Iranian Journal of

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Background: The importance of feed controlling has been proved in metabolic control of diabetic patients. An appropriate metabolic control prevents later complications. Patients with diabetes mellitus are deprived from eating sweat foods. Considering the effect of different carbohydrates on blood sugar, physicians and patients confront a lot of questions about eating these foods. The aim of this study was to compare the effect of sugar cube and Date consumption on blood sugar in patients with type 1 diabetes.
Methods: As a clinical-trial, we selected 20 patients with type I diabetes mellitus sequentially. They were divided into two groups with 10 subjects in each group. The patient’s blood sugar was measured in 2 days with one week interval, before and after eating a Date (10gr) and a sugar cube (5gr). We measured blood sugar at 30, 60, 90 and 120 minutes after consumption. Data analysis was performed by SPSS software version 11, and the results were compared by paired t test.
Results: There was no significant difference between the blood sugar after eating Date and sugar cube. We also compared the surface under the curve of blood sugar after eating date and sugar cube in 2 hours, which was 1619.4 ± 614 mg.min/dL and 1572 ± 967 mg.min/dL for sugar cube and Date respectively, which the difference was not significant.
Conclusion: Rising in blood sugar after Date consumption has not significant difference in comparison with sugar cube consumption in patients with type I diabetes. So, eating Date in diabetic patients is not preferable to eating sugar cube.

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Background: Mitochondria is one of the intracellular organelle with specific DNA. Some diseases caused by mtDNA mutations have been reported up to now. Mutation of A3243G and deletion of 5kb are two of them that related to Diabetes type II. The aim of this study was to evaluate the frequency of A3243G mutation and 5kb mt DNA deletion in type II diabetic patients.
Methods: The DNA extracted from blood of 130 patients with diabetes type II. Serum insulin of the patients were also measured. Sequence assigning, PCR – RFLP and SSCP methods were used to detect the A3243G or other mutation in mitochondrial tRNA (leu) gene. Standard and multiplex PCR were used to detect 5kb deletion in patient’s mt DNA and were compared with 40 healthy persons.
Results :We couldn’t identify any deletion of 5kb or A3243G point mutation in our patients but SSCP results showed new pattern of PCR Product in patients. An “A” nucleotide deletion in A 3314 position was detected in mitochondrial ND1 gene in 6 patients. So far this point deletion has not been reported.
Conclusion: Identification of the mitochondrial gene mutations helps to preclinical diagnosis of diabetes type 2. More research is necessary in this field.

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Background: Several studies and research have shown a higher prevalence of celiac disease (CD) and elevation of serum antibody (AGA-IgA & IgA-tTG & EMA-IgA ) in patient with diabetes mellitus type I (T1DM) in versus general and non-diabetic population. Thus screening of CD is recommended in T1DM). This study was conducted to compare frequency of celiac disease in patients with T1DM and healthy persons.
Methods: As a case-control study,60 patient with T1DM that reffered to endocrine clinic of Qazvin’s Boo-Ali hospital , in nearly one year period were enrolled as case group. 60 non-diabetic healthy subjects with age and sex matched, were selected as control group. Blood levels of Total IgA, AGA-IgA and IgA-tTG were measured in all of them, subjects who had elevated of both AGA-IgA and IgA-tTG underwent an upper GI endoscopy and biopsy was done from distal part of duodenum.
Results: Any one in case group hadn't IgA deficiency. 14 subjects in control and 12 subjects in case group had positive AGA-IgA that there was no significant difference between them . 2 subject of case group had positive IgA-tTG. Duodenal biopsy in 1 of 14 cases who had elevated AGA-IgA )1 of 2 cases who had elevated IgA-tTG) , revealed total villous atrophy indicating CD (Type IIIC with revised Marsh criteria 2001) and in other cases pathologic findings were normal or with nonspecific changes.
Conclusion: Frequency of CD in T1DM in our study is 1.67%. There is not any significant difference between case and control groups in prevalence of Celiac disease . But we conclused that screening with AGA-IgA is not a reliable screening test for CD , because there is not significant difference between T1DM and general population .

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Background: Type 1 diabetes mellitus (T1DM) is an autoimmune disease in which T-cell mediated selective pancreatic β- cell destruction occurs. Half the risk of T1DM development is given by the HLA gene region while the remaining risk is assigned to non-HLA genes , probably those engaged in the formation of antigen interaction complex. The CD4 gene product, which is among the most prominent T-cell surface receptors with a key role in antigen processing, could be regarded as a strong candidate.
Methods: We investigated the possible association of the CD4 gene polymorphism with T1DM using the candidate gene approach. The pyrimidine- rich pentanucleotide repeat polymorphism residing in the promoter region of the CD4 gene was studied. In the present study 92 Iranian T1DM patients and 108 healthy matched control individuals were screened by PCR technique.
Results: The analysis of our results shows the protective association of CD4*A3 (RR= 0.159, 95% CI: 0.036-0.707 Pc=0.025) and the susceptible role of CD4*A5 (RR= 7.379, 95% CI: 1.630-33.414 Pc=0.010) with T1DM. Conclusion: Our results suggest that the certain CD4 alleles are associated either negatively or positively with T1DM in the Iranian population.

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Background: Foot complications are among the important problems of diabetic patients. Vascular and neurological involvements are two major causes for such complications.
Methods: We studied 142 diabetic outpatients referred to diabetes clinic of Dr.Shariati Hospital from Dec. 2003 to Sep. 2004. We performed different neurological and vascular tests to assess the diabetic foot and data were analyzed by SPSS software.
Results: 54.9% of the cases reached the symptom score of 5 and upper so they had neuropathy regarding the Michigan Neuropathy Disability Score (MNDS). By analyzing the overall symptom and sign scores, 61% had neuropathy. Regarding MNDS, 42.7% of the subjects were neuropathic. Finally 23.9% were unable to sense at least one point from 12 points of monofilament examination. 16.9% of the patients had the complaint of intermittent claudication, in 8.8% at least one of the peripheral pulses was not palpable, whereas 10.6% had some degree of PAD regarding to ABI and toe pressure.
Conclusion: Using a monofilament is the most reliable method for screening of the neuropathy in diabetic patients. On the other hand, relying on symptoms like intermittent claudication and physical examination in order to find peripheral arterial disease in diabetic patients may lead to miss many cases, thus, performing some more precise diagnostic tests, such as ABI and toe pressure are highly recommended and reliable.

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Background: Hyperhomocysteinemia may increase blood pressure by inducing endothelial cells dysfunction . The aim of this study was determining the relationship between plasma Homocysteine (Hcy) levels and blood pressure in new cases of type 2 diabetes mellitus.
Methods: As a cross sectional study, 46 new cases of type 2 diabetes mellitus referred to Isfahan Endocrine and Metabolism Research Center were selected by convenient sampling. Basal characteristics of patients were recorded. Systolic and diastolic blood pressure was measured two times with 30 minutes interval on two consequent days. After ten hours of overnight fasting, blood samples were taken to measure fasting plasma glucose, HbA1c, triglyceride, Total cholesterol, HDL-C and creatinine. All data were expressed as mean (SD). Relationship between plasma Homocysteine levels and both systolic and diastolic blood pressure was assessed by Pearson's correlation coefficient. Patients were divided into three groups according to their plasma Homocysteine levels, (Hcy<10mol/L, 10Hcy<15 mol/L and Hcy15mol/L).. Then mean of systolic and diastolic blood pressure between groups were compared by one – way ANOVA and Tuckey-HSD tests.
Results: Mean (SD) of plasma Homocysteine levels was 12.2 (6.8) mol/L and of systolic and diastolic blood pressure was 128.8 (18.1) and 82.3(9) mm/Hg, respectively. There was a significant correlation between plasma Homocysteine levels, and both systolic (r=0.39, P<0.01) and diastolic (r=0.46, P<0.01) blood pressures. Mean (SD) of systolic and diastolic blood pressure in patients with plasma Homocysteine level of 15mol/L was 152.5 (17.7) and 91.8 (7.3) mm/Hg, respectively, so blood pressure in those group with hyperhomocysteinemia was higher than other two groups (P<0.001). There was no correlation between Homocysteine levels and FPG, HbA1c and lipid profile.
Conclusion: There is a significant correlation between plasma Homocysteine levels and both systolic and diastolic blood pressure in newly diagnosed type 2 diabetics. Patients with hyperhomocyteinemia have higher blood pressure.

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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: To determine the importance of type 2 Diabetes mellitus as a risk factor for osteoporosis in postmenopausal women, this study was designed in endocrine clinic of zanjan in 2003.
Methods: As a case-control study, 40 diabetic and 40 healthy menopause women have been recruited. These two groups were matched in terms of their age, length of their menopausal period and body mass index. Serum Calcium, Phosphorus, Alkaline phosphatase and Estradiol were measured in all the cases and bone densities in three sites (Femoral neck, lumbar spine and forearm) were evaluated with DXA. All data were analyzed using T-test, analysis of variance, chi-square and multiple regression tests.
Results: The frequency of osteoporosis and osteopenia in diabetic women were not significantly different from non diabetics. The mean bone density in femoral neck was higher in diabetic group (P= 0.013). In both groups there was a significant relationship between bone density and length of menopause (P<0.01) .The relationship between BMI and Bone density was significant only in femoral neck (P<0.01) in both groups. In diabetic women, the higher HbA1c accompanied with the lower bone density in lumbar spine.
Conclusion: Although the level of HbA1c as a marker of blood glucose control, has a relationship with lumbar spine density in diabetics, Diabetes type 2 is not a risk factor for osteoporosis, So screening, diagnosis and management of osteoporosis in diabetes type 2, Should be done independently and according to other risk factors.

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Background: Diabetes mellitus is an insidious disease which can affect different organs. One of the problems is resistant vaginitis, which is related to factors such as high blood glucose levels, allergy and atopia. One of the most common pathogens associated with this condition is Candida Albicans. Thus most physicians begin anti-fungal therapy in first visit even without documented evidence of fungal origin.
Methods: This descriptive analytical cross-sectional study was performed on 160 non-pregnant diabetic women in diabetes clinic of Shariati Hospital during a period of three years (2002-2005). Fasting and 2 hours postprandial blood glucose levels and HbA1C were measured and culture of vaginal discharge was performed. Fisher's exact test was used for statistical analysis.
Results: 71% of women had clinical vaginitis (fungal or bacterial) and 12.5% were diagnosed with Candida vaginitis. Microscopic findings were positive in 1.3 % of patients who had Candida vaginitis (16.7% of all patients). Culture of vaginal discharge revealed that the Candida was responsible of 4.4% of Candida vaginitis. Overlay, the prevalence of Candida vaginitis based on positive culture was 8.8 % in this study. There was significant statistical relationship between mean FBS and infectious vaginal culture. However, the difference was not significant between positive culture of Candida and age, controlled blood glucose, history of allergy, genital hygiene, occupation, level of education, kind of treatment , and type or duration of diabetes.
Conclusion: We suggest in the patients with positive signs of vaginitis, especially Candida vaginitis (even with positive smear) culture of vaginal discharge be carried out.

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Background: Artichoke with the scientific name of Cynara scolymuse is a plant from compositae family. In this research, the effect of hydro alcoholic artichoke extract on serum glucose, lipids and lipoproteins and prevention of type 1 diabetes mellitus was investigated.
Methods: Twenty mature male Rats with mean weight of 200-250 gr in four groups were arranged. Rats in the control group, received physiological serum. The Second group (diabetic) received 120 mg/kgbw Alloxan monohydrate. The Third group (diabetic + Glibenclamide) received 0.5 mg/kgbw Glibenclamide in addition of the similar treatment with second group. The Fourth group (Alloxan monohydrate + Cynara scolymus), received 120 mg/kgbw Alloxan monohydrate with 300 mg/kgbw of Cynara scolymus simultaneously. Prescribing materials in all groups was done as interaperitoneal injection(IP). Fourty eight hours after last IP, blood sample was taken from each animal via cardiac puncture to measure blood factors.
Results: The results indicated significant reduction in glucose, cholesterol, triglyceride, VLDL and LDL levels in the treated group with extract and Alloxan monohydrate simultaneously as to compared diabetic group. Also, the result indicated significant increase in HDL level. Hydroalcoholic Artichoke extract could not reduce blood glucose level as compared with Glibenclamide, but had similar effects on other factors in comparison with Glibenclomide.
Conclusion: Artichoke contains antioxidants compounds, that plays a protective role on beta cells against Alloxan. The results of this research indicate that hydro alcoholic extract of Cynara scolymus could effectively prevent type 1 diabetes mellitus.

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Background: Few studies have investigated maternal leptin concentrations in women with pregnancies complicated by gestational diabetes mellitus (GDM), and these published results are conflicting. We examined the association between plasma leptin concentration and GDM risk.
Methods: As a cross-sectional study 741 pregnant women that referred to five university hospital clinics were recruited. The universal screening was performed with a GCT-50g and those with plasma glucose level ≥130mg/dl, were diagnosed as GDM if they had an impaired GTT-100g based on Carpenter and Coustan criteria. The level of insulin was measured during OGTT-100g. Also maternal plasma leptin concentrations were measured.
Results: GDM patients had higher age, parity, BMI, and serum leptin concentration as compare with normal pregnancies. In logistic regression model serum leptin levels were independent factor for GDM.
Conclusion: Serum leptin concentrations can predict GDM.

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Background: Detecting mothers with gestational diabetes mellitus (GDM) is not only important in prevention of prenatal morbidities but also has significant effect on neonatal and maternal long term outcomes. Today, there are screening tests for GDM but they are time-consuming and expensive, therefore it seems necessary to perform testes that are uses expensive but with higher sensitivity and specificity. The aim of this study was to determine a cut - off point of fasting plasma glucose (FPG) for screening of GDM.
Methods: 200 pregnant women referring to the perinatal clinic of Imam Khomeini hospital, (Sari – Iran) were studied. All cases with age ≥25 years old, history of recurrent abortion, GDM, preeclampsia, macrosomia, still birth, diabetes mellitus(DM) in first degree family or pre gestational body mass index ≥25kg/m2 were selected. Those with pre gestational diabetes mellitus were excluded. All of participants underwent a 50 g glucose challenge test (GCT) between the 24th and 28th gestational week. If 1- hour plasma glucose was more than 130 mg/dl, a 3- hour 100g oral glucose tolerance test (OGTT) was performed. The diagnosis of GDM was made by ADA 2006 recommendation (Carpenter and Coustan diagnostic criteria). Referring to the Receiver Operative Characteristic Curve, level of FPG having highest sensitivity and specificity in diagnosis of GDM was determined.
Results: From 200 participants, 65 women had positive GCT, of them 58 (response rate 89%) referred for 100g OGTT and 20(10%) were diagnosed GDM. Using ROC curve and under curve area of 0.853 the FBG level of 91.5 mg/dl, showed the highest sensitivity and specificity, 80% and 92% respectively in diagnosis of GDM.
Conclusion: FBG ≥ 91.5 mg/dl has good sensitivity and specificity in screening of GDM. Since this is simpler and cheaper than 50g GCT, is recommended as a screening method in diagnosis of GDM.

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Background: Pregnancy is a condition that favors oxidative stress mostly because of the mitochondria-rich placenta. Transitional metals, especially Iron, which is particularly abundant in the placenta, are important in the production of free radicals. Also studies showed that free radicals has a role in GDM. This study was performed to compare Iron status between gestational diabetes mellitus (GDM) patients and control groups.
Methods: As a case- control study 34 women with GDM were compared with 34 Healthy women matched for referred center, age, parity and BMI. Iron status measurements including ferritin, serum iron, total iron binding capacity (TIBC), hemoglobin, MCV and MCH at 24-28 weeks of pregnancy were assessed and compared between two groups.
Results: In this study, concentration of serum ferritin, Iron, transferin saturation and hemoglobin, MCV and MCH were significantly higher in GDM group and TIBC was significantly lower in this group as compared with controls (P<0.05). No significant association was observed in other variables including familial history of diabetes and GDM
Conclusion: Our findings indicate an association between increased Iron status and GDM. The role of excess Iron from Iron supplementation in the pathogenesis of GDM needs to be examined.

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Background: Diabetes mellitus can have variable and sometimes profound effects upon the oral tissues. It has been shown that uncontrolled or poorly controlled diabetics have particularly a greater incidence of severe recurrent bacterial or fungal infections and periodontal diseases. The purpose of this study was to determine thee relationship between oral manifestations in diabetic patients and duration of disease, and glycemic control.
Methods: We studied 116 diabetic outpatients referred to Diabetes Clinic of Shahid Bahonar Hospital of Kerman Province. We evaluated the following parameters: dental caries, periodontal status, xerostomia, burning sensation and mucosal alterations. We also recorded information about history of diabetes and glycemic control. Data were subjected to SPSS and X, t- test.
Results: The most frequent alterations in this study were gingivitis (96.3%), periodontitis (90.2%), and xerostomia (97.24%). Burning sensation and periodontal diseases were significantly correlated to duration of diabetes (P=0.002, P=0.012 respectively).The results of the present study showed that periodontal diseases occur more frequently in moderately and poorly controlled diabetic patients than in those with good glucose control, but this difference was not statistically significant.
Conclusion: In this study, dry mouth and periodontal diseases are common complaints among diabetic patients. Therefore management of oral diseases in diabetic patients should include a comprehensive evaluation of salivary function and periodontal status.

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Background: Single nucleotide polymorphisms of Adiponectin gene have been associated with BMI, insulin sensitivity and type 2 diabetes, reportedly. In present study we performed a genetic association study for Adiponectin gene at position +45*T/G in type 2 diabetes and normal subjects of Tehran population.

Methods: Diabetic patients were selected from diabetes clinic and normal healthy control subjects aged between 25-64 years selected from zone 17 of Tehran. Adiponectin gene polymorphism was analyzed using PCR-RFLP method in normal healthy controls (N=70), obese diabetic patients (N=80) and non-obese diabetic patients (N=72).

Results: Frequency of TT genotype was 62.5% in non-obese diabetic patients and 78% in control group, that was statistically significant (TT vs TG+GG: P=0.02, OR=2.2, CI:0.98-5.00). There was also a significant difference for allele T and G frequencies when we compared between non-obese diabetic patients and controls group. The frequency of allele G was increased in non-obese diabetic (20.1%) patients compared to controls (12%) (P: 0.04 OR: 1.8 CI: 0.9-3.7).

Conclusion: This study showed TG and GG alleles of Adiponectin gene polymorphism at position +45*T/G are risk factors for development of diabetes mellitus while this effect is independent from BMI and obesity.

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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.

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Background: Type 2 diabetes mellitus is a common metabolic disorder witht increasing prevalence is increasing worldwide. C-Reactive Protein (CRP) is a marker of systemic inflammation and an independent risk factor for cardiovascular disease (CVD). The aim of this study was to elucidate the correlation between glycemic control and systemic inflammation by measuring serum CRP levels.

Methods: In this cross sectional study 136 patients with type 2 diabetes mellitus (69 females, 67 males) were recruited. In addition to measurement of CRP levels by highly sensitive methods and measurement of hemoglobin A₁C effects of influencing factors on the CRP level was considered. Fasting plasma glucose was determined via the glucose oxidase method, HbA_1C via HPLC, serum lipid profile enzymatically and hs-CRP with sandwich immunoassay method.

Results: The mean concentrations of CRP levels in these patients (5.2 ± 4.8 mg/L) were higher than normal range and in women greater than men (6.4 ± 5.5 vs. 3.9 ± 3.6 mg/L). Before adjusting for influencing factors the association between hs-CRP levels and hemoglobin A_1C was negative but not statistically significant (r= -0.15, P=0.07). After adjusting, the association was negative and significant. (r= -0.22, P= 0.02). In this study the relation between hs-CRP and lipid profile was also determined.  There was no significant relationship between the levels of hs-CRP and total cholesterol, LDL-C and HDL-C. A positive correlation between hs-CRP with serum triglyceride and triglyceride / HDL ratio was observed. However, the correlation was not significant.

Conclusion: These results demonstrate that hs-CRP levels is influenced with multiple factors, and increased hs-CRP levels in patients with type 2 diabetes mellitus can not be explained with hyperglycemia alone.

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Background: The prevalence of Diabetes mellitus as the most common metabolic disorder of human is progressively increasing. Dyslipidemia is common among diabetic patients characterized by elevated plasma TG, LDL-C and reduced HDL-C levels which increase risk of cardiovascular events. Fish oil supplement which contains omega-3 has been proposed to correct the atherogenic lipid profile associated with diabetes mellitus. Doubt remain whether the net effect of fish oil supplement on lipid profiles are beneficial in diabetes. We therefore performed this randomized double-blind clinical trial to investigate this.

Methods: Ninety six patients with type 2 diabetes mellitus were randomized assigned to take 3 times daily supplementation (capsule) with either fish oil or corn oil for 8 weeks (48 patients in each group). At begining also end of study we measured laboratory variables (FBS, TG, Total cholesterol, LDL and HDL) in both groups.

Results: At begining of the study demographic and laboratory measurements were similar in both groups (P>0.05).At 8^th weeks there  were  no statistically  significant  differences  in variables  measured except for  LDL and HDL in fish oil  group that leads to increase and decrease respectively. Although both groups show improvement in LDL / HDL and Total cholesterol / HDL ratios but mean charges were statistically significant in fish oil as compared with corn oil group. (P=0.001, P=0.005 respectively).

Conclusion: Fish oil supplement showed statistically significant improvement in LDL/HDL, Total cholesterol/HDL ratios as compared with corn oil. This may leads to decrease cardiovascular events.

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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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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.