Showing 13 results for Screening
Bagher Larejani, Arash Hossein Nezhad,
Volume 1, Issue 1 (7-2001)
Abstract
Diabetes during pregnancy is either concurrent diabetes, diagnosed before pregnancy, or ‘gestational diabetes mellitus’ (GDM), first diagnosed in pregnancy.
GDM is the commonest metabolic disorder of pregnancy, with a prevalence of one to 14 percent, depending on the reporting team. The prevalence of GDM in Tehran is 4.7%. Diabetes concurrent with pregnancy is diagnosed according to the recently revised criteria of the National Diabetes Data Group (NDDG). GDM is diagnosed with a 100-gram 3-hour glucose tolerance test (3hGTT100), with at least two abnormally high readings being required for a definite diagnosis.
Screening for GDM is still a matter of dispute. Universal or selective screening? Each has its supporters. The American Diabetes Association (ADA) recommended universal screening until 1997, and this is still recommended for areas with a high prevalence of GDM.
Diabetes during pregnancy has multiple potential consequences for mother and fetus fetal macrosomia being the commonest. The children of diabetic mothers are also more likely to become overweight and develop impaired glucose tolerance.
ADA recommendations for glycemic control in diabetic mothers-to-be include maintaining their fasting blood glucose between 60 and 95mg/dl, and their postprandial blood glucose between 80 and 120mg/dl. Measurement of urinary ketones is recommended when the patient is on a calorie-restricted diet. Lifestyle changes are an integral part of management. Insulin requirements and calorie intake must be adjusted in line with weight gain as pregnancy progresses.
Arash Hossein-Nezhad, Bagher Larijani,
Volume 1, Issue 1 (7-2001)
Abstract
Background: Estimation of cost effectiveness and cost benefit are intrinsic to the design and evaluation of healthcare systems. The aim of most studies of gestational diabetes screening has been to modulate screening parameters to reduce the eligible population and therefore costs. We analysed the findings of a cross-sectional study of gestational diabetes mellitus carried out in Tehran to determine the screening method best suited to the socio-economic profile of our population.
Methods: 2416 pregnant women were universally screened in Tehran teaching hospitals. Each patient’s risk factors and laboratory results were recorded. The 50gGCT was used to screen and the 100gOGTT to confirm a diagnosis of GDM.
Results: Switching from the 130mg/dl to the 140mg/dl threshold, case-detection sensitivity declined by 12% (to 88%), with the per-pregnancy cost dropping from 30,410 to 25,641 Rials (from US$3.80 to 3.20) [-15.6%], and the cost per detected case from 644,488 to 619,500 Rials (from US$80.56 to 77.43) [-3.87%].
Conclusion: We recommend adoption of the universal screening approach in Iran for 4 reasons: (1) The high prevalence of gestational diabetes in the low-risk group (2) The poor level of healthcare provided in Iran compared with societies that have opted for the selective approach (3) The lower cost of screening and diagnostic tests in Iran compared with the aforementioned and (4) The high cost of treating the complications of diabetes.
Massoud Amini, Mehrdad Hosseinpour, Gashtasb Sattari, Sasan Haghighi,
Volume 1, Issue 1 (7-2001)
Abstract
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.
Fariba Karimi, Iraj Nabipoor, Mojtaba Jaafari, Farkhondeh Gholazmzadehi,
Volume 2, Issue 1 (5-2003)
Abstract
Background: The American Diabetes Association in 1997 switched its recommendations regarding the screening of pregnant women from universal to risk factor-based screening. The ADA specifically recommended that screening is not cost-beneficial in women under the age of 25, with a normal weight and negative family history of diabetes.
Methods: 910 pregnant women attending the diabetes clinic at Bushehr University of Medical Sciences were screening for gestational diabetes using a 50-gram glucose challenge test. All the women were 24-28 weeks pregnant at the time of testing. Women with a post-load blood glucose of ≥140mg/dl were referred for a 3-hour oral glucose tolerance test. The presence of ADA risk factors was recorded, as was the absence of all three risk factors, and compared with the results of 50-gram GCT. We evaluated the predictive value of different combinations of risk factors relative to the results of screening.
Results: 66 women (6.9%) had a positive screening test, with 16 (1.75%) eventually diagnosed with GDM based on OGTT results. GCT was negative in 616 (95.3%) women, who had at least one of the three risk factors – age >25 years, BMI ≥27kg/m2, or a positive family history of diabetes – and in 231 (27.3%) women who had none of these risk factors [odds ratio = 70.3, 95%-CI = 2.23-22.21 p<0.0001].
Conclusion: Selective screening of pregnant women will detect most cases of gestational diabetes where resources to implement universal screening are limited. The most important factors in selecting screening candidates are age, body mass index, and family history of diabetes mellitus.
Arash Hossein-Nezhad, Bagher Larijani,
Volume 2, Issue 2 (6-2003)
Abstract
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.
Shahin Yarahmadi, Bagher Larijani, Ebrahim Javadi, Mohammad-Hassan Bastan Hagh, Mohammad Pajouhi, Reza Malekzadeh, Mahmood Mahmoudi, Aliereza Shafaei, Mohammad-Reza Mohajeri-Tehrani, Ali Rajabe, Mohammad Farshadi,
Volume 3, Issue 1 (5-2004)
Abstract
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.
Amir Bahrami,
Volume 3, Issue 2 (6-2004)
Abstract
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.
Hossein Fakhrzadeh, Rasoul Pourebrahim, Fatemeh Bandarian, Ramin Heshmat, Fouruzan Djalilpour, Masoumeh Noori, Ozra Tabatabaie, Farzaneh Zahedi, Iman Rahimi, Sara Ghotbi,
Volume 4, Issue 1 (7-2004)
Abstract
Background: Cardiovascular disease is one of the major leading cause of death in Iran. There is a strong association between parental history of cardiovascular disease clustering of risk factors in the offspring. Detection and treatment of cardiovascular risk factors since childhood is essential to reduce the incidence of disease in adulthood. This study was performed to identify major cardiovascular risk factors in middle school-aged children and their parents in high risk compared to control families.
Methods: The middle schools of the 6th of Tehran were divided randomly into two groups. A total of 169 high-risk children with their families were recruited from the first group while 105 control children with their families were recruited from the second group of schools. Coronary risk factor survey was performed in the participants.
Results: Prevalence of increased total- and LDL-cholesterol and high FBS were higher in high-risk parents and children. Prevalence of increased BMI was higher in fathers and children of high-risk families. More fathers in high-risk families were smoker. The means of waist circumference and WHR were significantly higher in high-risk fathers. The means of total- and LDL- cholesterol were significantly higher both in parents and children of high-risk group. The means of FBS were significantly higher in fathers and offspring of high-risk families.
Conclusion: Cardiovascular risk factors are more prevalent and clustered in high-risk families. Screening of these families is essential to prevent progression of cardiovascular disease since childhood and reduce its burden in adulthood.
Farzad Hadaegh, Hadi Harati, Fereidoun Azizi,
Volume 4, Issue 3 (5-2005)
Abstract
Background: a variety of studies have noted seasonal variation in blood lipid levels, yet the mechanism for this phenomenon has not been clear. This leads to significant difference in prevalence of lipid disorders in different seasons.
Methods: A cross sectional study conducted on 6894 individuals (2890 men and 4004 women) aged 20-64 years who participated in the 1st phase of Tehran Lipid and Glucose study from March 1999 to September 2001. The mean level of plasma lipid values was compared between seasons by ANCOVA after adjustment for age, physical activity, smoking, BMI and waist-to-hip ratio. The sex specific prevalence of lipid disorders in summer and winter was calculated.
Results: 58% of participants were women. The mean age of men and women was 38.3±11.3 and 39.4±11.6 respectively (P=0.13). There was a significant seasonal variation in serum total cholesterol, LDL-C and HDL-C in men (P<0.05) with a peak in winter and a trough in summer (P<0.05). In women, only triglyceride levels showed significant seasonal variation characterized by increase in summer and decrease in winter (P<0.05). In men, there was 26.2% increase in prevalence of hypercholesterolemia (>240 mg/dl) in winter compared to summer (P<0.05). The corresponding increase in level of high risk LDL-C (≥160 mg/dl) was 26.7% and 24.9 % in men and women respectively (P<0.05). There was 23.8% decrease in the prevalence of hypertriglyceridemia (>200 mg/dl) in winter compared to summer in women (P<0.001).
Conclusion: This study confirms seasonal variation in blood lipid levels and suggests greater amplitude in seasonal variability in men than women. On the other hand, the increase in the prevalence of high risk LDL-C in both genders in winter should be considered in patients screening and follow-up strategies.
Hossein Fakhrzadeh, Azadeh Sadat Khezri, Ali Refaei, Rasoul Pourebrahim, Mohammad Jafar Mahmoudi, Ramin Heshmat, Fatemeh Bandarian,
Volume 6, Issue 1 (8-2006)
Abstract
Background: Cardiovascular Diseases are becoming increasingly prevalent due to urbanization and industrialization of our country. Therefore Screening of the Cardiovascular Risk Factors is one of the most important health system priorities. The aim of this study was to evaluate a screening method implementing family history for cardiovascular risk factors.
Methods: We chose 10 Junior-high schools in the 6th district of Tehran using simple random sampling. Then a questionnaire asking about family history of cardiovascular disease in the first degree relatives (including grand parents) was distributed between them and was completed –
with contribution of parents. Then high-risk and low-risk families were invited separately to Dr Shariati Hospital for further evaluation. SPSS software version 10 using student T-test, Chi-Square and descriptive tests were applied for data analysis
Results: Approximately 40% of families had positive family history (high risk). From this group, 72% participated for follow-up. From the low-risk group, only 34% participated. Total cholesterol and LDL-C levels were significantly higher in high risk (HR) group. FBS was also significantly higher in fathers and children of the HR group (P<0.05). High TC, LDL-C and FBS levels were more prevalent among the HR families (P<0.05). No significant differences were observed in age, BMI, BP, TG and HDL-C between the 2 groups.
Conclusion: Families with a history of cardiovascular disease participated in greater numbers in the screening process and the prevalence of risk factors in this group was significantly higher. The findings confirm the usability of family history in screening programs.
Fatemeh Mohammadzadeh, Kobra Omidfar, Ramin Heshmat, Mazaher Rahmani, Bagher Larijani,
Volume 6, Issue 3 (5-2007)
Abstract
Background: Microalbominuria (MA) is early presentation of renal damage which acts as an independent factor of cardiovascular events in these patients. There are various methods for sampling and also different laboratory tests to measuring albominuria. The aim of this study was to compare of different urine collection methods for measuring albominuria using immunoturbidometry assay which has acceptable accuracy and sensitivity after HPLC (High Performance Lipid Chromathography).
Methods: Forty seven diabetic patients were selected for a cross-sectional study in 2006. For all patients 24-h urine sample were collected, also an overnight urine sample (8 hour long) and spot urine sample (morning time) was provided in the next day. The level of albumin in all samples were measured via immunoturbidometry assay. Then the results of agreement coefficient were accounted and comprised with each others.
Results: In this study 47 patients were selected which 46 of them were type 2 and one of them type 1 diabetic. Our results revealed significant correlation between all methods. In addition agreement coefficient (kappa) was accounted for all methods, time 24-h urine in comparison with 8 hours overnight urine, timed 24-h urine in comparison with spot urine and overnight urine samples in comparison with spot urine which were 0.876, 0.936 and 0.807 respectively.
Conclusion: Regarding significant agreement for screening of microalbominuria between different collecting methods, we suggest 8-h overnight or spot urine sampling carry out instead of 24-h urine collection.
Mohammad Reza Kalantarhormozi, Seyed Javad Siadatan, Arash Aria, Mohammad Hossein Dabbaghmanesh, Mesbah Shams, Abdosamad Sadeghalvad, Bagher Larijani, Gholamhossein Ranjbar Omrani,
Volume 7, Issue 2 (9-2007)
Abstract
Background: Type 2 diabetes mellitus is the most common type of diabetes which is triggered by various factors such as obesity, hyperlipidemia, hypertension, dietary habits and inheritance. With respect to geographic variation of diabetes prevalence, it is important to know the risk factors regionally.
Methods: As a case-control study, we looked for important risk factors of diabetes in our region. This study consisted of 400 individuals in case group and 400 individuals in control group. All these anthropometric measurements were calculated by standard methods. Blood samples taken from two groups were studied for TG, FBS, Cholesterol and HbA1c. Data are reported as the Mean±SD. P<0.05 was considered as statistically significant.
Results: There was no significant difference between two groups about mean age and sex ratio. Statistically significant difference were found for central obesity, hyperlipidemia, hypertension, polycystic ovarian syndrome (PCOS) and positive family history of diabetes in both groups (P<0.05).
Conclusion: The results showed that central obesity, hyperlipidemia, hypertension, PCOS and positive family history of diabetes are important risk factors of diabetes mellitus in Shiraz. In concordance with the results of this study, screening programme for that risk factor of diabetes in this region is suggested.
Hanieh-Sadat Ejtahed, Shirin Hasani-Ranjbar, Hanieh Malmir, Azin Pakmehr, Rezvan Razmande, Yasaman Khorshidi, Golaleh Asghari, Ahmadreza Soroush, Afshin Ostovar, Bagher Larijani,
Volume 23, Issue 6 (1-2024)
Abstract
Background: Considering the increasing and alarming trend of overweight and obesity as well as its related complications, in this study, a comprehensive clinical guide for the medical care of patients with obesity was written based on the clinical recommendations of the American Endocrinology Association and the American College of Endocrinology, and it has been adjusted as much as possible based on the conditions in Iran.
Methods: A complete search was performed in the available databases without any restrictions with a specific strategy. Using the opinions of experts in this field, the best clinical guidelines were selected and obesity clinical guidelines were written for Iranian adults. Recommendations were given based on a detailed review of available clinical evidence and considering objective factors.
Results: A total of 1788 references were used and in response to 9 clinical questions, 123 recommendations, including 160 special statements, were provided to determine a comprehensive medical care program for obesity. In this article, we discuss the prevention, screening, diagnosis, benefits and goals of obesity treatment. Questions 6 to 9 regarding obesity treatment steps and its individualization will be published in the next part of the article.
Conclusion: The detailed evidence-based questions and recommendations outlined in this study identify clinical considerations that facilitate decision-making in obese patients from screening and diagnosis to goals of treatment.
