Iranian Journal of Diabetes and Obesity

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OBJECTIVE: We determine the prevalence of the metabolic syndrome in an urban population of Jahrom, a city located in the south of Iran. MATERIALS AND METHODS: Randomly selected subjects ≥30 years-old were studied using stratified sampling. Target study sample was 892 (405 men and 487 women). Metabolic syndrome was diagnosed using modified Adult Treatment Panel guidelines when any three of the following were present: central obesity, raised triglyceride ≥150 mg/dl, low high-density lipoprotein (HDL) cholesterol (<40mg/dl in men and <50mg/dl in women), blood pressure ≥ 130/85mm Hg, and diabetes or fasting plasma glucose (FPG) ≥ 100 mg/dl. We used body mass index instead of central obesity. RESULTS: Metabolic syndrome was present in 257 (28.8% CI 95%: %) subjects, 24.7% in men and 32.2% in women (P= 0.013). This prevalence increased with age in both men and women (p<0.05). The most common component of metabolic syndrome was high blood pressure (51.2%) and low HDL cholesterol (51.3%) in men and women, respectively. CONCLUSION: There is a high prevalence of metabolic syndrome in this urban population. Method of cardiovascular prevention should be focused on this issue

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Objective: Measurement of glomerular filtration rate (GFR) is the best determinant in assessment of kidney function for diagnostic and therapeutic purposes. As extremely accurate methods of GFR measurement (i.e. Inulin clearance) are expensive and Time-consuming and due to limitations of the 24 hour urine collection method, some formula have been developed for the GFR measurement. Here we have compared the GFR calculated via CG or MDRD formulas and that measured by creatinine clearance in 24-hour urine collection method in diabetes patients with chronic kidney disease (CKD). Materials and Methods: This study was performed on 75 diabetes patients with stage 3 or 4 CKD (15-19 ml/min/1.73m2) in the nephrology clinics of the Yazd medical university. The GFR was measured via CG and MDRD formula and also via creatinine clearance in 24-hour urine collection method. Correlation test and Bland altman plot was utilized to check for the relationship between creatinine clearance and the GFR. Results: Results show a significant correlation of the GFR calculated via creatinine clearance in 24-hour urine collection with GFR calculated via CG (r= 0.75) and with MDRD (r=0.70) formulas. This correlation was even increased when serum levels of creatinine was >1.5 mg/dL or in patients with stage 4 CKD. Comparison of the differences between GFR calculated via CG or MDRD formulas and creatinine clearance in 24-hour urine collection method using Bland altman showed a lower bias (CG: 17.76 MDRD: 10.64 ml/min/1.73 m2) and narrower limits of agreement (MDRD: -11.33 – 32.62, CG: -4.68 – 40.20) to the creatinine clearance in 24-hour urine collection for the MDRD formula compared to that for the CG formula. Conclusion: CG and MDRD correlate well with creatinine clearance in 24-hour urine collection, while MDRD is more accurate in diabetes patients with stage 3 or 4 CKD.

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Objective: Type 2 diabetes is amongst the most common chronic illnesses in Iran. Its prevalence is increasing and it has significant economic importance. The aim of this study was to estimate direct therapeutic and non-therapeutic costs of type 2 diabetes Patients Referred to the Diabetes Research Center of Yazd in 2012. Materials and Methods: This cross-sectional study was carried out on 250 type 2 diabetes patients referred to Yazd Diabetes Research Center in 2012. Direct health costs were estimated from costs of physician visit, Nutrition counseling, Anti diabetic agent, Testing, Hospital inpatient care, imaging, wound, Cataract , Physiotherapy, dialysis and other costs included (Insulin ,Test tape), as well as direct costs of non-treatment including Cost of travel and accommodation and required data was gathered by questionnaire. Mann-Whitney Test, Kruskal -Wallis Test and T-test analysis was used to identify the Results. Results: The total estimated cost of 250 type 2 diabetes patients in 2012 is 1369913472 rials, including 1258651472 rials indirect costs of treatment (91.87%) and 111262000 rials indirect non-therapeutic (8.1%). The per capita cost is 5479653 rials .The major parts of medical expenditures are hospital inpatient care (28% of the total medical cost), other cost include Insulin ,Test tape and etc(23% of the total medical cost) , Cataract(10.96% of the total medical cost), imaging (9.77% of the total medical cost),prescription medications to treat the complications of diabetes (8.68%),physician visits (7.04%), Testing (6.31%), dialysis(2.6%), wound(2.1%), Physiotherapy (0.89%) and Nutrition counseling (0.18%). Conclusion: This estimate highlights the substantial burden that diabetes imposes on society. Additional components of societal burden omitted from our study include intangibles from pain and suffering, resources from care provided by nonpaid caregivers, and the burden associated with undiagnosed diabetes.

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Objective: Patients with metabolic syndrome are prone to cardiovascular disease and diabetes. Regarding the importance of nutritional factors in management of metabolic syndrome, this study was designed to evaluate the effects of dark chocolate consumption on serum lipid profile in patients with metabolic syndrome. Materials and Methods: In this randomized clinical trial, 114 patients with metabolic syndrome, aged 30 to 60 years, without heart, renal and hepatic diseases were recruited. The eligible patients were randomly allocated to receive either dark chocolate (76% purity), 20 or 40 grams daily for two months. Total cholesterol, high-density lipoprotein (HDL), triglycerides (TG) and fasting blood glucose (FBG) were measured with enzymatic methods before and after intervention. A low-density lipoprotein (LDL) level was calculated by the Friedewald formula. Data were analyzed using SPSS version 16.0 and ANOVA test P<0.05 was considered significant. Dietary intake was measured with NUT4 software at the beginning and the end of the study. Results: There were no significant changes in dietary intakes of patients during the intervention in three groups. No significant differences were seen in mean concentration of lipid profile before and after intervention in groups (P>0.05). Conclusion: Consumption of 20-40g/day dark chocolate with 76% purity for 2 months doesn't change the lipid profile of patients with metabolic syndrome.

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Objective: Diabetes is now known as one of the chronic diseases that besides body have negative effects on the psychological status of patients. The present study aimed to assess the physical and mental attributes of patients to evaluate and compare life expectancy and mental health among diabetic patients with normal ones. Materials and Methods: This was an analytic cross-sectional study, that was done on 91 adults about 30 to 60 years old in Kermanshah that 51 had type 2 diabetic patients and 40 was normal. The Sampling method of this research was convenience. Life Expectancy Inventory (LEI-33) and General Health Questionnaire (GHQ-28) were used to collect information. SPSS-16, descriptive statistics, Pearson correlation and T-test were used for analyzing data. Results: Analyzing data showed a negative significant correlation between life expectancy and general health among adults (P<0.01). T-test results showed that life expectancy and general health status in non-patients was better than type 2 diabetic patients that this difference was statistically significant (P<0.05). Conclusion: The results of this study showed that type 2 diabetic patients have too much psychological pressure exposure, which reduces their hope to live. Hence of psychotherapy and pharmacological interventions is needed to improve the psychological care as well.

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Ramadan, the holy month of Muslims, is the ninth month of the Islamic calendar. During fasting, plasma glucose levels and circulating insulin decrease gradually and counter regulatory hormones such as glucagon and catecholamines tend to rise. Diabetic Muslims who insist on fasting should be aware of potential complications and techniques of decreasing the risks. Muslims should be evaluated 2-4 weeks before Ramadan and high risk patients should not fast. Low risk patients should receive adequate education and appropriate medication change to cope with fasting. During Ramadan frequent blood glucose monitoring is an effective method for preventing hypoglycemia. Nutritional change is an essential component for safe fasting. In this article we was review studies that evaluate changes that would affect diabetic patients in Ramadan.

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Objective: Type 2 diabetes (T2D) as a complex disease is the result of genetically heterogeneous factors and environmental issues interaction. Linkage and small-scale candidate gene studies were successful in identification of genetic susceptibilities of monogenic form of diseases. However, they were largely unsuccessful while applying to the more common forms of disease. By designing Genome Wide Association studies (GWAs), the new windows open to genetic approaches. So far, around 153 variant were discovered for T2D and missing rare variants are waiting to be discovered. The new findings are beneficial to explain molecular signaling and pathways responsible for pathophysiology of T2D, which offered opportunities for the development of novel therapeutic and preventive tactics. The GWAs findings need to be confirmed in on going researches. In this review, we address, genetic susceptibilities related to T2D since 2007. Also challenge advantages and disadvantages of GWAs and discuss about the next confirmatory approaches need to be done.

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Objective: Retinopathy is a microvascular complication of diabetes in the retina. It is hypothesized the aqueous flow decrease in patients with retinopathy which effects the Intra-ocular pressure (IOP). The purpose of this study is to determine whether a significant correlation exists between IOP and diabetic retinopathy grades.
Materials and Methods: Our study is analytic cross sectional. About 413 type 2 diabetic patients were studied. They were between 40 to 70 years and did not have glaucoma. They were examined in the ophthalmologist’s clinic and grading of retinopathy was done. IOP was recorded in each cases. Data was then analyzed in SPSS.
Results: Of the 413 type 2 diabetic patients, 329 were diagnosed with diabetic retinopathy and 84 without diabetic retinopathy. There was no significant difference between the mean IOP of patients with diabetic retinopathy and without diabetic retinopathy (P-value=0.53). Also there was no significant difference between the diabetic retinopathy grades. (P-value=0.07).
Discussion: In conclusion, our findings showed that there was no a significant correlation between IOP and grade of diabetic retinopathy.

 

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Objective: The study evaluated the prevalence and progression of different thyroid tumors in patients who referred to Shahid Sadoughi Hospital during 2005 to 2013, Yazd, Iran.
Materials and Methods: In this retrospective follow-up study, cytopathological data of patients suffering from thyroid masses was collected during 2005-2013. Age and sex of patients were recorded.
Results: Totally, 2055 patients were evaluated in this study. The patients were between 21-50 years old .Among the patients, pathological types identified were as follow: 86.8% goiter, 5.8% inflammatory lesions, 3.2% follicular lesions, 3.5%papillary carcinoma and 0.8% follicular neoplasm. Among 2055 patients, 91.7% were women and 8% were men. The frequency of thyroid nodules was increased from 2003 to 2013 with steep slope.
Conclusion: In total, regarding the current study, different kinds of thyroid tumors had growing trends in recent years and new plan and strategies are recommended to deal with this problem.

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Objective: Gestational Diabetes Mellitus (GDM) is an important condition in diabetes categories causing significant complications including pre-eclampsia and eclampsia among pregnant women. The aim of this study was to estimate the trend of annual GDM incidence and its risk factors in Yazd province, Iran, from 2008 to 2013.
Materials and Methods: The present study was conducted as a prospective cohort study in which all pregnant women who had attended primary health care centers were screened for GDM. Annual GDM incidence was calculated for all and also according to 5-year age groups and residential area (urban/rural). Secular trends for GDM incidence and its risk factors were also evaluated.
Results: In this study, 67320 pregnant women were screened for GDM and 5425 pregnant women were diagnosed as GDM with 6-year incidence of 8,6%. Annual incidence of GDM increased from 3.1% in 2008 to 18.9% in 2013. Assessment of crude and age-adjusted incidence across the years of follow up revealed incremental secular trend (P-value<0.001). Changes in GDM risk factors including maternal age and family history of diabetes were also significantly positive. GDM incidence increased in both rural and urban areas but the observed trend slopes were opposite in these different contexts.
Conclusion: Clinicians should have specific regard to pregnant women with some risk factors for timely diagnosis and treatment. Meanwhile returning to previous life style of rural area can help to decrease GDM incidence. 

 

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Objective: Diabetes is a chronic disease that influences mental and physical health. Regarding the importance of diabetic patients’ psychological status, this research studied the effect of group positive psychotherapy on life expectancy and general health of type 2 diabetic patients.
Materials and Methods: This clinical-trial study was done on 30 type 2 diabetic patients in Kermanshah diabetes research center. The experimental and control groups were randomly selected. Data were gathered before and 10 weeks after intervention. Demographic, life expectancy and general health (GHQ) questionnaires were used for gathering data. SPSS-16 and Kolmogorov-Smirnov (K-S), Chi-square and analysis of covariance (ANCOVA) were used for analyzing data.
Results: Results showed that group positive psychotherapy caused significant enhancement on life expectancy in intervention group than control group (P-value: 0.001). Although positive psychotherapy caused significant reduction on anxiety disorder and somatic symptoms in mental health, there was no significant difference of general health between two groups (P-value: 0.347).
Conclusion: Positive psychotherapy was effective on increasing diabetic patients’ life expectancy. So this efficient psychotherapy can be used for increasing type 2 diabetic patients’ life quality.

 

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Objective: Remote Ischemic Preconditioning (RIPC) as the transient ischemia and reperfusion of the arm is a promising method for protecting different tissue from future ischemia. These effects might be mediated through vascular and endothelial growth factor (VEGF) pathway. We investigated the influence of RIPC on diabetic macular edema (DME) as a chronic ischemic condition in patients who were candidate to receive anti-VEGF therapy.
Materials and Methods: In this Single blinded, randomized controlled trial, 40 eligible type 2 diabetes mellitus (T2DM) patients with macular edema who were candidate to receive anti-VEGF therapy randomized into intervention (CP) and sham controlling (SP). The CP received RIPC in three consecutive days before anti-VEGF injection. Data of optical cochrane tomography (OPC) before and 10 days after procedure were compared as outcomes.
Results: Central foveal volume and visual acuity mean difference before and after intra-vitral anti-VEGF injection in both groups was significant. There were no significant mean differences in central macular thickness in case groups. Comparing the mean between two groups did not show a significant difference in visual acuity, central foveal volume (P-value: 0.69) and central macular thickness (P-value: 0.62). There were no significant differences in the desired changes pattern of DME between two groups (P-value: 1.00).
Conclusion: This pilot study did not show any additive positive effect of RIPC on retinal outcomes especially visual acuity in T2DM patients with DME who were received anti-VEGF treatment.

 

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Objective: There are changes in plasma glucose and HbA1c of type 2 diabetes mellitus (T2DM) patients in different seasons. HbA1c levels may increase during winter season in most T2DM patients without weight gain. In this study, we described the seasonal changes of HbA1c levels in T2DM patients.
Materials and Methods: This analytical cross-sectional study conducted from 2013 to 2017 on 402 patients with T2DM, aged 20–80 years old who referred to Yazd diabetic research center. Body weight, height, waist circumferences (WC), blood pressure (BP), body mass index (BMI), fasting plasma glucose (FPG), 2 hours post-prandial (2hpp), and HbA1c measured and compared during four seasons.
Results: Four hundred and two T2DM patients invited and fulfilled this study. Most of them (56%) were women. The mean age of patients was 58.96 (± 11.10) years old. The mean HbA1c, 2hpp, systolic and diastolic blood pressure were significantly different in four seasons (P-value respectively: 0.022, 0.007, 0.001 and 0.005). The mean difference of HbA1c was significant in the warm and cold seasons (P-value: 0.047). The percentage of people who were below 7% had a significant difference between the warm and cold seasons (P-value: 0.015).
Conclusion: The results of this study showed that, in Yazd with desert climate, postprandial hyperglycemia is more prominent in summer. The seasonal changes of glycemic status are an important factor in management of T2DM patients.

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Objective: We conducted this study to compare the psychological effects between diabetic patients taking fast and non-fasting counterparts to better investigate the effects of fasting on mental health of diabetes sufferers.
Materials and Methods: This study was a prospective cohort conducted among diabetic patients. In this study, two types of fasting and non-fasting patients were invited to take part. During One week before and after the Ramadan, all patients were asked to complete 28-scale General Health Questionnaire (GHQ).
Results: In this study, 116 patients who were suffering from diabetes completed the study. They were compared with each other in format of three groups (two fasting and one non-fasting). Mean changes of total and subscales' score were negative in nearly all groups but there were no significant difference between groups. In addition, total and subscale A, B and C scores significantly increased (positive change) but subscale D score didn’t change in fasting patients during this month.
Conclusion: The results of present study revealed that fasting during the whole month of Ramadan can exacerbate patients' general health in comparison with non-fasting patients. However, because we can't determine whether this finding is attributed to fasting regardless of diabetes or has been resulted from the co-existence of fasting and the disease, it is recommended to design a study to compare diabetic and healthy fasting individuals.  
 

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Objective: Insulin resistance (IR) is the major cause in Type 2 diabetes mellitus (T2DM). Expression of some miRNAs can be changed in response to a drug treatment for IR, and used as the biomarker in IR. This study set out to determine the effect of cinnamon extract (cinnamaldehyde) on some miRNAs expression in IR adipocytes.
Materials and Methods: In this In-vitro study the 3T3L1 cells were expanded in Dulbecco’s modified Eagle’s medium (DMEM), differentiated into adipocytes phenotype and insulin resistant with high glucose medium, then the cells were treated with cinnamaldehyde. To determine of the miRNAs profiling in 3T3L1 adipocytes, insulin-resistant adipocytes and treated insulin-resistant adipocytes quantitative real-time PCR method was performed.
Results: IR adipocytes exhibited a significantly increase in miRs 29a, 223 and 320 expression, and decrease in miR26-b expression in compare to the normal adipocytes
(P-value<0.001 and P-value= 0.024 respectively). However in response to cinnamaldehyde in IR adipocytes, expression of miRs 29a, 223 and 320 were down-regulated while expression of miR26-b was up-regulated neared it to the normal level (P-value= 0.003 and P-value= 0.002 respectively).
Conclusion: IR changes expression of intended miRs, so that cinnamaldehyde treatment helps to improve and normalize the changes. Cinnamon as the herbal product can be helpful for IR particular in adipose tissue.

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Objective: Oxidative stress plays an important role in the onset and progression of diabetic nephropathy. So antioxidant agents may be one of the key treatment strategies for prevention of diabetic nephropathy progression .The aim of this study was to determine the effect of selenium (Se) on micro-albuminuria in type 2 diabetic (T2DM) patients.
Materials and Methods: This study was a clinical study on 60 T2DM patients with micro-albuminuria who were referred to Yazd diabetic research center from March 2016 till April 2017. Patients were randomized in to two groups: Se (200 microgram Se daily) and control. The control group did not receive placebo. The intervention duration was 12 weeks. Micro-albuminuria, fasting blood sugar (FBS), cholesterol, triglycerides, HDL-C, LDL-C, urea, creatinine, HbA1c, plasma Se concentration were measured at the baseline and after 12 weeks. 
Results: Micro-albuminuria decreased after 12 weeks in both studied groups but it was not statistically significant. Cholesterol and LDL levels improved statistically in both studied groups at the end of study (P-value: 0.034, 0.023 respectively). Plasma Se level increased in intervention group (P-value< 0.001). There were clinically improvement in other studied variables after 12 weeks in two studied groups but not statistically significant
Conclusion: Our study demonstrated that Se supplementation for 12 weeks among patients with micro-albuminuria had no beneficial effects on micro albuminuria.

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Objective: Obesity is a factor in the development of insulin resistance and type 2 diabetes. Obesity contributes a wide variety of metabolic changes such as insulin resistance. The insulin signal mechanism to intra-cells occurs in insulin resistance, primarily in adipose tissue cells, which can be appropriate targets for therapeutic approaches by recognizing the proteins in this pathway. The study aimed to evaluate the simultaneous impact of metformin and sitagliptin on the expression of protein levels involved in insulin resistance Protein Kinase B (Akt) and Glucose Transporter 4 (GLUT4) in diabetic adipose tissue.
Materials and Methods: In order to evaluate the content of proteins involved in insulin resistance Akt and GLUT4 in adipose tissue of diabetic patients with the use of SDS-PAGE and western blot analyses, we studied 6 persons of type 2 diabetic patients who obtained 3 months of care with simultaneous metformin and sitagliptin, 4 persons returned from them after treatment and 8 persons as a stable case (control group).
Results: There was an increase in glucose intake and a decrease in serum glucose levels (P-value= 0.025) and no decrease in insulin resistance (P-value= 0.6) following simultaneous metformin and sitagliptin therapy, but no improvement in serum insulin levels (P-value=1.01). Increases in the content of Akt protein (P-value= 0.682) and GLUT4 protein (P-value= 0.851) involved in insulin resistance in diabetic patients' adipose tissue, were not observed.
Conclusion: Simultaneous treatment with metformin and sitagliptin had no effect on insulin resistance proteins Akt and GLUT4 in type 2 diabetic adipose tissue.

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Objective: Obesity is a major public health concern and there are different ways to detect it in population. The aim of the present study is to evaluate the neck circumference (NC) in a simple and practical way.
Materials and Methods: This cross-sectional survey utilized data from the Yazd Health Study (YaHS) which is a population-based cohort study. In brief, 9962 individuals aged 20-70 years with measurement of body weight, height, waist circumference (WC) and NC were available for analysis. To determine the relationship between NC and other anthropometric measurement, we utilized of Pearson's correlation coefficient. Receiver operator characteristic (ROC) curve analysis was used to find out an optimal cut off value for detecting general and central obesity as well as to determine the sensitivity and specificity of NC in predicting general and central obesity. The whole analysis was performed using SPSS version 22.
Results: NC correlated positively with body mass index (BMI) (r= 0.608, P< 0.001 in men and r= 0.541, P< 0.001 in women) and WC (r= 0.662, P< 0.001 in men and r= 0.542, P< 0.001 in women). The best cut-off point for NC to determine people with general obesity was 40.25 cm for men and 35.75 cm for women.
Conclusion: The NC has an acceptable correlation with BMI and WC. In addition, NC is a simple free measurement which may be utilized in various health-care settings. These properties make the NC as the best anthropometrics to determine overweight and obesity and it can be used as an appropriate predictor for overweight and obesity in population-based screening programs.