Iranian Journal of

---

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

---

Introduction: The prevalence of type 2 diabetes is increasing daily all around the world and is a serious threat to the well-being of the community in terms of renal failure, cardiovascular disease, blindness, and neuropathy. The assessment of difference screening approaches is of great importance in this disease. We compared ADA and WHO criteria for the diagnosis of type 2 diabetes.
Methods: 982 individuals (age range: 30 to 64 years), residents of the city of Bushehr, were chosen by systematic random sampling for this study, each providing a fasting blood sample for a standard oral glucose tolerance test. Plasma glucose was measured by the glucose oxidase-peroxidase method, using a Technikon RA1000 autoanalyser. Data was analysed with the Chi-squared and Student’s t tests and, when required, Fisher’s Exact test.
Results: 354 (36%) men and 628 (64%) women took part in this study. 42.9% were in the 30-39 age group. 69 (20 men and 49 women) of the 982, that is 7% of the sample, had known diabetes before recruitment into the study. The crude prevalence of type 2 diabetes and impaired glucose tolerance using WHO criteria was 13.6 and 15.6 percent, respectively. The crude prevalence of type 2 diabetes using ADA criteria was 13.4 percent. 51% of patients were already aware of their disease. The sensitivity of fasting blood glucose testing for detecting diabetes was 45.8% using WHO and 62.5% using ADA criteria. Both sets of criteria were equally specific.
Conclusion: Given the overall prevalence of glucose intolerance (impaired glucose tolerance and type 2 diabetes) in Bushehr, it should be considered as a high-prevalence area for diabetes. Accordingly, we recommend screening with fasting plasma glucose and oral glucose tolerance testing.

---

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.

---

 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.

---

Background: Polycystic ovary syndrome (PCOS) which is characterized by menstrual irregularities (due to chronic anovulation) and hyperandrogenism is one of the most common endocrine disorders of women at reproductive age. The precise cause of PCOS is unknown, but it seems that several factors may have role in its pathogenesis. Insulin resistance and impaired insulin secretion are common findings in PCOS patients. Approximately 30 – 40 % of women with PCOS have impaired glucose tolerance or type 2 DM. According to my knowledge, there is no published study about prevalence of IGT and type 2 Diabetes Mellitus (type 2 DM) in Iranian women with PCOS. The aim of this prospective, controlled study was to determine the prevalence of abnormal glucose metabolism in women from north west part of the country.
Methods: 302 PCOS women and 116 normal women as a control group were prospectively studied. The diagnosis of PCOS was made based upon the presence of chronic anovulation and hyperandrogenemia. Other causes of hyperandrogenism were excluded by appropriate clinical and laboratory evaluations. None of the patients were known diabetics prior to study. In all patients with PCOS and control women appropriate medical history was taken and physical examination was done. Blood pressure, body weight, height, BMI, waist / hip ratio, score of hirsutism and other signs of androgen excess were determined. Serum concentrations of total testosterone and DHEA–S were measured by RIA methods in both patients and control group. Standard Oral Glucose Tolerance Test (OGTT) with 75 grams oral glucose was performed between 8 -9 AM after an overnight fast of 10 – 12 hours. Fasting and 2 – hour post - glucose plasma sugars were measured by glucose oxidase method. Results: Results of OGTT were interpreted according to WHO criteria. Mean age and mean BMI were similar in both patients and controls. Serum levels of total testosterone and DHEA – S were significantly higher in PCOS women in comparison with controls. 65% of patients and 68% of controls had BMI of ≥ 25 kg / m2. 55% of PCOS women and 51.6% of control women were obese (BMI ≥ 27kg/m2). 96 (31.7%) of PCOS women had impaired glucose tolerance (IGT) and 27 (8.9%) were diabetics. The prevalence of IGT and diabetes in controls were 14.6% and 5.1% respectively. In non-obese PCOS women the prevalence of IGT and DM were 17.2% and 3.6% respectively, while only 8.9% of control women had IGT and 1.7% were diabetics. Finally, 44.1% of obese PCOS women were glucose intolerant and 13.5% had diabetes mellitus in comparison with 20% and 10% of controls. Conclusion: It is concluded that the prevalence of IGT and DM in both obese and non–obese PCOS women were significantly higher than in control women. Screening of all PCOS women for IGT and DM is highly recommended.

---

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.

---

Background: The aim of this study was to determine the level of agreement between the impaired fasting glucose (IFG) and abnormal glucose tolerance before and after application of the new IFG definition and to evaluate the impact of adding common clinical data on this agreement.
Methods: A cross sectional population based study was carried out in an Iranian urban population which enrolled 8766 men and women over 20 years. Fasting and 2-hour plasma glucose were measured in all subjects excluding those with previously diagnosed diabetes and fasting plasma glucose ≥126 mg/dl. The diagnostic parameters and kappa coefficient between the previous and revised definitions of IFG for detecting impaired glucose tolerance (IGT) and dysglycemia (IGT and diabetes) were calculated. Logistic regression and ROC curve analysis were used to determine the independent clinical risk factors and their optimal cut-points associated with IGT and dysglycemia. Results: After using the new criteria, sensitivity of IFG for detecting IGT or dysglycemia increased but specificity and positive likelihood ratio (LR+) decreased and the κ slightly improved (0.16 to 0.29 for IGT and 0.24 to 0.35 for dysglycemia). Adding the clinical data to the revised criteria considerably improved the agreement between IFG with IGT and dysglycemia (κ increased from 0.286 to 0.470 for IGT and from 0.354 to 0.574 for dysglycemia). This also increased the LR+ from 3.86 to 14.5 and from 4.46 to 17.4 respectively for detecting IGT or dysglycemia.
Conclusion: The new IFG definition in combination with common clinical risk factors most likely predicts IGT and dysglycemia.

---

Background: To determine the prevalence and characteristics of subjects with isolated post challenge hyperglycemia (IPH) defined as fasting plasma glucose (FPG) <126 mg/dl and 2-hour plasma glucose (2h-PG) ≥200 mg/dl.

Methods: We evaluated data and results of Oral Glucose Tolerance Test (OGTT) from 9745 participants in Tehran Lipid and Glucose Study (5589 women and 4156 men) aged>20years, without previously diagnosed diabetes mellitus (DM). A logistic regression model for having IPH was developed among subjects with FPG<126mg/dl to predict.

Results: The prevalence of IPH was 3.1% (n=302). 26.5% (n=80) of subjects with IPH had FPG<100mg/dl. The odds ratios for IPH were statistically significant for FPG≥100mg/dl (OR=9.5 95% CI: 7.1-12.5), age≥40 years (OR=2.6 95% CI: 1.8 - 3.7), triglycerides≥200 mg/dl (OR=2.1 95% CI: 1.6-2.7), hypertension (OR=2.0, 95% CI: 1.5-2.6) and abnormal waist circumference (females≥80, males≥90cm) (OR=1.9, 95%CI: 1.3-2.8).

Conclusion: This analysis showed that in Tehran urban subjects with FPG<126 mg/dl, variables such as FPG≥100 mg/dl, older age, hypertriglyceridemia, hypertension and abnormal waist circumference were significantly associated with higher likelihood of IPH OGTT would hence be recommended in subjects with above mentioned characteristics.

---

Background: Gestational diabetes in on of common complications of pregnancy which has different complications for fetus and mother. Aim of present study was to review the effect of six weeks aqua training in second trimester of pregnancy on visfatin and glucose tolerance of gestational diabetic women.
Methods: In this semi experimental research 24 gestational diabetic mothers who recourse to hafez clinic of shiraz city which were in 23- 24 week of pregnancy select as sample and divided in two groups of 12 persons of aqua training and control. Aqua training group trained aqua trainings 6 weeks, 3 sessions per week and 45 minutes per session. In this period of the time control group has just their daily activities. For measure the research variables fasting blood sample gathered from antecubital vein in pretest and post test.
Results: Six weeks aqua training in second trimester of pregnancy has significant effect on increase of visfatin and decrease of glucose tolerance of gestational diabetic women (p=0.001).
Conclusion: It seems that for improvement of visfatin levels and glucose tolerance of gestational diabetic women can use six weeks aqua training in second trimester of pregnancy.