Iranian Journal of

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

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Insulin resistant states are emerging rapidly and lots of efforts have gone into understanding their pathogenesis and major metabolic consequences. Hypertriglyceridemia, a major complication of this metabolic syndrome, seems to be caused by overproduction of lipoproteins (LPs) containing apo B that are rich in triglycerides. Some in vitro and in vivo models have been introduced so as to understand mechanisms governing lipid metabolism in insulin resistance states. Human and animal studies have suggested a key role for overproduction of VLDL in hypertriglyceridemia and dyslipidemic states. Recently, we have employed a diet-induced animal model of insulin resistance (hamster fed with fructose) in our laboratory in order to examine the relationship among development of insulin resistant state, impaired metabolism of LPs and overproduction of LPs containing apo B. These experiments have indicated that insulin resistant states occur along with overproduction of VLDL containing apoB105 from liver and enteral LPs rich in apo B 48. In insulin resistant states, decreased metabolic signaling to liver and intestine seems to play a critical role in overproduction of LPs. We have also been recognized a number of intracellular factors which may regulate VLDL production. This article reviews recent advances in the area the hypothesis indicating that a complex interaction exist between increased free fatty acids flow from peripheral tissues to the liver and intestine (caused by hyperinsulinemia) and prolonged lipogenesis has also been expounded.

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Diabetes mellitus is characterized by several adverse consequences among which diabetic foot is a major complication. With a life long incidence of 15%, diabetic foot is accountable for more than 50% of non-traumatic lower limb amputations. Regular care, proper footwear and early treatment, but, have proved effective measures in preventing such outcome. The problem and features as infection, ulceration, or gangrene. Neuropathy, poor circulation, and decreased resistance to infection are the three major contributors to the development of diabetic foot which when present, foot deformities or minor trauma can readily lead to ulceration and infection. Not all diabetic foots are preventable, but appropriate preventive measures can dramatically reduce their occurrence.

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Background: A controversy exists on the prevalence of hearing impairment in diabetic patients. Previous studies have reported figures ranging from 0 to 93%.
Methods: 80 diabetic patients (mean age: 49.0816 range: 16-65 years) were evaluated with regards to their hearing thresholds, using pure tone and speech audiometry. The results were compared with 78 healthy controls. None of the patients or controls reported histories on exposures that might affect their hearing power.
Results: For all frequencies, lower hearing thresholds were registered in diabetic patients (on average 5.741.8 dB) compared to the controls. In sum, 53.7% of diabetics showed hearing thresholds lower than controls. Diabetics had poorer speech discrimination function but equal speech reception as compared to the controls. Age seemed to influence the mode of hearing impairment in the diabetic patients. To say, high frequencies disturbances were more commonly affected in older diabetics the reverse was true for the younger ones. Genders, duration of diabetes and positive family history for diabetes were not related to the degree of hearing impairment. Patients with retinopathy had poorer hearing threshold.
Conclusion: Hearing loss seems to be a frequent feature of diabetes mellitus.

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Background: Diabetes type 1 is characterized by autoimmune destruction or primary dysfunction of pancreatic  cells. The more common form is the autoimmune type, which can be associated with other endocrine malfunction such as adrenal insufficiency and Hashimoto’s thyroiditis. Autoimmune thyroiditis is characterized by presence of anti TG, anti TPO and anti TSH antibodies in the plasma. This study has investigated the prevalence of autoimmune thyroid disorders in type 1 diabetic patients.
Methods: 200 type 1 diabetics and 200 age/sex matched non-diabetic controls were recruited. Blood samples were taken to determine serum levels of thyroid hormones (T3RU, T3, T4, and TSH) and antithyroid antibodies.
Results: TG-Ab and TPO-Ab levels were significantly higher (P<0.001) in diabetics compared to controls (mean TG-Ab: 955.7±495.5 in diabetics and 451.0±189.5 in controls mean TPO-Ab: 463.2±182.3 in diabetics and 112.4±38.3 in controls). Clinical and subclinical hyperthyroidism was four times more common in diabetics. Conclusion: It seems reasonable that type 1 diabetic patients, especially those at younger ages, be screened for thyroid hormones and anti-thyroid antibodies

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Background: Diabetes mellitus, the most common metabolic disorder of childhood, has important physical and emotional complications this urges the role of patient education and self-monitoring. Diabetes is costly since patients have to do several lab tests and spend a lot on treatment.
Methods: 150 patients with IDDM entered this cross-sectional study. The metabolic control and degree to which these patients were utilizing available facilities were determined and compared with same surveys from Germany, France, USA, Australia, and Saudi Arabia.
Results: 91.3% of patients had no glucometer thus were unable to do self-monitoring. HbA1C had been regularly determined in only 8.66%. Insulin therapy was improper or inadequate in 59.1%. The quality of metabolic control was significantly poorer than the other mentioned nations (P< 0.001).
Conclusion: The study advocates educational programs for diabetics. Complete insurance coverage and free weekly lab tests are also suggested.

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Background: Early detection of carbohydrate intolerance is important to prevent maternal and perinatal complications. This study aims to determine association of symptoms and clinical feature with different degree of carbohydrate intolerance in comparison with healthy pregnant women.
Methods: Two thousand four hundred sixteen pregnant women referred to five university hospital clinics were followed up until delivery. Previously known diabetic patients were excluded from the study. The universal screening was performed with a 50-g 1-hour glucose challenge test (GCT). Those with plasma glucose 130mg/dl underwent a 100-g 3-hour glucose tolerance test (GTT) to diagnose gestational diabetes mellitus (GDM) according to Carpenter and Coustan criteria. Also based on result of GCT and GTT all pregnancy divided to four groups GDM, impaired GCT (IGCT), impaired GTT (IGT) and normal pregnancy. Family and obstetric histories were taken followed by a complete physical examination included: BMI and blood pressure measurements, excess weight gain during pregnancy, proteinuria, glycosuria, polyhydramnios, and edema. Symptoms were considered were as followed: polyuria, polydipsia.
Results: Among the 2416 pregnant women, 114(4.7) were diagnosed with GDM. Of the 114, 42(36.8%) were obese, 39 (34.2%) had glycosuria, 5 (4.3%) had pre-eclampsia, , 22 (19.2%) had abnormal excess weight gain during pregnancy. The most important symptoms were polyuria (14.9%), polydipsia (12.6%). In comparison with healthy group, GDM patients had a significantly higher BMI, glycosuria, polyhydramnios, proteinuria, and excess weight gain. Association of these symptoms in GDM patients was significantly different from that in healthy pregnant women. Out of 114 GDM patients 59 (51.7%) did not have any symptoms or any abnormal clinical features.
Conclusion: The rate of asymptomatic patients in different level of carbohydrat intolerance indicates that symptom – based screening would miss many subjects. Despite clinical feature is not a reliable basis for screening GDM patients, it maybe used to improve maternal surveillance.

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Celiac disease and typel diabetes mellirus have been linked to the same HLA markers and chromosomal loci, which may account for the concurrence of the two disorders in a significant number of patients. This study was designed to investigate the frequency of anti-gliadin antibodies, a marker for celiac disease, in diabetic patients.
Methods: In this study, 182 diabetic patients (52 with typel and 130 with type2 diabetes) were screened for anti-gliadin IgG by indirect immunofluorescence. Age range was 3-29.5 and 42-65 years for type 1 and type 2 diabetes groups.
Results: Anti-gliadin IgG was found in 1.9% and 1.5% of patients with type land type 2 diabetes. In Tehran, 0.02% of healthy blood donors have been reported to be seropositivitive for anti-gliadin IgG.
Conclusion: The prevalence of anti-gliadin seropositivity in type 1 and type 2 diabetics, was respectively 30 and 24 times higher than the general population of Tehran. This concurs with other reports indicating higher occurrence of celiac disease in diabetic populations. The rather low sensitivity and specificity (both around 80%) of the antigliadin antibody test has made it a suboptimal diagnostic test. However, it is quick and inexpensive and can be suitable for screening programs. We recommend the test in all at-risk populations including diabetics.

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There are controversies on the effects of diabetes and lifestyle of affected patients on their bone mineral densities (BMDs). This study has investigated the effects of lifestyle of type 2 diabetics on BMD at the lumbar spine and proximal femur in pre and postmenopausal women.
Methods: In a historical cohort study, 20 pre-menopausal type 2 diabetics and 57 non-diabetics and 126 type 2 Diabetics and 315 non-diabetics postmenopausal women, were recruited. BMD measurements were also made to the spine and proximal femur (Neck, Wards, and Shaft) by dual energy X-ray absorptiometry (DXA) technique. Exclusion criteria were endocrine, rheumatologic or chronic diseases. Type 2 diabetic cases and non-diabetics were matched for age and body mass index (BMI) in both pre menopausal or postmenopausal groups.
Results: A total of 146 type 2 Diabetic patients without any other endocrine disorder and 372 non-diabetic women, aged 40-81 years were enrolled. No significant differences were found between diabetics and healthy controls in terms of BMD values of spine and femur regions in the pre‌menopausal women. Postmenopausal diabetics, however, had higher BMD at the lumbar spine compared with the healthy postmenopausal controls. An age-related decrease in BMD values (lumbar and femur) was observable in all groups and a significant correlation between BMI and BMD was found. Adjusting for age and BMI, the effect of lifestyle on BMD at all sites was investigated. Occupation was associated with BMD in postmenopausal, but not in premenopausal women. Among the investigated dietary items, milk, yogurt and cheese were all associated with increased BMD in at least one region in diabetic patients. Smoking was not associated with BMD.
Conclusion: Type 2 Diabetes does not seem to be complicated by bone loss and osteoporosis. Physical activity and milk consumption in postmenopausal diabetic women can be a protective factor against bone loss.

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Diabetes is a common endocrine disease with complications such as retinopathy, nephropathy and neuropathy which has its monitoring through biomarkers desirable. At present, glycosylated hemoglobin (HbAic) is used for monitoring the long term control of glucose levels in diabetic patients. However, absence of a standardized range, has led to investigations that recently have suggested insulin-like growth factor-I (IGF-I) as a good biomarker for monitoring blood glucose levels in diabetics. The aim of this study was to examine the correlation between IGF-I and HbAic in Type 1 diabetes.
Methods: We designed a cross-sectional case-control study. The study composed of 26 newly diagnosed patients with Type 1 diabetes (15 male and 11 female mean age, 23.7±9.1 years) and 26 healthy controls (9 male and 17 female mean age, 24.1±4.4 years). Levels of fasting plasma glucose (FPG), HbA]C) IGF-I and IGF-binding protein-3 (IGFBP-3) were measured in both groups. FPG was measured by enzymatic glucose oxidase method and the colorimetric method was used to measure HbAlc. Determination of total serum levels of IGF-I and IGFBP-3 were done using immunoassay methods. P-value<0.05 was considered as statistically significant.
Results: The mean value of IGF-I concentrations in type 1 diabetics was significantly lower than controls (p< 0.05). A reverse correlation was observed between IGF-I and HbAic. Conclusion: The study indicates that in poorly controlled diabetics, levels of FPG and HbAic rise concurrent with a drop in levels of IGF-I decreases. Our study also showed a significant correlation between IGF-I and HbAie. Therefore, IGF-I could be indirectly used as a biomarker for controlling glucose levels in diabetics.

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Diabetes mellitus (DM) is the commonest cause of renal failure, blindness and non traumatic amputation. According to ADA, prevention of DM complications is possible through monitoring and control of blood glucose levels.
Methods: The Betachek strip, produced in Australia, is able to determine biood glucose level with no need for electronic glucometer devices.
Results: In this study, we compared venous and capillary blood glucose levels as determined by lest strips with measurements of enzymatic method (the standard laboratory kit). The mean capillary and venous blood glucose measured by the strip test was 21.85 mg/dl (P< 0.0001) and 17.9 mg/dl (P< 0.002) respectively that was 11.13% more than the standard method.
Conclusion: In this study, standard method had higher correlation with venous samples glucose level, than capillary samples (as measured by Betachek) (0.84 vs. 0.824). This difference was statistically significant (P< 0.0001).
Good correlation between the Betachek strip and the standard enzymatic method of blood glucose measurements, advocate its usage in home setting.

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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.

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At least 2 million people are affected by type II diabetes mellitus in Iran. Neuropathy is one of the commonest complications of diabetes affecting the quality of life of patients and can result in foot ulcer and amputation. The current study aimed to examine possible factors that could alter development of diabetic neuropathy.
Methods: In this case-control study, 110 diabetic patients were selected from Shariati hospital diabetes clinic. Michigan Neuropathic Diabetic Scoring (MNDS) was used to distinguish cases from controls. The neuropathic status of patients was confirmed with EMG-NCV. Multiple factors were compared between the two groups including ACE-I consumption, blood pressure, serum lipid level, sex, smoking, method of diabetes control and its quality.
Results: Statistically significant relations were found between neuropathy and age, gender, quality of glycemic control and duration of diabetes (P values: 0.04, 0.04, 0.000 and 0.005, respectively). No correlation existed between atherosclerotic risk factors (high BP, hyperlipidemia, cigarette smoking) and diabetic neuropathy.
Conclusion: In this study, hyperglycemia was the only modifiable risk factor for diabetic neuropathy. Glycemic control can decrease the incidence of neuropathy and delay its progression leading to improvement in the quality of life in diabetics. Aged and male diabetic patients and those with poor diabetes control are groups in most need of regular foot exam and more practical educations.

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Diabetes is one of the most common metabolic diseases. The prevalence of diabetes, which is around 4.5 - 6% in Iran, reaches as high as 14.2% in population of age 30 years and over in Yazd. Microalbuminuria is diagnosable before development of nephropathy and could be detected at an early stage when effective therapy can still be carried out. In this stage near normalization of blood glucose, strict blood pressure control and administration of ACE inhibitors can prevent nephropathic complications.
This study was aimed to determine the correlation among microalbuminuria, age, duration of diabetes, body mass Index, serum triglyceride, serum cholesterol and blood pressure in type 2 diabetic inhabitants of Yazd diabetes research center.
Methods: This cross-sectional study was carried out during November 2002-July 2003 to investigate the correlation between microalbuminuria and assumed risk factors. Two hundred and eighty eight type 2 diabetic patients (141 males and 147 females) were selected through consecutive sampling. Results: Overall prevalence of microalbuminuria was 14.2%. Chi-square analysis revealed the association between microalbuminuria and high diastolic blood pressure (P-value=0.003) and duration of diabetes (P-value = 0.001). No statistically significant correlation was found between microalbuminuria and body mass index, serum triglyceride, serum cholesterol and systolic blood pressure.
Conclusion: Determination of urine albumin/creatinin ratio is an easy method for screening microalbuminuria which is recommended for all diabetics especially those with hypertension and a long term history of diabetes.

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Neuropathy is a common complication of diabetes mellitus. Meticulous neurological examination and electrodiagnosis are valuable tools in early diagnosis of neuropathy and prevention of its sequels.
Methods: A hundred and three randomly selected diabetic patients were recruited from the endocrine clinic. Mean age of patients was 52.6 ±14 years. 29.4% had type 1 and 70.6% had type 2 diabetes.
Medical history was taken from patients and neurological examination was done. Electroneurographic examination included nerve conduction velocity, action potential amplitude, distal latency and H reflex measurements.
Results: Neuropathy was found in 79.4% of patients. The prevalence of neuropathy had a direct relation with duration of the disease. The most common complaints were tingling and numbness of extremities (72%) and burning sensation of the feet (36%). The most common physical findings were abnormal ankle jerk (92%), and decreased vibration perception (76%) in feet. Abnormal H reflex
(92.5%) and decreased amplitude of action potentials (79%) were the most common electroneurographic findings. There was a strong correlation between clinical and electroneurographic findings.
Conclusion: Neuropathy was quite common in diabetic patients. Neurologic examination is, therefore, recommended to prevent unnecessary workups and prevent complications.

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 Alterations in carbohydrate metabolism are frequently observed in cirrhosis. We conducted this study to define the prevalence of diabetes mellitus (DM) and impaired glucose tolerance (IGT) in patients with chronic liver disease (CLD), and explore the factors that may be potentially associated with the development of DM in these patients.
Methods: From October 2002 to March 2003, 185 consecutive patients with CLD, who referred to "Tehran Hepatitis Center", were enrolled into the study. Fasting plasma glucose and two-hour plasma glucose were measured in patients' sera. DM and IGT were diagnosed according to latest American Diabetes Association criteria.
Results: The subjects included 42 inactive HBV carriers, 102 patients with HBV or HCV chronic hepatitis, and 41 cirrhotic patients. Mean age was 43.8±12.0 years ranging between 22 to 84 years. DM and IGT were diagnosed in 40 (21.6%) and 21(11.4%) patients, respectively. Univariate analysis showed that age (P=0.000), CLD status (P=0.000), history of hypertension (P=0.007), family history of DM (P=0.000), and body mass index (BMI) (P=0.009) were associated with DM. Using Multivariate analysis, age (P=0.01), family history of DM (P=0.0001), chronic hepatitis (0.0004), and cirrhosis (P=0.0004) remained as the factors independently associated with DM. When patients with cirrhosis and chronic hepatitis were analyzed separately, higher Child-Pugh's score in cirrhosis (P=0.04) and older age (P=0.04), higher fibrosis score (P=0.04), and higher BMI (P=0.003) in patients with chronic hepatitis were found to be associated with higher prevalence of DM. Conclusion: Our findings indicated that patients with cirrhosis and chronic hepatitis are at risk of developing DM. Older age, sever liver disease, and obesity were associated with development of DM.

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

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Depression is one of the most prevalent mental disorders in diabetics, which affects treatment course and disease prognosis. This study focuses on the association between diabetes and depression as well as depression and glycemic control.
Methods: 375 diabetic patients (type I and II) of diabetes clinic of Doctor Shariati Hospital and diabetes association of Iran participated in this cross-sectional study.Patients were screened for depression with Beck Depression Inventory. Then depressed subjects were
evaluated with DSM IV criteria for determination of the depressive disorders category.
Results: Depression was diagnosed with Beck Depression Inventory in 41.9% of patients. Of these patients major depressive disorder was defined in 23.7%, dysthymic disorder in 9.3% and association of two disorders in 0.8% of patients. Major depressive disorder was more prevalent in 31-59 year old group and dysthymic disorder in more than 60 year age group. Also depression was more prevalent in
women, diabetics with uncontrolled blood glucose and patients with diabetes complications.
Conclusion: Depression is a prevalent psychiatric disorder in diabetics, which is associated with female gender, poor glycemic control and diabetes complications. Therefore, glycemic control and prevention and treatment of diabetes complications can prevent depressive disorders in diabetics.

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Background: Insulin dependant Diabetes Mellitus (IDDM) is associated with a reduction in production or secretion of insulin from pancreatic Islets. On the other hand increase in insulin secretion will result in destruction of islets that will lead to Diabetes .Therefore the factors that could regulate secretion will prevent the onset of diabetes . Glucose metabolism that commences with the glucokinase action is closely related to insulin secretion. The aim of this study is to survey the effect of eat ions Zn2+, V5+ and W5+ on insulin secretion and on the key enzyme, glucokinase, which is known to play an important role in insulin secretion .
Methods: 20 single islets were seprated from pancreatic tissues of each normal and diabetic rats and placed in tubes containing perfusion medium . Method ions with different concentrations/ and controls were provided with each set of experiment . Insulin secretion were determined using IDMA method. Glucokinaes activity in homogenate supernatant of normal and diabetic rats was assayed by spectropho to metric methods.
Results: the level of insulin concernlyation was shown to increase with vandate and tungsten treatment in normal and diabetic rats / and decreased by zinc .The effect of zinc on glucokinase activity was similarly reducing . Tungsten caused an increase in glucokinase activity (p<.001) while vandate showed no effect on the activity of enzyme .
Conclusion: The inhibitory effect of zinc on insulin secretion and the enhancing effect of tungsten correlate closely with their effect on glucokinase activity. There for the effect in insulin secretion could be assumed to be via glucokinase activation or inhibition . The effect of vandate on insulin secretion my be through other mechanisms which is not yet clarified.

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Background: Type 1A Diabetes Mellitus (T1DM) is a chronic and progressive auto- immune disorder resulting from immune mediated destruction of Langerhans islet beta cells. The etiology of T1DM like the other autoimmune diseases is unknown and many factors are involved, Both humoral and cell-mediated immunity have a critical role in T1DM pathogenesis. The cytokines, the immunomodulatory peptides, are responsible for the immune cell recruitment and producing auto-antibodies by the immune effector cells. To evaluate the role of cytokines in sensitivity or resistance to T1DM, we have employed IFN gamma to determine their gene polymorphisms and their association with T1DM.
Methods: 30 patient suffering from T1DM and 40 normal control were studied simultaneously .PCR technique was used to characterize the polymorphisms of cytokine. Salting out method was performed for DNA isolation .The polymorphosime of IFN gamma gene was determined on position UTR+5664`5.The PCR products were evaluated by Gel Electerophoresis Technique.
Results: There was a significant difference between patient and control group in TT allele IFN gamma gene: p<0.05, RR: 0.39(0.22