Iranian Journal of

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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.

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Background: Diabetes mellitus is a common chronic disorder with multiple disabling long- and shorter-term complications, the majority of which can be controlled if not prevented. The management of diabetic patients is a major drain on both health budgets and time.
Methods: We reviewed the records of 101 patients with diabetic foot ulcer, who had received treatment at either Doctor Shariati or Imam Khomeini hospital.
Results: Out of 101 patients (56.4% male and 43.6% female) with diabetic foot ulcer, 34.7% had eventually undergone amputation.
Conclusion: Our findings highlight the need for control and prevention programmes aimed at reducing the risk factors for and complications of diabetic foot ulcer.

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Background: The health assistant and treatment assistant in the Ministry of Health and Medicine are in charge of educating people with diabetes and empowering them to achieve self-management of diabetes. The present study was conducted with the aim of determining the status of education and support for diabetes self-management in comprehensive health service centers and diabetes clinics in Isfahan province.
Methods: The diabetes education units of 20 comprehensive health service centers and 11 diabetes clinics in Isfahan province formed the sample size. The data collection tool was a checklist with 107 items, which was completed by observing and reviewing 170 paper/electronic files of patients with diabetes.
Results: In more than two-thirds of the files of diabetes centers/clinics, initial assessment were neither performed nor recorded. Educational needs assessment was recorded in 5% of the files and educational planning was not recorded in nearly 100% of them. In more than a third of the files (36.5%), diet education was recorded once when the case was filed. In 3.4% of files, educational effectiveness evaluation was recorded and in three quarters of files (75.78%), continuous support for self-management was not recorded.
Conclusion: There is a significant gap between the status of education and support for diabetes self-management and the process and outcome standards of DSMES in the educational units covered by the provincial health and treatment department. This gap seriously and negatively affects the results of this approach.