percentile for their age and height were invited for the study. Anthropometric measurements were done and blood samples for fasting serum leptin levels were collected from 563 enrolled obese children. Multivariate linear regression analysis was used to evaluate relationship of various factors with obesity.
Results: Mean Serum leptin levels were 8.65 ±2.18 (ng/ml). Serum Leptin levels were higher in girls than boys (P=0.009). There were significant correlations between body mass index (BMI) and serum Leptin levels, child age, systolic and diastolic blood pressure. Systolic blood pressure and diastolic blood pressure lost their association with serum Leptin level in multivariate linear regression analysis.
Conclusion: BMI is independently associated with Leptin levels among obese children. This may affirm a role for this hormone in the pathogenesis of childhood obesity. It seems unlikely that plasma Leptin be a major mediator of association between obesity and hypertension. However, severe hyperleptinemia may act as a risk factor for increased blood pressure.

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Background: Elevated total plasma Homocysteine, is an independent risk factor for cardiovascular disease. Folate and vitamin B12 have not only a protective effect on cardiovascular disease but also an essential effect on total Homocysteine concentrations (tHcy). This survey has been conducted to evaluate the determinants of tHcy in 1191 healthy Iranian adults.
Methods: This study which was a part of the Cardiovascular Risk Factors Survey in the Population Lab Region, has been designed and conducted based on MONICA/WHO project. A total of 1191 people have been recruited and assessed on serum Homocysteine, Folic acid and vitamin B12, triglycerides, cholesterol, HDL-C, LDL-C, FBS, BMI, BP and smoking, with interview, questionnaires, examination and blood sampling. Blood samples were analyzed according to standard methods.
Results: The variables were assessed in 1191 participants include 416 men (34.9%) and 775 women (65.1%). Prevalence of hyperhomocysteinemia was correlated significantly with male sex and aging. Hcy levels were inversely related to serum Folate and vitamin B12 concentrations. After further adjustments, we detected a positive correlation between tHcy and age, male sex, smoking and BMI, and a negative one with LDL-C and diabetes. Although there was a correlation between tHcy and blood pressure, after age, sex, BMI and smoking adjustment, it just remained significant in women and with systolic blood pressure.
Conclusion: We found that dietary and lifestyle parameters such as Folate intake and smoking habit are the main determinants of distribution of plasma Homocysteine in an apparently healthy population. We assumed that lifestyle changes could have considerable subsequences in public health. Our findings confirm the potential advantages of dietary improvements and increased intake of nutrients along with smoking cessation in order to prevent cardiovascular diseases in high-risk patients.

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Background: Uncoupling protein-2 (UCP2), one of the mitochondrial transporter memborane protiens, is suggested as a contributor gene for obesity. A common G/A polymorphism in the UCP2 promoter region is associated with obesity and diabetes.
Methods: As a cross-sectional study, 75 healthy 25-64 years volunteers were randomly selected from Tehran University of Medical Sciences population Lab. DNA was exracted from blood samples then polymorphism and A & G Allel frequencies were determined via PCR and RFLP. The correlation between genotype and such clinical and biochemical parameters as BMI, serum cholesterol and TG was investigated. Results were compared with other similar surveys.
Results: The frequencies of the UCP2 -866G/A genotypes in 75 Iranian normal population were AA: 7 (9.4%), GA: 41 (54.6%), and GG: 27 (36%).
Conclusion: Significantly higher HDL cholesterol was detected in people with GG allele (P=0.02) as compared with GA and AA alleles. 866 UCP2 G/A genotype frequencies in our study were significantly different as compared with Japanese population but no with European studies that may emphasize on genetical similarity between Iranian and European Caucasians populations.

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Background: Dyslipidemia accounts as a major risk factor for cardiovascular diseases. The aim of this survey was to determine the prevalence of dyslipidemia among relatives of patients with premature coronary artery disease (PCAD).
Methods: As a cross-sectional study 232 first degree relatives of patients with PCAD were recruited. A questionnaire was filled out by all of the participants all of them undergone physical examination and blood sampling. Lipid profile was categorized according to the NCEP: ATPIII criteria.
Results: Total Cholesterol>200 in 29.7%, LDL>160 in 10.3%, HDL<40 in 12.9%, TG>200 in 32.8%, ApoB100>130 in 14.2%, Apo A1<90 in 1.7% and LP(a)>30 in 47% of participants were seen. Serum levels of TG were significantly higher in men than women levels of HDL and ApoA1 were lower in men than women. The Prevalence of dyslipidemia among relatives was 59.6%.
Conclusion: In view of high prevalence of Dyslipidemia among relatives of PACD patients, active interventions in order to primary prevention of cardiovascular diseases via exact screening is recommended.

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Background: The risk of cardiovascular diseases increase in diabetic patients. So, it is important for patients to achieve the optimal lipid levels. Nutrition including consumption of anthocyanins plays a primary role in reducing the risk of heart disease and hypertension. In this study, we assessed the effect of concentrated sour cherry juice (SCJ) consumption as a rich source of anthocyanins on lipid profile and blood pressure of type II diabetic patients.
Methods: In this quasi-experimental study 16 type II diabetic women with fasting blood sugar ≥110 mg/dl and LDL-C ≥100 mg/dl were recruited and consumed 40 g/day of SCJ for 6 weeks. Measurements of weight, lipid profile and blood pressure were done in baseline and after completion of the study. A 2-day food records was completed by patients so. The Wilcoxon test was used for statistical analysis. Results: Mean (± SD) age, weight, total cholesterol, LDL-C, systolic and diastolic blood pressure were 53.6±8.8 years, 72.8±14.9 kg, 213.9±27/0 mg/dl, 118.4±14.7 mg/dl, 129.1±15.7 mmHg and 81.7±8.1 mmHg respectively in the beginning of the study. After consumption of SCJ, a significant decrease (P<0.05) in weight, total cholesterol, LDL-C, systolic and diastolic blood pressure was seen. Changes in serum triglyceride and HDL-C concentrations were not significant statistically.
Conclusion: It is concluded that SCJ consumption may modify cardiovascular disease risk factors in diabetic type 2 patients.

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Background: Peroxisome Proliferators- Activated Receptor-Gamma2 (PPAR- γ2) is a nuclear receptor that regulates adipocyte differentiation, lipid metabolism and insulin sensitivity. The aim of this study was to evaluate the association of the Pro12Ala polymorphism at the PPAR- γ2 gene in Iranian population with obesity.
Methods: The genomic DNAs of the 156 subjects including obese and healthy isolated from EDTA whole blood. Pro12Ala polymorphism detected by Polymerase Chain Reaction – Restriction Fragment Length polymorphism (PCR-RFLP).
Results: In the obese group , one sample (1.3%) was as homozygote Ala/Ala genotype , 24 samples (30.8%) were Pro/Ala heterozygote and 53 samples (67.9%)as Pro/Pro genotype were identified . in the control group , one sample (1.3%) was as Ala/Ala genotype , 12 samples (15.4%) were Pro/Ala genotype and 65 samples (83.3%) were Pro/Pro genotype. allele frequencies of Ala in obese subjects (qAla=%16.7)were significantly different from those in control subjects (qAla=%8.9).
Conclusion: Our results revealed that Pro12Ala polymorphism in PPAR- γ2 gene associated with obesity in the Iranian population and presence Ala allele cause to significantly higher BMI and lower fasting blood sugar.

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Background: Cardiovascular Diseases are becoming increasingly prevalent due to urbanization and industrialization of our country. Therefore Screening of the Cardiovascular Risk Factors is one of the most important health system priorities. The aim of this study was to evaluate a screening method implementing family history for cardiovascular risk factors.
Methods: We chose 10 Junior-high schools in the 6th district of Tehran using simple random sampling. Then a questionnaire asking about family history of cardiovascular disease in the first degree relatives (including grand parents) was distributed between them and was completed – with contribution of parents. Then high-risk and low-risk families were invited separately to Dr Shariati Hospital for further evaluation. SPSS software version 10 using student T-test, Chi-Square and descriptive tests were applied for data analysis
Results: Approximately 40% of families had positive family history (high risk). From this group, 72% participated for follow-up. From the low-risk group, only 34% participated. Total cholesterol and LDL-C levels were significantly higher in high risk (HR) group. FBS was also significantly higher in fathers and children of the HR group (P<0.05). High TC, LDL-C and FBS levels were more prevalent among the HR families (P<0.05). No significant differences were observed in age, BMI, BP, TG and HDL-C between the 2 groups.
Conclusion: Families with a history of cardiovascular disease participated in greater numbers in the screening process and the prevalence of risk factors in this group was significantly higher. The findings confirm the usability of family history in screening programs.

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

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 Background: Microalbominuria (MA) is early presentation of renal damage which acts as an independent factor of cardiovascular events in these patients. There are various methods for sampling and also different laboratory tests to measuring albominuria. The aim of this study was to compare of different urine collection methods for measuring albominuria using immunoturbidometry assay which has acceptable accuracy and sensitivity after HPLC (High Performance Lipid Chromathography).

Methods: Forty seven diabetic patients were selected for a cross-sectional study in 2006. For all patients 24-h urine sample were collected, also an overnight urine sample (8 hour long) and spot urine sample (morning time) was provided in the next day. The level of albumin in all samples were measured via immunoturbidometry assay. Then the results of agreement coefficient were accounted and comprised with each others.

Results: In this study 47 patients were selected which 46 of them were type 2 and one of them type 1 diabetic. Our results revealed significant correlation between all methods. In addition agreement coefficient (kappa) was accounted for all methods, time 24-h urine in comparison with 8 hours overnight urine, timed 24-h urine in comparison with spot urine and overnight urine samples in comparison with spot urine which were 0.876, 0.936 and 0.807 respectively.

Conclusion: Regarding significant agreement for screening of microalbominuria between different collecting methods, we suggest 8-h overnight or spot urine sampling carry out instead of 24-h urine collection.

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Background: Children with Type 1 diabetes were present one of the greatest challenges in the worldwide. Health-care providers must be sufficiently aware of diabetes so that such children make utmost benefit of their educational opportunities. The aim of the present study was to compare the effect of three educational methods in raising the level of knowledge of school health-care providers. Therefore the best method would be applied for this purpose.

Methods: In this interventional study 132 samples were randomly chosen from the list of school health care providers of Tehran and divided to the three groups (educated by posters, booklets, and group education). A questionnaire was completed for all the three groups before and after the education. Questionnaire consisted of two parts: -demographic information and 16 questions about diabetes information. Scores were analyzed by descriptive and inferential methods (T-test, ANOVA).

Results: The level of knowledge of school health-care providers was weak in   23.5% of the case, average in   59.8% of cases, and good in 16.7% of cases. The level of knowledge in the groups educated by booklets and group education increased meaningfully, while no obvious increase was observed in the group trained via posters.

Conclusion: From the three aforementioned training methods, group education and education by booklets have the most effect on raising the level of knowledge of health-care providers.

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Background: Increasing number of people with diabetes make it the greatest world-wide epidemy which indicates importance of education in physical and mental health of the patients. Since researches report different results about cognition status of diabetic patients, this study was conducted to determine and compare cognitive status in older people with and without type 2 diabetes.

Methods: In this case- control study 80 patients with type 2 diabetes mellitus compare with 80 persons without diabetes. Cases were selected from the patients refer to diabetes outpatient clinic and control group were patients referred to other clinics. Instruments were questionnaire for gathering demographic data, glucometer, DSM-IR-TR questionnaire, FBS for control group and TSH - T4- HbA1c for cases..

Results: The mean scores of MMSE were 23.3 and 26.8 in case and control group respectively. Difference between two groups was significant in MMSE scores (P<0.01), furthermore between men and women of two groups (P<0.01 for both). No significant difference of MMSE scores between men and women in case group was seen (P=0.45). There was negative association between MMSE scores and age also duration of illness according to the results.

Conclusion: Elderly diabetic patients encounter some cognitive impairment which is exacerbated   with increasing age.

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Background: High prevalence of consanguineous marriages has been reported in Iran. Since this pattern of marriage may increase the prevalence of diseases with autosomal recessive pattern of expression, the study was assigned to determine this among patients referred to diabetes and osteoporosis clinics of Dr Shariati hospital, Tehran, Iran.   

Methods: The consanguineous marriage was studied among 1789 couples of three successive generations via Questionnaire.

Results: The prevalence of consanguineous marriages in three successive generations was 9%, 17% and 19%, respectively with an increasing pattern of prevalence. Overall the prevalence of first cousins marriage was 10% with 69% among consanguineous marriage group. The higher the level of education, the lower the prevalence of consanguineous marriage.

Conclusion: In view of the increasing prevalence of consanguineous marriage that may be followed by some trouble consequences about disease expression, it seems necessary to provide facilities for genetic counseling before marriage for youth.

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Diabetes accounts as one of the most prevalent diseases worldwide that affects roughly 2 million people with a prevalence of 4.67% in Iran. Despite clinical knowledge of the benefits of optimal glycemic control and preventive care, current studies show that many people with diabetes don't receive such care. Changing physician behavior is a crucial step in implant of scientific evidence into improved patient outcomes. Clinical practice guidelines (CPGs) have emerged as a means for this and for reducing variation in care.
"Iranian guidelines for diabetes mellitus care" is intended for use by health care practitioners involved in the care of people with diabetes in the community, such as general physicians endocrinoligists, podiatrists, nutritionists and optometrists.
Iranian Diabetes Guidelines (IDGs) was designed for the Iranian physicians who manage diabetic patients. IDGs consist management of types of diabetes and their acute and chronic complications in primary, secondary and tertiary care levels, also screening and life style modifications.
IDGs are the first practical guideline for management of diabetic patients in Iran.

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