Iranian Journal of

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Background: Although dietary guidelines recommend increased intake of grain products to prevent chronic diseases, epidemiologic data regarding whole-grain intake associated with metabolic syndrome is sparse. This study was undertaken to evaluate the relationship between whole-grain intake, metabolic syndrome and metabolic risk factors in Tehran adults population.
Methods: In this cross-sectional study, 827 subjects aged 18-74 were randomly selected from participants of the Tehran Lipid and Glucose Study. Usual dietary intake was assessed using a semi-quantitative food frequency questionnaire and two 24-hour dietary recalls. BMI, FBS, blood pressure, hypertriglyceridemia, hypercholesterolemia, high LDL, low LDL, metabolic syndrome (according to ATP III guidelines) and hypertension (based on JNC VI) were assessed subjects were categorized on quartile cut-points of whole and refined grain intake.
Results: Mean (±SD) consumptions of whole- and refined grains were 93±29 and 201±57 g/d, respectively. Compared with subjects in the lower quartile category, those in the upper category of whole-grain intake had lower prevalence of metabolic risks. Conversely, those in the higher category of refined grain intake had higher prevalence of metabolic risk factors, except for diabetes. After controlling for confounders, a significant decreasing trend was observed for the risk of having hypertriglyceridemia [odds ratios among quartiles: 1.00,0.89, 0.74, 0.61, respectively], hypertension and metabolic syndrome. Higher consumption of refined grains were associated with higher risk of having hypercholestrolemia [1.00, 1.07, 1.19, 1.23), hypertriglyceridemia [1.00, 1.17, 1.49, 2.01), hypertension and metabolic syndrome.
Conclusion: Whole grain intake is inversely and refined grain intake is positively associated with the risk of developing metabolic syndrome. Recommendations to increase whole-grain intake may reduce the risk of developing metabolic syndrome.

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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: Previous in vitro and animal studies have supported a role for growth hormone in development of diabetic nephropathy. The purpose of this study was to investigate the relation between basal and stimulated growth hormone and proteinuria in type 2 diabetic patients.
Methods: 21 type 2 diabetic patients with macroalbuminuria were selected. Fasting insulin, basal and levodopa stimulated growth hormone levels were measured. The control group consisted of 21 type 2 diabetic patients with 24 hr urine protein of less than 50 mg. The two groups were matched according to sex, age, duration of diabetes, body mass index, creatinine clearance, fasting blood sugar, glycosylated hemoglobin, and blood pressure.
Results: The patients with macroalbuminuria had higher basal growth hormone (3.1  2.6 vs 1.25  0.7 ng/ml, P = 0.024). Stimulated growth hormone and fasting insulin levels were not significantly different.
Conclusion: There is direct relation between basal growth hormone and development of diabetic nephropathy and this relation suggests a role for growth hormone in human diabetic nephropathy.

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Background: Diabetes Mellitus is a common chronic disease with severe of complications. Proper glycaemic control can prevent these complications considerably. Evaluation of effectiveness of community based and patient centered interventions on glycaemic control, quality of life, patient satisfaction, patient knowledge and reported symptoms were the main aims of this research.
Methods: In a clinical trial, patients referring to Iranian Diabetes Association, who were more than 18 years old, divided to intervention and control group randomly. After three months of general interventions in both groups, including diabetes education and specific interventions including telephone calls, continuous corresponding and sending educational issues in intervention group, changes in variables were studied. Results: Among 52 patients in each group, 17 were male and 42 had type 2 diabetes. The average age was 49 in intervention and 51 in control group. Two groups had no significant difference in age, sex, type of diabetes, treatment method and duration of diabetes, other diseases and education. Both groups showed significant improvement in glycaemic control. The mean reduction in HbA1c was 1.45 in intervention and 0.86 percent in control group the difference is statistically significant (P= 0.02). Patient satisfaction increased in both groups. The satisfaction is significantly higher in intervention group (P=0.000). Knowledge has increased significantly in both groups the difference in groups is not significant. The improvement in Quality of Life was just significant in intervention group. The reported sign and symptoms have not changed in both groups.
Conclusion: Community based and patient centered interventions with emphasis on continuous education and support can improve glycemic control, quality of life, patient satisfaction and patient knowledge in diabetes mellitus.

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Background: Previous clinical and experimental studies suggest the valuable effect of antioxidants on lipids status. The present study was designed to investigate the efficacy of silymarin treatment as an antioxidants on lipids profile in type II diabetic hyperlipidemic patients. Methods: A 4-month randomized double blind clinical trial was conducted in 54 non-insulin dependent diabetic hyperlipidemic patients in a two well – matched groups. First group (n=29) received 200mg silymarin tablet 3 times a day plus standard therapy, while the control group (n=25) received placebo tablet 3 times a day plus standard therapy. The patients were visited monthly and fasting blood glucose, total cholesterol, LDL, HDL cholesterol, triglyceride, SGOT and SGPT were determined at the beginning and at the end of the study after four months.
Results: Results revealed that in silymarin treated patients, fasting blood glucose, LDL and total cholesterol, triglycerid, SGOT, SGPT and glucose level at the end of the study were significantly decreased as compared to beginning of the study. In placebo treated patients fasting blood glucose level at the end of the study were significantly increased as compared to beginning of the study.
Conclusion: In conclusion, the silymarin as an herbal antioxidant have beneficial effects on reducing glucose and lipids profile in type II diabetic patients

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Background: Due to homeostatic and regulatory potentials of nitric oxide (NO) in vascular physiology, regulatory systems that determine NO bio-synthesis and bioavailability have been the subject of extensive research in molecular medicine. In the field of vascular system pathophysiology, endothelial nitric oxide synthase (eNOS) which is the major producer and regulator of NO in vascular tissues has received the most attention. Impairment of NO bioavailability (NO quenching) is a common feature in poorly controlled diabetics due to increased catabolism and decreased production of NO. Such impairment in severe forms could end to vasodilation breakdown in peripheral tissues (mainly in skeletal muscles) and defective regional blood flow, that in turn disturb insulin-dependent glucose uptake ensuing insulin resistance state.
Methods: The phenotypic impact of an eNOS gene polymorphism at position 786*C/T (that its functionality has been revealed already) on genetic propensity to diabetic retinopathy is evaluated in a British-Caucasian population with type 1 diabetes (T1DM).
Results: In contrast to genotypes, there was a significant difference in distribution of allele frequencies between T1DM patients (n= 249) and healthy controls (n= 104) (p= 0/036), that may imply eNOS and/or NO involvement in development of T1DM. Most notably a significant difference also was evident in allele frequency between retinopaths (n= 134) and healthy controls (p= 0/02). No significant difference was detected when the genotype/allele frequencies were compared between retinopaths (n= 134) and non-retinopaths diabetics (n= 115) (p=NS).
Conclusion: Our data is compatible with previous studies which demonstrated that allele C of eNOS 786*C/T polymorphism is associated with increased HbA1c levels. By emphasizing the phenotypic and prognostic value of the abovementioned polymorphism, our data calls for further investigations to find out whether this polymorphism can be employed as a genetic marker in clinical medicine to recognize high-risk diabetics at the time of diabetes onset/diagnosis.

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Background: Type 1 diabetes (T1DM) is an organ specific auto-immune disease, which is resulted by selective destruction of  islet cells. Insulitis as the initial event prior to T1DM development is featured mainly by lymphocytic infiltration, that may recede frequently leading to healthy state (benign insulitis). Among the issues that govern which of these outcome lie ahead in insulitis are the genetic background of the host and also the immunological circumstances in  islets' micro-environment.
Methods: As a "case-control association study" the impact of a polymorphism within TNF- gene at position -308*G/A on genetic susceptibility to T1DM is analyzed in a British-Caucasian population (248 cases and 118 healthy controls).
Results: The distribution of genotype/allele frequencies between patients and controls did not reflect significant differences (p= NS).
Conclusion: Since the crucial role of TNF- in development of T1DM is well established, our data may confer that the examined polymorphic marker does not have functional effects on TNF- gene expression, influencing the local or systemic level of this pro-inflammatory cytokine. However, in addition to addressing the uncertainties in "genotype-phenoype" correlations in complex diseases (i.e. T1DM), the negative results of our study also may instead draw attention to the potential impacts of post-transcriptional regulatory mechanisms relative to gene structural-based regulatory systems.

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Background: up to know many herbal medicines with different oral formulations have been recommended for diabetes. The aim of this study was to investigate the effect of 4 herbal hypoglycemic agents include garlic (Allium sativum) neem (Azadirachta indica), tulsi (Ocimum sanctum) and bitter gourd (Momordica charantia) on blood glucose, antioxidant enzymes and metal ions in diabetics
Methods: Crude extracts of herbal agents was prepared and each one was given to one group of diabetic rats. Two group of diabetic rats received insulin and glibenclamide. As controls, two groups of healthy and diabetic rats received saline. Body weight, fasting blood glucose, antioxidant enzymes and metal ions were measured before and after the study.
Results: All agents including herbal preparations, insulin and glibenclamide reduced the levels of blood sugar and lipid peroxide when compared with diabetic control. These agents also increased levels of antioxidant enzymes in diabetic rats. Antioxidant enzymes decreased significantly in diabetic controls. Metal ions increased in diabetic rats treated with herbal agents, insulin and glibenclamide but decreased in diabetic controls.
Conclusion: Above mentioned herbal plants may be useful in the treatment of diabetes as they not only have hypoglycemic effect but they also protect rats from free radical mediated cellular injury by improving the activity of antioxidant enzymes. They also improve the levels of metal ions which are associated with antioxidant enzymes.

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Background: Recurrent GDM are more common in women with previous GDM. Also GDM is an important risk factor for abnormal glucose tolerance and type 2 diabetes during postpartum. This study aims to determine the prevalence of postpartum IGT and T2DM in women with previous GDM.
Methods: A cohort study was conducted on 2416 pregnant women referred to five Tehran university hospital clinics. The universal screening was performed with a GCT-50g and those with plasma glucose level130mg/dl, were diagnosed as having GDM if they had an impaired GTT-100g based on Carpenter and Coustan criteria. All pregnancies were followed up until delivery. Available GDM patients underwent an OGTT-75gr within 6 to 12 weeks after delivery. Postpartum diabetes mellitus was diagnosed according to ADA criteria. Student T test and ANOVA used for comparing means of variables and Chi Square used for comparing of frequency of variables. Value of P less than 0.5 determine as significant different.
Results: the prevalence of GDM was 4.7%. In fallow up 85.9% of women with GDM were screen in postpartum. 16.3% of women required insulin treatment and other patients were managed with diet. Prevalence of postpartum diabetes mellitus and IGT were 8.1% (CI 95%: 3.5-15.4) and 21.4% (CI 95%: 13.7-30.8) respectively, and 70.5% returned to normoglycemy.
Conclusion: Abnormal glucose tolerance is a common disorder in the early postpartum in GDM patients. Because of the high incidence of glucose tolerance disorders in women with previous GDM, screening, diagnosis and management during pregnancy was important for prevention of these disorders. Following up these mothers after delivery is highly recommended.

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Background: Diabetes type 2 is one of the most prevalent reasons of Hyperglycemia. Different areas experience varying degrees of epidemic intensity. Diabetes is one of the most important causes of death and disability in most countries and imposes heavy financial burdens on people and governments. Although much research has been conducted on its prevention and treatment. It has been recognized as a hereditary disease, the genes causing it or its mode of inheritance are not yet known. Because of the significant role they play in metabolism of glucose, several genes have suggested, but the main cause of the disease has not yet been identified. Our objective is to investigate the epidemic aspects of the hereditary diabetes in people aged 20 years and over.
Methods: A cross sectional study was conducted on 14687 subjects, in the urban setting of east Tehran between 1379 and 1380. Of 407 families, 180 agreed to and completed related questionnaires and underwent the necessary tests 180 diabetic families, with at least one member suffering from diabetes type 2, were studied closely in order to clarify the degree of spread and family background. Analysis was performed using Chi Square and t-test.
Results: Of 1612 subjects, 497 had diabetes, including 802 women and 792 men (p<0. 001). Most of the diabetics (approx. 79%) were between the ages of 41-70 years old with the highest (55.3%) and lowest (6.2%) rates in the age groups of 51-60 and 20-30 years respectively. Diabetes was more prevalent among siblings with 53% in comparison to the prevalence among offsprings-44%. The prevalence of Diabetes type 2 in first-degree relatives was more frequent between sister and brother (52.7%), followed by that between father and daughter (36%). Conclusion: It is recommended that the related authorities implement strategies, including screening of families, with a view to identify those at risk and reduce related complications.

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Background: Currently different criteria are used to diagnose Gestational Diabetes. ACOG (American college of obstetric and Gynecology) accepted NDDG's (criteria National Diabetes Data Group) Criteria and ADA (American Diabetes Association) accepted Carpenter Caustan’s. Although both of these criteria have been achieved by O Salivan and Mahan’s reaserches, the number of patients has been diagnosed are different .The aim of this study was to compare Gestational Diabetes prevalence according to Carpenter Caustan’s and NDDG’s Criteria.
Methods: 1200 pregnant women were screened in a prenatal care clinic. Patients with definite diabetes were excluded. According to universal GDM screening method, for all of the patients GCT and GTT (if GCT > 130) were preformed. The results evaluated according to Carpenter Caustan’s and NDDG’s criteria. Results: In this screening, 377 participants had positive GCT, according to Carpenter and Caustan’s criteria 83 women (6.9%), and according to NDDG criteria 50 women (3.6%) had Gestational Diabetes Mellitus. If the cut of point of GCT was 140 mg/dl instead of 130 mg/dl, according to Carpenter and Caustan’s criteria 16 women (18.1%), and according to NDDG 4 patients (9%) were missed.
Conclusion: Regarding the significant difference between two methods in diagnosis of gestational diabetes mellitus, assessment of each method value in improving prognosis and outcomes is necessary. According to the results the cut of point of 130mg/dl, as recommended in previous studies, has more accuracy for screening.

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Background: Type 2 diabetes is a hereditary disease but the inheritance and responsible genes have not been clearly clarified yet. According to the most studies, diabetes is one of the most common causes of mortality and morbidity in populations. Diabetes occurs in 30% of first degree family members of diabetic patients, But most people are not aware of their disease.
Methods: We studied first degree relatives of type 2 diabetes and screened them for diabetes, IFG and IGT.174 families(1556 people) of Tabriz residents were studied, among them 1232 persons grater than 30 years were alive and FBS and OGTT were done in this group .
Results: According to this study, 1232 persons were alive and 324 persons had died and DM was found in 343 (27.9%) and 82 (25.3%) of them respectively. We found 179 (14.5%) persons with IFG and 89 (7.2%) with IGT.The percent of diabetes in offspring and siblings were 32.9% and 22.1% respectively. The majority of patients had 41 – 50 years old. Risk of diabetes among offspring who had diabetes in both parents was more than the ones who had diabetic father or mother. In this study, women with diabetes were more than men (32.4% vs. 22.2% respectively). The prevalence of Diabetes type 2 in first-degree relatives was more frequent between sister and brother (41.95%), followed by that between father and son (10.9%).
Conclusion: Prevalence of diabetes in most populations is 8 – 10 %. If diabetes occurs in someone, risk of development of diabetes will increase to 30% in their family members. Therefore, screening must be done in all family members of diabetic patients to recognize the problem and to prevent from diabetes complication.

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Background: Gliclazide is a second generation sulfonylurea which its efficacy and safety in the treatment of diabetes has been established. Diamicron MR (30 mg) is a new formulation of gliclazide with modified release which offer once daily dosage administration. This study was designed to assess the effect of combination therapy with diamicron and metformin in the treatment of type 2 diabetes. Methods: 16 patients with type 2 diabetes (2 males, 14 females) more than 35 years old who despite treatment with glibenclamide and metformin had poor diabetes control participated in this clinical trial.HbA1c, lipid profile, liver and renal function tests at the end of study were compared with before. Results: No significant changes was found in FBS, BS2hpp, lipid profile and renal and liver function tests at the end of study. Patients' weight was stable during the study.
Conclusion: Regardless of well efficacy of diamicron in the treatment of new diabetics cases, it is not recommended for patients with poor diabetes control despite of combination therapy with metformin and glibenclamide.

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Background: Diabetes type 1 is an autoimmune disease that is associated with other autoimmune disorders like Hashimoto thyroiditis. The purpose of this study was to determine the prevalence of autoimmune thyroid disease (ATD) in type 1 diabetic patients in the south of Iran (Bandar Abbas).
Methods: A cross-sectional study, was conducted 48 type 1 diabetics and 41 age and sex matched healthy controls were evaluated for the presence of ATD. Blood sample were collected from all of the subjects for the measurement of thyroid autoantobodies [anti thyroid peroxidase (anti-TPO) and anti thyroglobulin (anti-TG)], T3, T4, TSH, RT3U and HbA1c.
Results: Prevalence of positive anti-TPO and anti-TG was 29 % and 29% respectively in diabetic patients and 2% and 7% respectively in control group (P<0.05). The prevalence of ATD (positive anti TPO or anti TG) in diabetic patients and control subjects was 35% and 7% respectively (P<0.05). The prevalence of positive anti TPO and anti TG was higher in girls. There was no association between the prevalence of positive autoantibody and duration or age of onset of diabetes. 17.6% of diabetic patients with positive autoantibody had thyroid dysfunction (subclinical hypothyroidism and hyperthyroidism).
Conclusion: Regarding high prevalence of ATD in type 1 diabetic patients in Bandar Abbas (approximately 1 out of 3 patients), screening for ATD and thyroid dysfunction is recommended for all type 1 diabetic patiens and in those with positive autoantibody consecutively.

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Background: Hypertension and dyslipidemia are common in patients with type 2 diabetes mellitus. The high prevalence of cardiovascular disease in diabetic patients is, in part, related to these two risk factors. This study was performed to determine the prevalence of hypertension and dyslipidemia in newly diagnosed patients with type 2 diabetes mellitus in Isfahan.
Methods : In this cross – sectional study during 2001 – 2003, 310 newly diagnosed type 2 diabetic patients, in Isfahan endocrine and metabolism research center, were studied. Height, weight, blood pressure, Plasma lipid and lipoproteins, and HbA1c were determined for all subjects.
Results: Mean age at presentation was 489.83 years, and mean BMI was 28.44.62 Kg/m2. Hypertension was present in 32.9%, hypercholesterolaemia in 61.3%, hypertriglyceridaemia in 61.6%, high LDL in 77.3%, and low HDL in 67.8% of these patietns. The mean systolic and diastolic blood pressure were 119.0816.59 and 70.0214.02mmHg, respectively. The mean for total cholestrol was 216.1043.65, for triglyceride 207.46105.67, for LDL 124.7331.45, and for HDL 43.119.29 mg/dl.
Conclusion: Hypertension and dyslipidemia are common in newly diagnosed type 2 diabetic patients. This fact demonstrates the importance of early interventions for proper diagnosis and treatment of these two risk factors in diabetic patients.

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Background: Alloxan is on of the xenobiotic agents which is classified as diabetogenic materials. Magnesium is an important cofactor regulating the activity of carbohydrate enzymes and lipid synthesis. In this study the contrasting effects of Alloxan and magnesium on plasma free fatty acids (FFA) in rats was investigated.
Methods: Male mature rats were used as test models for the diabetes induction. 28 rats received Alloxan (120mg/kg) intraperitoneally and plasma glucose level measurement after 72 hours demonstrated diabetes induction.
Results: The results were compared to the control groups, and confirmed the presence of diabetes in rats. Analysis of plasma FFA showed a significant increase (751.25 mM), compared to the control group (286.68 mM). In contrast, Measurement of red blood cell (RBC) Magnesium showed a significant decrease from 7.18 mg/dL in control group to 4.89 mg/dL in diabetic rats.
Conclusion: The results of this study showed that in diabetic condition, there was an inverse relationship between plasma FFA and RBC Magnesium. Therefore, these data suggest that analysis of the effects of Magnesium upon induction of diabetic condition could provide important information for management of diabetes.

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Background: Diabetes mellitus is the most common cause of renal failure, blindness, non- traumatic amputation and neuropathy. Homocysteine, a sulfurated amino acid, has a close correlation with Methionine and Cysteine. The conversion of Methionine to Homocysteine and Cysteine is required coenzymes like vitamin B6, B12 and Folate. The effect of Metformin on serum Homocysteine level by decreasing vitamin B12 level in patients with type 2 diabetes mellitus was described previously. Methods: This is a prospective clinical trail study among patients with type 2 diabetes mellitus in Shiraz. 76 patients were divided into two groups (38 patients in each group). First group treated with Metformin 500-2000 mg/day and the second group treated with Glibenclamide 5-20 mg/day with follow up period of at least 6 months. Hb and MCV were used in follow up to detect megaloblastic anemia, indicator of B12 and folate deficiency. Fasting plasma Homocysteine level Hb A1C and blood sugar were measured in baseline and at 3 and 6 months follow up periods. Results: There was no significant difference between age, sex, weight, height and BMI and baseline serum profile between the two groups. Homocysteine level increased significantly in Metformin group at 3 and 6 months(P=0.003 and 0.001 respectively). Mean plasma homocysteine level after 6 months were 10.98±0.58 μmol/l in Metformin and 10.0± 0.88 μmol/l in Glibenclamide group, with significant difference between the two groups (P=0.001). Conclusion: Metformin increases the plasma Homocysteine level. Metformin will accumulate highly in gastrointestinal wall and cause malabsorption of vitamin B12, therefore we can conclude that the use of Metformin for 6 months can cause vitamin B12 malabsorption and increase in plasma homocysteine level. Increase in plasma homocysteine level was 7.54% in our study that is higher in comparing to the other studies. It can be explained by longer duration of Metformin therapy in our study. Rising in Homocysteine levels may have detrimental effect on vessels that need further study.

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Background: The goal of dietary recommendations in children with type 1 diabetes mellitus is to achieve moderate to good control of blood glucose regarding to decrease in diabetic long-term complications. Although educational programs on appropriate dietary habits are offered in Isfahan Endocrine and Metabolism Research Center for diabetic patients, there is no information about their dietary habits . This study has been performed to investigate dietary intake in children with diabetes mellitus type1 and to compare the results with that of non-diabetic ones.
Methods: A cross-sectional study was performed in two groups of healthy and diabetic children. Data were collected by questionnaire and interview. The validity and reliability of the questionnaire were determined by content validity and pilot study. Data were described and analyzed by t-student and Pearson correlation tests in four age groups, using SPSS software.
Results: Findings showed that in “A” age group the intake of total calorie and fiber, in “B” age group the intake of fiber, fat, protein, carbohydrate, sugar and SFA, also fat, protein, carbohydrate, sugar and SFA-derived calorie consumption, in “C” age group the intake of sugar and fiber, also PUFA and sugar-derived calorie consumption and in “D” age group the intake of fiber, total calorie, protein, carbohydrate and sugar were higher in diabetic children as compared with the control group.
Conclusion: In all subjects, the intake of carbohydrate and total fat was the same as standard recommendations, while protein intake was a little higher which increases the risk of diabetic nephropathy. In all study groups, fiber intake has been decreased with increasing the age, so it is suggested to have dietary educational programs for general population with the goal of changing the life style of people, which itself can result in less social isolation in school-aged diabetic children.

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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.

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Background: Family satisfaction in subpopulations referred to the endocrine clinic including diabetic and non diabetic patients and their spouses are compared in the present study. This study also assesses the correlation between family satisfaction and variables such as age, sex, educational level, economic status, type of diabetes, duration of the disease, type of therapy and dosage of drugs. A comparison of the frequency of sexual dysfunction between diabetics and non-diabetic pairs was also done.
Methods: In this case- control study, 400 subjects were selected as simplified non-randomized method from outpatients referred to the Shahre Kord endocrine clinic in 2002. We assigned samples to group I (diabetic patients, n=100), group II (diabetic patients spouses, n=100), group III (non-diabetic patients, n=100) and group IV (non-diabetic patients spouses, n=100). Groups I and II were similar in sex, socioeconomic status and educational level. GRIMS family relationship questionnaire was used to evaluate family satisfaction.
Results: Family satisfaction for diabetics in comparison with non-diabetics (P=0.05), diabetics in comparison with their spouses (P=0.003), and non-diabetics in comparison with their spouses (p=0.002) were significantly less. There was no significant difference between family satisfaction in diabetic and non-diabetic patients spouses (p>0.05). Relative frequency of sexual dysfunction was 76% and 29% and relative frequency of decreased libido was 32% an 12%, in diabetic and non- diabetic couples, respectively. Family satisfaction was less in patients with diabetes type I and whom using higher dosage of drugs.
Conclusion: This study emphasized on the attention to the family as a part of approach to the diabetic patients. According to our results, it is recommended to focus the most attention in this field to the patients with type I diabetes and who consume more amounts of drugs.