Tehran University Medical Journal

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A cross-sectional study was conducted on type II diabetic patients during 1991-1996 in Isfahan. By systemic sampling, 715 patients were enrolled. Variables studied, include: age, gender, duration of diabetes, body mass index (BMI), literacy, smoking habits, hypertension, lipid profiles, fasting blood glucose (FBS), retinopathy, ischaemic heart disease (IHD), proteinuria and type of treatment of diabetes. Prevalence of IHD in males (37.4%) was more than females (32.6%). Logistic regression analysis revealed a direct association between IHD prevalence with age, BMI, hypertension, proteinuria, diabetic retinopathy and type of treatment. Conclusions: 1) The factors mentiond are good predictors of IHD, but genetic influences may also contribute to the risk of IHD. 2) As obesity and BMI are prone to medical manipulation, control of these risk factors may decrease prevalence of IHD.

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Diabetes Mellitus is the most common endocrine disorders in children. There is a close association between diabetes and other autoimmune disease especially thyroid disorders. As many as 20 percent of Insulin dependent diabetic patients may have thyroid antibodies in their serum. The prevalence is 2-20 times greater than observed in normal populations. In this study, 122 patients with Diabetes Mellitus type I who referred to Institute of Endocrine & Metabolism and private office during a 3 years period were studied. A complete history was taken and physical examination was done in al patients by Endocrinologist. The diabetic patients due to major thalassemia excluded from this study. The grading of the goiter was determined by WHO classification and T4 and TSH were measured by RIA method in all patients. All patients were on Insulin treatment. There were 64 girls (52.4 percent) and 58 boys (47.6 percent) in 2-16 years age group (mean age 11.2 years). The mean duration of diabetes was 4.2 years. Prevalence of goiter was 53.2 percent and 7.3 percent of patients with goiter had hypothyroidism and 1.6 percent, had hypothyroidism. Most of the patients with goiter were euthyroid (91.9 percent). The patients with hypothyroidism had marked growth retardation and frequent episodes of hypoglycemia. The findings of this study indicate that the risk of development of goiter and thyroid disorders is higher in our diabetic patients and decelebration of growth and brittle diabetes may be due to thyroid disorders. It is suggested that all of the diabetic children should be screened yearly for thyroid disorders.

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Diabetes Mellitus is the most common endocrine disorders in children. There is a close association between diabetes and other autoimmune disease especially thyroid disorders. As many as 20 percent of Insulin dependent diabetic patients may have thyroid antibodies in their serum. The prevalence is 2-20 times greater than observed in normal populations. In this study, 122 patients with Diabetes Mellitus type I who referred to Institute of Endocrine & Metabolism and private office during a 3 years period were studied. A complete history was taken and physical examination was done in al patients by Endocrinologist. The diabetic patients due to major thalassemia excluded from this study. The grading of the goiter was determined by WHO classification and T4 and TSH were measured by RIA method in all patients. All patients were on Insulin treatment. There were 64 girls (52.4 percent) and 58 boys (47.6 percent) in 2-16 years age group (mean age 11.2 years). The mean duration of diabetes was 4.2 years. Prevalence of goiter was 53.2 percent and 7.3 percent of patients with goiter had hypothyroidism and 1.6 percent, had hypothyroidism. Most of the patients with goiter were euthyroid (91.9 percent). The patients with hypothyroidism had marked growth retardation and frequent episodes of hypoglycemia. The findings of this study indicate that the risk of development of goiter and thyroid disorders is higher in our diabetic patients and decelebration of growth and brittle diabetes may be due to thyroid disorders. It is suggested that all of the diabetic children should be screened yearly for thyroid disorders.

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Background: There are many surgical approaches for hyperinsulinemic hyperglycemic treatment. Subtotal pancreatectomy which has been used for many years, is abounded know due to high recurrence rate, and has been replaced by near total resection. This study focuses on “near total resection”.

Materials and Mehods: In this study 15 cases of hyper insulinemic hyperglycemia patients which has been operated since year 1985 till 2000 in the Children's Medical Center, has brought into consideration and described as a case series study.

Results: From the patients, three cases were operated by subtotal pancreatomy and all of them have had recurrence. In the remaining twelve cases, the method used was different and “near subtotal pancreatomy” were used. The recurrence rate in this group was zero and there were not also any case of sepsis. Postoperative complications were rather low and the most common postoperative finding in these patients was transient hypoglycemia.

Conclusion: Near total pancreatomy for hyperinsulinemic hypoglycemia which is implemented by an expert surgeon with low complication and high cure rate, can be considered as a safe technique with high cure rate and satisfactory results.

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Background: Patients with type 2 diabetes are often obese and require large dose of insulin to achieve glycemic control. Insulin therapy often cause weight gain and results in increasing insulin requirements. This study was conducted to evaluate the efficacy of metformin in combination with insulin in patients with type 2 diabetes poorly controlled with insulin therapy alone.

Materials and Methods: In a randomized clinical trial in outpatient diabetes clinic at university medical center, 39 patients with poorly controlled type 2 diabetes who were receiving insulin therapy were randomly assigned to receive metformin in combination with inslin or insulin alone for six months.

Results: Hemoglobin A1C levels decreased by 1.56 percentage (95% cl, 0.77 to 2.34 percentage point) in metformin group, a significantly greater change (P=0.008) than the increase of 0.03 percentage points in the insulin alone group. Average final hemoglobin A1C levels were 7.96% in the metformin group and 10.32% in the insulin alone group (difference 17%). For patients who did not received metformin, the insulin dose increased 9.37 units (95% cl 6 to 12 units) or 37% more than did the dose for patients who received metformin. (P<0.0005): for these patients, the insulin dose decreased 6.6 units (95% cl-1.24 to –11.96) Patients in insulin alone group gained an average of 3.08 kg of body weight (95% cl 1.56 to 4.58 kg) patient in the metformin group gained an average of 1.8 kg (95% cl 0.21 to 3.36 kg) Difference (1.9%) was not meaningful. Change of total cholesterol, low density lipoprotein cholestrol and triglyceride levels was not significant.

Conclusion: The addition of metformin to insulin therapy resulted in hemoglobin A1C concentrations that were 17.8% lower than those achieved by insulin therapy alone. This improvement occurred with use of 37% less insulin. Metformin is an effective adjunct to insulin therapy in patients with type 2 diabetes.

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Background: In 2-4% of couples in fertile ages, recurrent pregnancy loss (RPL) occurs which consisted one out of 300 pregnancies. The aim of this study was to comparison insulin resistance (IR) in patients with RPL to normal individuals.
Materials and Methods: In a case-controlled, prospective study, 49 non-pregnant, non-diabetic women with early RPL as the case group and 49 non-pregnant, non-diabetic women without RPL who had at least one live infant as the control group, and were matched by age, weight, and height, were enrolled. In both groups fasting insulin and glucose levels were measured and insulin resistance, which was defined as a fasting insulin (FI) level ≥20 microU/mL or a fasting glucose to insulin ratio (FGI ratio) of <4.5, was calculated.
Results: The RPL and control groups were similar with respect to age, BMI, fasting glucose levels and glucose to insulin ratios. FI was significantly higher in RPL group than control group (15.20±5.82 vs. 12.23±5.64 microU/mL). Also the frequency of patients with high FI (FI≥20µU/ml) in RPL group was significantly higher than in control group (22.45% vs. 6.12%, Odds Ratio=4.44, Confidence Interval 95%=1.15-17.07). Among the RPL group, 24.49% demonstrated insulin resistance, whereas only 8.16% of the matched controls were insulin resistant (Odds Ratio=3.65, Confidence Interval 95%=1.08-12.26). The RPL and control groups had similar in frequency of low FGI ratio. Also there was no significant difference between mean of FGI ratio in patients with fewer than 12 weeks miscarriage compared to over 12 weeks in RPL group.
Conclusion: Women with RPL have a significantly increased prevalence of insulin resistance when compared with matched fertile controls. It's recommended that in all women with RPL the glucose and insulin measurement should be carried.

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Background: The aim of this study was to determine the effect of two different regimes, containing different carbohydrate to protein ratios on performance, serum glucose and insulin after exercise in soccer players in Tehran Iran.

Methods: Nineteen male soccer players under training [age = 17/5 +/- 1.5 (SE) yr] were selected and completed two sequential trials separated by 1 week, in a paired cross-over study design. In each trial, subjects after running to fatigue received one of three regimes, using a random- order design as follows: HPRO ( CHO 56%, PRO 19% & fat 25% of total energy) HCHO ( CHO 64%, PRO 11% & fat 25% of total energy) or control ( CHO 60%, PRO 15% & fat 25% of total energy). The calorie of 3 regimes were equal. After consumption of meal up to120 min, blood was obtained before and at intervals. After 3 hours athlete performance was measured.

Results: The study indicates no significant difference in the serum insulin and glucose response among three regimes (P > 0.05). There was no difference in performance between three regimes after 3 h (p > 0.05).

Conclusion: The results suggest that post exercise regimes have no influence on performance, serum glucose and serum insulin. Thus total energy content and carbohydrate content may be important in recovery after exercise.

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Background: The present study designed to assess the effect of Mg+Zn, vitamin C+E, and combination of these micronutrients on glycemic control and insulin resistance in type 2 diabetic patients
Methods: In a randomized, double-blind, placebo controlled clinical trial, 69 type 2 diabetic patients were randomly divided into four groups, each group receiving one of the following daily supplement for 3 months group M: 200 mg and 30 mg Zn (n=16), group V: 200 mg vitamin C and 150 mg vitamin E (n=18), group MV: minerals plus vitamins (n=17), group P: placebo (n=18).Fasting blood glucose, fructosamine, HbA1c and serum insulin were measured at the beginning and at the end of 3 months supplementation. Insulin resistance was calculated by HOMA score. Treatment effects were analyzed by general linear modeling.
Results: After 3 months of supplementation fasting blood glucose decreased in MV group (165±46 vs 177±41 mg/dl, p=0.035). There was no significant change in fructoseamin, HbA1c, serum insulin or insulin resistance in treatment groups.
Conclusion: The results of the present study provide evidence for the effects of combination of Mg, Zn and vitamin C and E supplementations on improvement of fasting blood glucose but not fructosamine, HbA1c, serum insulin or insulin resistance in type 2 diabetic patients.

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Background: Hyperglycemia after acute stroke is a common finding that has been associated with an increased risk of death. For the last several years, it was believed that post-stroke hyperglycemia may worsen brain infarction in animal models. According to previous studies, the anti-inflammatory effect of insulin has a protective role on ischemic tissues. Glucose-insulin-potassium (GIK) infusions can be safely administered to acute stroke patients with mild to moderate hyperglycemia producing a physiological but attenuated glucose response to acute stroke, the effectiveness of which remains to be elucidated. In this study, we compared the effects of GIK infusion vs. placebo in ischemic stroke patients.
Methods: In this double blind randomized controlled trial, the intervention group consisted of 48 patients who received GIK infusion for 24 hours and the control group included 50 patients who received normal saline infusion for 24 hours. All patients had been admitted to Shariati Hospital during the first 24 hours after the onset of ischemic stroke. At one and three months after the treatment, patients were examined for morbidity and mortality using the Bethel and Modified- Rankin-Scale (MRS) questionnaires.
Results: GIK infusions significantly reduced plasma glucose concentrations. Statistically significant differences between the two groups were observed for disability and mortality. However, in spite of the protective effects of insulin and adverse effect of hyperglycemia in ischemic tissues, we observed no significant therapeutic effect from the GIK solution on patient outcome.
Conclusions: Although hyperglycemia following acute stroke has been associated with subsequent mortality and impaired neurological recovery, the maintenance of euglycemia in the acute phase has not been shown to improve prognosis. According to this study, GIK infusion has no significant clinical benefit on the outcome of stroke patients. Thus, we cannot recommend routine use of GIK infusion in post-stroke hyperglycemia as an adjuvant treatment for ischemic stroke.

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Background: Cell-therapy provides a promising alternative for the treatment of type 1 diabetes. Monocytes which have a reprogramming or differentiation potential and are more available than any other types of stem cells, have been recognized as candidates for such investigations. The aim of the present study was to evaluate the differentiation potential of rat peripheral blood monocytes into insulin-producing cells by the use of rat pancreatic extract (2 days after a 60% pancreatectomy).

Methods: Rat peripheral blood monocytes were isolated and cultured. Adherent monocytes were induced to differentiate into programmable cells in RPMI supplemented by 10% FCS, &beta-mercaptoetanol, M-CSF and IL-3 for six days. The dedifferentiated cells were analyzed by invert microscopy. Cultures of Programmable Cells of Monocytic Origin (PCMOs) were continued in RPMI, containing 10% FBS, pancreatic extract and 5 mmol/L glucose for 15 days. The medium was replaced every three days. At the end of the protocol, insulin and c-peptide excreted by the differentiated cells were tested by radioimmunoassay on days 6, 14, and 21. In order to verify insulin production in the cells, dithizone-staining, which is a method for insulin identification, was employed.

Results: The results showed that the cells cultured in rat pancreatic extract secreted insulin and c-peptide relative to the control group. Dithizone-staining was positive in the aforesaid cells (P<0/05).

Conclusion: The results of the current study showed that pancreatic extract treatment can differentiate rat peripheral blood monocytes into insulin-producing cells which can be regarded as a potential source for the treatment of diabetes.

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Background: The characteristic of stem cells in self renewal and differentiation to different types of cells has stimulated the interests for using stem cells as a starting material for generating insulin secreting cells. We've evaluated the differentiation potential of Programmable cells of monocytic origin (PCMOs) into insulin producing cells effected from the growth factors and fibroblasts conditioned media (FCM).

Methods: Peripheral blood monocytes of rat were cultured for 6 days in RPMI with 15% FBS, β- mercaptoethanol, MCSF and interleukin-3. Then, these cells were incubated in differentiation media with HGF, EGF, Nicotinamide, 15% fibroblasts conditioned media and glucose for 15days. Morphological differences of cells were studied by invert microscope. In several stages, the amounts of insulin in supernatant of cells were measured by radioimmunoassay kit. Also productions of insulin from differentiated cells were studied with DTZ special staining.

Results: In response to MCSF and IL-3, monocytes dedifferentiated. These programmable cells of monocytic origin (PCMOs) were capable of differentiating into insulin producing cells in differentiation media. The morphology of differentiated cells was similar to Beta cells and the amount of insulin in supernatant of differentiated cells was much higher than PCMOs (P<0.05).

Conclusion: HGF, EGF, Nicotinamide and fibroblasts conditioned media are differentiation factors of PCMOs into insulin producing cells. According to the results insulin producing cells can be differentiated from programmable cells of monocytic origin in presence of fibroblasts conditioned media.

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Background: Adipokines are proteins which are secreted from the adipose tissue. These groups of proteins are involved in the control of metabolism. Chemerin is one of these adipokines with different proposed biological roles. Serum levels of chemerin have been associated with increased body mass index, insulin resistance, metabolic syndrome, diabetes and cardiovascular diseases. The aim of this study was to assess the association between serum chemerin concentrations and polycystic ovarian syndrome.

Methods: This case-control study was performed in Taleghani Hospital in Tehran, Iran during 2011. On 45 patients with polycystic ovarian syndrome and 45 normal individuals as the control group. The participants were selected by easy given sampling method. Body mass index, fasting chemerin and serum insulin concentrations were measured by Enzyme-Linked Immunosorbent Assay (ELIZA) method. Fasting serum glucose was measured by the enzyme-calorimetric method and insulin resistance index (HOMA-IR) was measured by the calculation of relevant equation. Data was analyzed using independent t-test and Pearson's correlation coefficient by SPSS version 18.

Results: Serum chemerin, insulin, and glucose concentrations were significantly higher in patients with polycystic ovarian syndrome than the control group. There was no significant correlation between body mass index, serum levels of insulin, glucose, HOMA-IR, or chemerin in cases and controls.

Conclusion: This study showed that serum chemerin levels increase in polycystic ovarian syndrome. The findings also suggest that changes in chemerin serum levels could be considered as a criterion for polycystic ovarian syndrome.

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Background: Insulin resistant is important risk factors of diabetes and leads to development of chronic diseases such as diabetes and cardiovascular disease. Recent studies showed association between androgenic alopecia and insulin resistant. However, findings are controversial. Alopecia in women is a common heritable hair loss in central part of head. Aim of this study was investigation of androgenic alopecia distribution in type II diabetes and healthy women and hypothesis testing of relationship between diabetes and androgenic alopecia. Methods: This is a case-control study. Case and control groups were selected from type II diabetes and healthy women respectively that were refered to clinics of Alzahra, Noor and Amin Hospitals in Isfahan City, Iran in 2011. Participants were selected based on random sampling. Sample size was estimated 141 subjects in each group. Participants were visited by doctor and severity of androgenic alopecia was determined based on Ludwish criteria. Data were analyzed with SPSS software and 2 test. P<0.05 was considered as significant. Results: Mean age and body mass index were 58.96±12.8 year and 25.6±4.15 kg/m2 respectively in whole population. Findings not show any significant association between type II diabetes and androgenic alopecia (P<0.05). Comparison of distribution of alopecia severity according to Ludwish criteria separately showed similar result. In addition to, there was not any significant relationship between diabetes and alopecia after adjusting with body mass index as confounding factor (P<0.05). Conclusion: In the present study, there was not any significant relationship between type II diabetes and androgenic alopecia among diabetes and healthy women. However, more researches need to investigate this relationship in both gender and assess insulin resistant indices as homeostasis model assessment-estimated insulin resistance and androgenic alopecia.

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Background: Apelin is an adipokine which may contribute to the link between obesity and metabolic diseases. Regular exercise training has been proposed as a strategy for reducing the risk of these diseases by positive adaptations in adipokines, but there is limited research directly comparing different types of training. The purpose of this study was to determine and compare the effects of nonlinear resistance training (NRT) and aerobic interval training (AIT) on serum levels of apelin-13 and insulin resistance in middle-aged obese men. Methods: This quasi-experimental study was conducted from October to February 2012 in Ilam City, Iran. Eligible subjects (33 obese men) between aged 34-46 years participated in this study and were allocated to the following groups: NRT (n= 12), AIT (n= 10), and control (n= 11). The inclusion criteria were sedentary (less than 60 minutes physical activity per week), nonsmokers, no regular exercise for at least the past 6 months, no regular consumption of medication, no special diet, percentage body fat > 23% and no history of medical conditions that would prevent them from participating in the exercise intervention. Only the subjects who performed more than 90% of the training sessions were included in this study. The experimental groups performed 3 weekly sessions for 12 weeks, whereas the control group maintained a sedentary lifestyle. NRT consisted of 40-65 minutes of weight training at different intensities and with a flexible period. AIT consisted of running on a treadmill (4×4 min at 80-90% maximal heart rate, 3 min recovery intervals). Results: Analysis of variance showed that there were no significant differences betwee n the groups for apelin-13 and insulin resistance at baseline (P> 0.05). Compared to control group, two exercise programs were equally effective at reducing insulin resistance, but apelin-13 levels increased significantly only with the AIT (P= 0.04). After the training, maximal oxygen uptake increased significantly in AIT and NRT compared with control group (both P= 0.001) and in AIT more than NRT (P= 0.001). Conclusion: The practical applications indicate that obese men can use both AIT and NRT exercise programs to reduce insulin resistance. However, the AIT may have better beneficial effects (as indicated by apelin-13) compared to NRT.

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Background: Undercarboxylated Osteocalcin (ucOC) may contribute to the regulation of glucose homeostasis. Undercarboxylated osteocalcin is special protein secreted by bone as an endocrine regulation of energy metabolism and glucose. It plays an important role in insulin secretion and sensitivity. The aim of this study was to survey the effect of eight weeks resistance training on serum levels of ucOC, adiponectin and insulin sensitivity in obese women.

Methods: This quasi-experimental study performed on twenty obese women (BMI> 30) in Amol City Sport clubs, Iran, in May 2014. Samples randomly divided into two groups: a control group and an experimental group.  The experimental group consisted of eight weeks of resistance training, three times a week in six stations (including the movements of the leg press, bench press, triceps, biceps, abdominal motion, pull side and half scott) and with an intensity of 55% to 75% of one repetition maximum. Blood samples were collected after 12- 14 hours, fast and before it and also after eight weeks (48 hours after the last training session). Kolmogorov-Smirnov test was performed to confirm that data was normally distributed. The obtained data was analyzed using paired-sample t-test, independent t-tests and one-way ANOVA at the significance level of P< 0.05.

Results: The results showed that resistance training had no significant effect on serum ucOC (P= 0.094) levels and insulin sensitivity (P= 0.178) in obesity. However, the experimental group after resistance training showed significantly higher adiponectin level than the upper limit of normal range (P= 0.003). There was no relationship between adiponectin and ucOC.

Conclusion: Resistance exercise can increase levels of serum undercarboxylated osteocalcin (ucOC) and adiponectin in obese women. It can be said that this type of activity could possibly be effective in glucose hemeostasis.

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