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: 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.

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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.

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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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Background: Increased echogenicity of pancreas, due to hemosiderosis, is a frequent finding in  - thalassemic paitents. Hemosiderosis also leads to  - cell dysfunction. So diabetes and glucose intolerance are common consequences of hemosiderosis. The aim of this study was to investigate the association of increased pancreas echogenicity (IPE) with insulin sensitivity in  - thalassemic children aged 10-20 years.
Methods: After exclusion of thalassemic paitents with diabetes or familial history of diabetes, pancreas ultrasonography was performed in 42 -thalassemic children and they were divided into 2 groups with normal (21) and increased (21) pancreas echogenicity. Serum ferritin was measured, as well as serum insulin and glucose values, during an OGTT, at 0, 30, 60 and 120 minutes. A control group was selected randomly (n= 23). Insulin Sensitivity Index and Fasting Glucose/Insulin Ratio were calculated and the data were analysed using t-test and ANOVA statistical methods.
Results: Serum feritin differed significantly between 2 groups of thalassemic paitents (P<0.005), but the insulin and glucose values were not significantly different among studied population (P>0.05). Serum feritin was inversely correllated with ISI in patients IPE and 28.6% of them had IFG, as compared to patients with normal echogenicity (P<0.05).
Conclusion : Regarding the detection of all IFG cases among thalassemic paitents with IPE and the relation of feritin with ISI in this group, pancreas ultrasonography may be used to investigate the early stages of diabetes in these patients. however after conducting further studies with larger sample size and on older paitents are recommended.

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Background: Plasma concentration of adiponectin was found to play an important role in regulation of glucose metabolism, insulin resistance and conditions commonly associated with obesity. The aim of this study was to assess adiponectin level and its relation with percent of body fat mass and insulin sensitivity in over-weight men.
Method: This study was conducted on two groups of type 2 diabetic (n=20) and non-diabetic (n=20) overweight adult men. Serum level of adiponectin (ELIZA), FBS (GOD-PAP), fasting insulin (immunoreactive assay) and body fat mass (Bio-electric impedance) were measured. Insulin sensitivity was calculated using QUICKI.
Results: Diabetics had significantly higher mean of fat mass% than non-diabetics (26.55± 2.87% vs. 22.93±2.64 p< 0.05), despite fairly similar BMIs (27.7 kg/m2). Adiponectin concentration was lower in diabetics (7.77 ±3.53µg/ml) than non-diabetics (8.13 ± 0.03µg/ml) however, this difference was not statistically significant. The negative correlation between adiponcetin and fat mass didn't reach statistical significance. Adiponectin positively related with insulin sensitivity in non-diabetics (r= +0.5 p= 0.04).
Conclusion: Lower level of adiponcetin in diabetics than their non-diabetic counterparts. As well as the positive association of adiponectin with insulin sensitivity confirm the suggested role of decreased level of adiponectin in conditions such as insulin resistance and diabetes.

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Background: The aim of this study was to compare responses of Visfatin and insulin resistance index to various resistance exercise protocols. Methods: Ten healthy male subjects performed three resistance exercise protocols including maximal strength (three sets of 5 repetition at 85% of 1-RM with 3-min rest between sets), hyperthrophy (three sets of 10 repetition at 70% of 1-RM with 2-min rest between sets) and strength-endurance (three sets of 15 repetition at 55% of 1-RM with 1-min rest between sets) in three separate sessions. Two blood samples were taken before and after resistance exercise protocol. Responses to different resistance exercise protocols were compared by using repeated measures of ANOVA (3×2). Results: Irrespective of resistance exercise protocol, results showed that plasma visfatin reduced significantly (P<0.05) in response to resistance exercise. Between group comparisons revealed that reductions in visfatin concentration in response to strength-endurance and hypertrophy protocols were significantly higher than maximal strength protocol (P<0.05). Analysis showed that not only glucose, insulin and insulin resistance index did not change in response to resistance exercise significantly, but also there was no significant difference among the responses to different resistance exercise protocols (P>0.05). In addition, there was no significant relationship between changes in visfatin and other parameters (P>0.05). Conclusion: It could be concluded that performing strength-endurance and hypertrophy protocols that cause reductions in visfatin, possibly due to changes in growth hormone during these protocols, could be beneficial in reducing the hyperinsulinemia.

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Background: A unique subset of Individuals with normal body mass index (BMI= 18.5-24.9 kg/m2) and high body fat percentage (above 30% in women and 23% in men) that are termed as normal weight obese, are at increased risk for development of the metabolic syndrome and chronic diseases because the adipose mass and the excess of fat mass are an important source of proinflammatory cytokines. The aim of the present study was based on this hypothesis that women with high body fat percentage and normal body mass index are at increased risk for the metabolic syndrome in compared to healthy non obese women. Methods: This was as case-control study in which 40 obese women with normal weight (BMI= 18.5-24.9 kg/m2) and body fat percentage above 30% (FM> 30%) and 30 non-normal weight obese women (BMI= 18.5-24.9 kg/m2) and fat percentage less than 25% (FM <25%) who were matched for age (mean age = 28 years) recruited for this study. The components of metabolic syndrome including Anthropometric variables, blood pressure and fasting plasma concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, glucose and insulin were measured. Results: The anthropometric measurements including waist and hip circumferences in NWO was higher than non-NWO (respectively 74.78±4.81 vs. 70.76±2.91 and 99.12±4.32 versus 93.16±2/91, Pvalue<0.001), while the waist-to-hip ratio did not differ between the two groups (p=0.448).Also no significant differences were observed in concentrations of total cholesterol, LDL cholesterol, HDL cholesterol, triglycerides, fasting plasma glucose, systolic and diastolic pressure between groups. Fasting serum insulin and insulin resistance was higher in NOW compared to non NWO (Pvalue<0.05) and insulin sensitivity in NWO was lower than non NWO (0.357 versus 0.374, pvalue = 0.043). Conclusion: Because of the higher serum insulin concentration and the lower insulin sensitivity, obese women with normal body mass index but high body fat percentage can be associated with a higher risk for metabolic dysregulation and metabolic syndrome compared to healthy women with the same body mass index and normal body fat percentage

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Background: Apelin increases insulin insensitivity but its correlation with exercise training has less been taken in to consideration. The aim of this paper was to evaluation the effect of combined (resistance, endurance) and endurance training on plasma Apelin and in insulin sensitivity.

Methods: Forty -five volunteered students of eligible (BMI: 25-30,Health and inactive) were randomly divided into three groups, combined, endurance and control.The trainedgroups were trained forfour days per week, during 12 weeks. In combined group, endurance interval training was performed fromfivereplication with three minutebeginningand in final weeks reached to thirteen replications of 3 minutes with resting time of 1 to 2minutes. Intensity was 60-80% HRmax and resistance training planning: 2days per week,7 stations(Boat,leg press,buttreflys, Knee extension and flexion, forearm flexion and extension) 8-12 replication, resting time between the intervals and sets consequently:  30-60 ,60-90 second . The endurance group was trained with the same endurance section of combined group. Pre and post weeks, plasma Apelin,glucose and lipid profiles were measured in groups. Data were analyzed by One Way - Anova,significant level was P&le0/05, using SPSS, ver 18.

Results:  Plasma Apelin decreased significantly compared with the control group (P=0/0001).In training groups, HDL-c had in the training group increased compared with the control group (P= o/o43). Insulin Insensitivity wasn't different   among groups (P&ge0/05).

Conclusion: This paper showed that 12 weeks of combined or Endurance training had significantly decreased plasma Apelin and both training groups had an increase in their HDL-c but all of the exchanges were free of insulin sensitivity.

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Background: Although several tools for evaluating and screening of cognitive status have been introduced, most of them are not applicable in Iranian elderly population because of cultural differences and high illiteracy rate. This study is report of "Brief Cognitive Assessment Tool"(BCAT) was developed as a cognitive status-evaluating test and reported psychometric characteristics.
Methods: the BCAT tool includes memory assessment using three words recall test with a rating similar to Mini-Cog and the functional status including "ability to dress", "ability to use the phone," " ability to manage own medications", among both two sexes and financial management capabilities in men and ability to prepare food in women. Functional rating is different in educated and non-educated people. Diagnosis of dementia is considered, when memory impairment is accompanied by the dysfunction. Eighty-six residents of a nursing home (41 men and 45 women) among who had inclusion and no had exclusion criteria also consent to participate were randomly enrolled. Concurrent validity was shown as correlation coefficient between the BCAT categorization and score of mini meAntal state examination (MMSE). Criterion validity, sensitivity and specificity of BCAT were evaluated based on global deterioration scale (GDS). Reliability of two raters results within two weeks was indicated by Kappa coefficient.
Results: The sensitivity and specificity and accuracy rate of the BCAT based the GDS was 88.6%, 82.6%, and 84.9%, respectively. The correlation between the MMSE score and results of the BCAT classifying was significant. The Kappa coefficient between the results of two raters was 81.1%.
Conclusion: It seems that the BCAT has good psychometric properties to recognize cognitive impairment among Iranian older adults.

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Introduction: The purpose of this study was to investigate the effectiveness of self-compassion training on distress tolerance, anxiety sensitivity and emotional self-control in women with type 2 diabetes.
Method: This research was experimental and semi-experimental using the pre-test-post-test method with a control group. The statistical population of the intended research included all women with type 2 diabetes in 2023 who visited endocrinologists' offices in Sari, who were selected using a targeted method and then randomly divided into two experimental and control groups were placed. Data were collected using Simmons and Gaher's distress tolerance questionnaire, Tanji's emotional self-control anxiety sensitivity. Then, the data were analyzed using multivariate and single-variable covariance methods in SPSS-24 software.
Findings: The results showed that the treatment focused on compassion is effective on distress tolerance, anxiety sensitivity and emotional self-control of women with type 2 diabetes.
Conclusion: In fact, the treatment focused on compassion makes the person distance himself from blaming, condemning and self-criticism, which are all examples of lack of emotional self-control, and instead stabilizes his emotional self-control in the first stage and gradually be strengthened.