Iranian Journal of Diabetes and Obesity

---

OBJECTIVE: Diabetes mellitus is one of the most common medical problems worldwide. Approximately 18% of persons over 65 years old are diabetic. WHO estimates that the prevalence rate of diabetes (4% in 1995) will increase to 5.6% in 2025. Diabetic foot problems are potentially the most preventable long–term complication for diabetes. The purpose of this study was to test the utility of the Health Belief Model (HBM) in understanding and predicating the intention of diabetic patients in prevention of their foot lesions and amputations. MATERIALS AND METHODS: This cross–sectional study was carried out on 100 diabetic patients in Yazd. The data were collected using a researcher-made questionnaire in four sections. All of data were collected by direct interview and in basis of constructs of Health Belief Model (HBM). The data were analyzed by SPSS. RESULTS: There was no significant difference between mean grade scores of HBM and period of disease (P > 0.05). There was significant difference between perceived severity, perceived benefits and barriers and level of education of patients (P < 0.000). There was no significant difference between the foot care and period of disease (P > 0.05). The mean grade scores of knowledge, constructs of HBM and practice of participants about foot care was as follows: Mean grade score of knowledge 4.87 out of 12, perceived susceptibility 12.33 out of 20, perceived severity 14.56 out of 20, perceived threat 26.88 out of 40, perceived benefits 13.33 out of 20, perceived barriers 12.08 out of 20 and mean grade score of practice in foot care was 3.81 out of 10. DISCUSSION: The findings of this study showed that higher mean grade scores of knowledge and constructs of HBM resulted in better foot care by the patients. So our results and results of many other studies carried out on HBM, revealed that HBM constructs may change and improve behavior in participants.

---

OBJECTIVE: Low-grade systemic inflammation is associated with an increased risk of type 2 diabetes. C-Reactive Protein (CRP), an acute phase protein produced by hepatocytes, may be associated with diabetes. This study aimed to compare serum levels of CRP in women with gestational diabetes mellitus (GDM), impaired glucose tolerance test and control subjects. MATERIALS AND METHODS: In this case control study, 30 women with GDM and 28 women with impaired glucose tolerance, (according to Carpenter and Coustan criteria) were compared with 31 normal pregnant women as control group. Groups were matched for gestational age, age and BMI before pregnancy. At 24-28 weeks of gestation, CRP levels were measured in three groups and compared with each other. RESULTS: Our study showed serum CRP level was not significantly different among three groups. The median of serum CRP level in women with GDM, abnormal glucose tolerance test, and normal women was 8.8(7.5), 6.9(8.25) and 11.40(5.8) mg/dL respectively. In GDM patients, there was a significant correlation between CRP and BMI before pregnancy (r=0.467, p=0.033). CONCLUSION: We didn't find a significant correlation between maternal serum CRP level and gestational diabetes but our study showed a significant correlation between pre-pregnancy BMI and CRP in gestational diabetic women

---

OBJECTIVE: Diabetes is a metabolic disorder which impairs carbohydrate and lipid metabolism. It is accompanied by cognition impairment in diabetic patients and animal models. Lipids play an important role in nerve membrane composition, structure and function. This study was designed to evaluate the effect of dietary butter and sesame oils on passive avoidance memory of streptozotocin (STZ) diabetic rats. MATERIALS AND METHODS: Thirty six adult male Wistar rats were randomly allocated to four groups: normal control (NC) and diabetic control (DC) with free access to regular rat diet and diabetic sesame oil (DS) and diabetic butter oil (DB) groups with diet supplemented by 10% butter oil and 10% sesame oil, respectively. Diabetes in DC, DS and DB rats was induced by IV injection of 50 mg/kg (body weight) STZ. Passive avoidance memory was tested six weeks after confirmation of diabetes, and cholesterol and phospholipids were measured in hippocampal tissue. RESULTS: Diabetes, especially in diabetic butter oil group decreased learning and memory. The levels of cholesterol and phospholipids in hippocampus were higher in diabetic control and diabetic butter oil (P<0.05) groups in comparison with normal control. CONCLUSION: Consumption of butter may worsen diabetic cognition impairment and the elevation of cholesterol may be a reason for diabetic cognition impairment

---

OBJECTIVE: During recent years, opium consumption has increased among Iranian diabetic men. The belief that opium consumption can control or even eradicate DM is increasing. This study was conducted to compare the blood sugar, HbA1c, lipid profile and the frequency of diabetes complications in male type II diabetic patient with and without opium consumption. MATERIALS AND METHODS: Two hundred thirty two type 2 diabetic men were included in a case- control study between September 2009 and June 2010. They were divided into two groups: with (n= 88), and without (n=144) current opium consumption. Serum glucose was measured by two methods: hexokinase (automized and manual) and orthotolidine method, and Hb A1C was measured by chromatographic ion exchange. The opium consumption was evaluated by thin-layer chromatography (TLC) of urine. Analyses were performed using SPSS and P≤0.05 was considered significant. RESULTS: There was not a significant age difference between two groups. The mean duration of opium use was 36±6 months. The difference between mean serum fasting glucose levels in different methods of measurement was not significant between case and control groups. The results of this study showed a significant lower level of serum HbA1C (p=0.006) and triglyceride (p=0.005) in diabetic patients with opium abuse, but the frequency of peripheral neuropathy and ophthalmic photocoagulation was not different between two groups. CONCLUSION: Although the HbA1c was lower in males with opium consumption, the frequency of chronic complications of diabetes was not significantly different between two groups. We didn't evaluate other complications of opium consumption, especially mental and physical dependence. In summary, despite observed effects on some of glucose indices, opium is not a harmless treatment for diabetes.

---

OBJECTIVE: To determine the prevalence of non-alcoholic fatty liver disease (NAFLD) in type 2 diabetic patients and to assess its possible risk factors. MATERIALS AND METHODS: Two hundred and seventy two (186 females and 86 males) diabetic patients were studied. Liver ultrasound was performed along with the measurement of such labratoary tests as alanine transaminase, aspartate transaminase, alkaline phospahatase, fasting blood sugar, glycosilated hemoglobin, triglyceride, total cholesterol, low density lipoprotein, high density lipoprotein, thyroid stimulating hormone, thyroxine, blood urea nitrogen and creatinine. Patients with other causes of fatty liver disease such as autoimmune hepatitis or Wilson’s disease were excluded. RESULTS: The mean age of the subjects was 51±10 years. One hundred and eighty nine of them (70%) had fatty liver, of whom 60 (32%) and 129 (68%) subjects were males and females, respectively. One hundred and fifteen (61%) out of 189 patients were in grade 1, 66 (35%) were in grade 2, and the rest, 8 (4%), were in grade 3 of fatty change in liver. In logistic regression analysis, the variables with significant changes were Body Mass Index (BMI) with OR = 1.26 (95% CI = 1.16-1.37) and triglyceride (TG ) with OR = 1.46 (95% CI = 1.01-2.11). CONCLUSION: The prevalence of fatty liver disease was high in the studied patients (70%). In diabetic patients, Body Mass Index (BMI) and triglyceride (TG) had significant relationship with the presence of fatty liver.

---

The use of herbal medicines in diabetes is promising but still far from proven. The purpose of this article is to examine the effect of herbal medicines in the treatment of diabetes, focusing on potential benefits and risks. Medline, expert interviews, books, articles and internet searches were used to identify herbal medicines with anti-diabetic properties and their diabetes-related health effects, proposed anti- diabetic effect, adverse effects, contraindications and drug interactions. Forty five herbs with known effect in the treatment of diabetes were selected for review, including: Trigonella foenum graecum L, Allium cepa L. & Allim sativum L., Silybum marianum, Mamordica charantia L., Camellia sinensis L. Morus nigra L., Gymnema sylvestre L., Ginkgo biloba L., …. Anti-diabetic health effects included increasing serum insulin, decreasing blood glucose, increasing glucose metabolism, and/or stimulating pancreatic function. Side effects were few or not reported. Many herbal medicines can be used for treatment, prevention and control of diabetes and as a component of diabetic patients’ diet. Of course some of these plants have adverse effects, contraindications, and drug interactions and also interactions between herbal medicines and synthetic drugs exist and may cause serious clinical consequences however at these researches side effects were few or not reported, but patients should inform their physician of the use of herbal products and consider the possibility of herb-drug interactions.

---

OBJECTIVE: Due to the increased prevalence of thyroid dysfunction in subjects with type 2 diabetes and also this fact that antibodies could potentially identify subjects at risk of thyroid dysfunction, this study was conducted to investigate thyroid autoimmunity in type 2 diabetic patients. MATERIAL AND METHODS: Among patients referred to Yazd Diabetes Research Center, 4000 type 2 diabetic patients were recruited and clinical examination was carried out and samples for thyroid function test including thyroxin (T4), triiodothyronine (T3), thyroid stimulating hormone (TSH), T3 resin uptake (T3RU), thyroid peroxidase antibodies (TPO-Ab) and thyroglobulin antibodies (Tg-Ab) were obtained. RESULTS: Among 4000 type 2 diabetic subjects (1649 male and 2351 female), 1762(44%) were known to have thyroid disease. A total of 1466 (36.7%) had positive TPO antibodies and 1072 (26.8%) had positive Tg-Ab antibodies. The logistic regression of thyroid dysfunction on Tg-Ab as well as TPO-Ab status (positive vs. negative) was significant (P=0.0001). CONCLUSION: Our results showed strong association of thyroid dysfunction with autoantibodies, especially in patients with Tg-Ab positive. Therefore, the findings suggest that all subjects with type 2 diabetes, particularly those with positive antibodies, should undergo annual screening to detect asymptomatic thyroid dysfunction

---

OBJECTIVE: For decades, exercise has been considered as a cornerstone for managing diabetes. The current study aimed to determine the effects of short-term exercise on blood glucose, lipids and HbA1C in type-2 diabetes mellitus. MATERIALS AND METHODS: A total of 61 diabetic patients were randomly selected. Later, subjects with capability of doing exercise took part in a special four-week exercise program. The blood glucose, lipid levels (before and after 4 weeks) and HbA1C (before and three months after exercise program) of 32 subjects were measured and compared in the time scales. RESULTS: Our results showed a significant reduction in blood glucose and lipid concentrations. However, the reduction observed in HbA1C was not significant (P=0.12). Comparison of pre- and post-exercise results demonstrated a significant improved glycemic control. CONCLUSION: The findings confirm the benefits of exercise training in type 2 diabetic patients. There are many studies which support the importance of physical activities program in controlling and preventing the common metabolic disorder and its complication

---

OBJECTIVE: The aim of this study was to investigate the effect of pomegranate juice (PJ) on the paraoxonase and arylesterase activity of human serum paraoxonase( PON1). MATERIAL AND METHOD: Fifty patients with type 2 diabetes mellitus consumed 200 ml of PJ daily for a period of 6 weeks. Blood was collected from the patients before and after PJ consumption after 12 h of fasting. Blood sugar, total cholesterol, triglyceride, and HDL-C were measured by enzymatic kit method and autoanalyzer. The concentration of LDL-C was calculated by using Friedwald formula. The malondialdehyde concentration (μmol/L) was determined by thiobarbituric acid (TBA) assay. Paraoxonase and arylesterase activity of PON1 enzyme were measured using paraoxone and phenylacetate as the substrates. RESULTS: The concentration of fasting blood sugar, total cholesterol, LDL-C and malondialdehyde significantly (p<0.001) decreased after the intervention. Paraoxonase and arylesterase activity of PON1 significantly (p<0.001) increased after the intervention. However, there were no significant changes in serum triglyceride and HDL-C. There was a significant positive correlation between paraoxonase and arylesterase activity of PON1 and serum HDL-C concentration. A significant negative correlation was detected between paraoxonase and arylesterase activity of PON1 and FBS. CONCLUSION: It can be concluded that PJ consumption as an antioxidant may have a contribution in changing fasting blood sugar, lipid profiles, lipoprotein oxidation, and PON1 activity.

---

Diabetes mellitus is one of the major metabolic disorders. It is a global epidemic with an estimated worldwide prevalence of 6% (246 million people) in 2007. Diabetes is recognized for severe complications including diabetic nephropathy, neuropathy, and retinopathy. Currently, available therapy acts by increasing insulin secretion (sulphonylurea and glinides), decreasing insulin resistance (glitazones and metformin) or delaying the absorption of glucose from the intestine (acarbose). Insulin treatment is expensive and induces weight gain. None of these drugs have been shown to stop the progressive decline of beta-cell function. Many traditional plant treatments exist as a hidden wealth of potentially useful natural products for diabetes control. There are approximately 800 to 1200 plants that exhibit hypoglycemic activity. Herbal medicine represents one of the most important fields of traditional medicine all over the world and provides a valuable alternative therapeutic. Herbal medicines are frequently considered to be less toxic and free from side effects rather than synthetic ones. Many plants like Citrullus colocynthis, fenugreek and ginger are useful in diabetes. The hypoglycemic properties of the plants are surveyed in this paper such as Citrullus colocynthis, fenugreek, and ginger.

---

Objective: Limited joint mobility (LJM) has been described as the earliest clinical complication of diabetes mellitus. This study was performed to determine the frequency of limited joint mobility and to evaluate the association between LMJ and some chronic diabetic complications. Materials and Methods: A total of 125 patients with type 1 diabetes mellitus aged 11.89 ±3.75 years, with 4.2±2 years mean duration of disease were studied. Diabetic patients were compared with 125 healthy young controls that were group-matched for age and sex. Variables such as age, sex, duration of disease and mean HbA1c level were obtained from the patients′ medical records. LJM was assessed by observing the small joints of the hands in the prayer position. Student t-test and chi-square (X2) were used for comparisons between groups. Results: The frequency of LJM was significantly higher in diabetic patients compared to healthy controls (19.2% vs. 4%, p=0.001). Diabetic patients with LJM had not longer duration of diabetes than those without LJM (4.33 years compared to 4.08 years, p=0.55). Its presence was significantly related to microalbuminuria (p=0.017) and higher systolic blood pressure (p=0.001). Conclusion: Diabetic patients showed a significantly higher frequency of LJM than non-diabetic patients. LJM in the hands of patients with type 1 DM was associated with microalbuminuria but it was not related to retinopathy.

---

Objective: Adiponectin (an insulin sensitizing protein) and zinc have insulin like effect. This study was conducted to assess the effect of zinc supplementation on serum adiponectin and insulin resistance in first degree relatives of diabetic patients. Materials and Methods: This study was a randomized clinical trial performed on 58 first degree relatives of diabetic patients with normal glucose tolerance test and body mass index (BMI) more than 25Kg/m2. The subjects were divided into two groups: a case group which consumed 50mg zinc orally per day for twelve weeks and another group that was not given zinc but regular exercise and weight control were recommended. Adiponectin, fasting blood glucose, insulin and insulin resistance were calculated by the homeostasis model assessment (HOMA) and lipid profile was measured in both groups before and after treatment. Results: The mean age and BMI of participants were 37.6±7.4 years and 28.8±3.5 Kg/m2 respectively. The level of adiponectin increased significantly from 1.67 ±1.29 to 3.67± 3.08 mIU/ml in subjects who received 50 mg zinc compared to the control group (p=0.001). HOMA decreased from 1.89±1.07 to 1.54±1.34 in subjects who consumed zinc, but this reduction was not significant (p=0.13). Conclusion: Zinc significantly increases the level of adiponectin in first degree relatives of diabetic patients. The level of insulin and HOMA index after zinc supplementation decreased but this reduction was not significant.

---

Objective: Correlation of osteoporosis (OP) with type 2diabetes mellitus (DM) , is not as clear as type 1 DM. The purpose of this study was to compare the frequency of OP and osteoporotic fractures in post- menopausal women with and without type 2 DM in Sari, Iran. Materials and Methods: Eighty post-menopausal women with type 2 DM and 80 non-diabetic controls enrolled in this study. Bone mineral density was determined with dual energy X-ray absoptiometry of L2-L4 in spine and femoral neck. Vertebral fracture was reported by a radiologist on thoraco-lumbar x ray. Hip and wrist fractures were determined by patients self-report and ascertained by radiographs. T test, X2 and Fisher's exact tests were used for data analysis. Results: The mean age of diabetic women with and without osteoporosis was 69±2.7 and 69.3±5 years, respectively (p=0.01). Diabetes duration, HbA1C and BMI were not statistically different between two groups. Diabetic complications and anti-diabetic agents, or age and duration of diabetes were not different in diabetic patients with OP or osteoporotic fracture. The mean of T-score in lumbar spine was -1.65±1.3 in diabetics and -2.11±1.3 in controls (p=0.03). T-score in femoral neck was not significantly different. In diabetic patients, the prevalence of osteoporosis was 27.5% at lumbar spine and 17.5% at femoral neck and in controls were 46.3% and 27.5%, respectively (p=0.04 and 0.1). Fractures were less common in diabetics (18.8% vs. 32.5%, p=0.04). Conclusion: This study showed that osteoporosis and osteoporotic fractures is less common in post-menopausal diabetic women compared to non-diabetic subjects

---

Skin disorders are common in diabetic patients and may also act as clues for diagnosis in undiagnosed cases. These manifestations may be summarized in five categories including non-infectious, infectious, treatment-related and miscellaneous manifestations as well as diabetic foot ulcer. The most common non-infectious disorder occurring in up to 70% of patients is diabetic dermopathy. Infections with staphylococcus aureus and streptococcus hemolytic group A, and dermatophytoses are seen frequently in diabetics. Moreover, severe and life-threatening infections such as necrotizing fasciitis, malignant external otitis and rhinocerebral mucormycosis may be seen especially in elderly diabetics. Diabetic foot ulcer is also a major problem in longstanding diabetes and needs particular attention. Complications due to treatment of diabetes are also found in some patients. In conclusion, skin manifestations must be considered as an important issue in any patient, especially in obese ones. Improved metabolic control as well as using newly introduced drugs may help reduce or even resolve these problems.

---

Objective: Peripheral Arterial Disease (PAD) is a state characterized by atherosclerotic occlusive disease of lower extremities. Diabetes is the main risk factor for PAD. Material and Methods: To assess the prevalence of PAD, a cross sectional study was performed on 352 diabetic patients who referred to Yazd diabetes research center from 2007 to 2010. Vascular assessment was done by measuring the Ankle-Brachial Index (ABI) and Toe-Brachial Index (TBI). PAD was defined when ABI was less than 0.9 in each leg or ABI was more than 1.3 and TBI less than 0.6. Result: The mean age of diabetic patients was 56.97±10.3 and the mean of diabetes duration was 12.6±7.5 years. Fifty-two percent of these subjects were women and 48% men. ABI less than 0.9 was found in 8.5%, ABI 0.9-1.3 in 84.5%,and ABI more than 1.3 in 7%of the patients. Prevalence of PAD was 9.8%.In this study the age of diabetic patients with ABI less than 0.9 was significantly more than other groups. Conclusion: The prevalence of PAD in type 2 diabetes is 9.8% and history of cerebrovascular disease significantly associated with PAD.

---

Objective: Control of weight gain is an important strategy in reducing the diabetes incidence. Recently, herbal drugs have been used as a complementary and alternative medicinal care. This study was conducted to determine the effect of Ferula asafoetida on weight gain, fat accumulation, liver steatosis and leptin level. Materials and Methods: All rats of control and treatment groups received daily tap water (P.O) as vehicle mixed with fructose 10%. Two treatment groups received FAF oleo-gum resin at doses of 25 or 50 mg/kg (P.O). Normal rats received only tap water and standard chow food. Body weights, abdominal fat, size of epididymal adipocyte and serum leptin were recorded. Result: Administration of Ferula asafoetida significantly decreased body weights, abdominal fat and size of epididymal adipocyte compared to untreated rats (P<0.05). Levels of serum leptin were significantly decreased in treated rats (P<0.05). Conclusion: This study showed that Ferula asafoetida extract has anti-obesity, fat lowering effects and can prevent liver steatosis in type 2 diabetic rats. Reduction of serum leptin is associated with protective effects of Ferula asafoetida in obese diabetic rats.

---

Objective:Fasting plasma glucose (FPG) analysis is the most importantmethod for detection and diagnosis of diabetes mellitus. Due to difficulty and problems of this method for determination of glycemia in diabetic patients, recently the use of Fasting Salivary Glucoseas a simple and non-invasive method to evaluate FPGhas came into significant considerationof specialists. The aim of this study was the presentation of a new method to evaluate FPG by salivary glucose measurement Material and Methods:This was a cross-sectional study which was done on 52 diabetic patients (test group) and 47 non diabetic patients (control group). After collection of saliva and blood samples, The FPG level was measured by GOD-PAP method and FSGlevel was measured by Glucose oxidase/peroxidase method. The statistical significance was calculated by T-Test and regression test for quantitative variables and Chi-square test for qualitative variables. Results:The average FSG in diabetic and non-diabetic groups were 11.43mg/dl and 5.2mg/dl, respectively. Also the correlation coefficients between FPG and FSG in diabetic and non-diabetic groups were 0.835 and 0.583 respectively (p-value=0.0001). Conclusion: This study showed that there is a significant linear relationship between FPG and FSG. Therefore, FSG amounts can be used as a non-invasive method to detect FPG.

---

Objective: Diabetes is one of the most prevalent disorders in human. During recent years the rate of diabetes had been increased in the world and it will be increased by 122% from 1995 to 2025. The aim of this study was to determine the self-care of diabetic patients referred to Rahmatabad health care center in Yazd city, Iran. Materials and Methods: This was a descriptive study done on 152 diabetic patients referred to Rahmatabad health care center, Yazd, Iran in 2011. Data were collected through a questionnaire consisting of demographic data (age, sex, level of education, job, and types of diabetes) and also the questions about self-care. The questionnaire was developed in consultation with three health educators and three questionnaire validation experts. After entering into SPSS, data were analyzed using descriptive statistics, t-test and ANOVA. Results: Their behavior about using the rate of the insulin, physical activity, using weekly food plan and using food was not suitable, but they used their oralantidiabetic drugs and insulin suitably. Results showed there was significant relation between self- care and job of participants (P=0.02). Conclusion: Results of our study and also other studies revealed that self- care in diabetic patients is very important and can decrease the cost of treatment and complication of diseases. More than 75% of diabetic patients are type 2, and their self-efficacy is not suitable, there is need to stress on type 2 patients in education program.

---

Objective: GLUT4 is a type of glucose transporter and plays a central role in whole-body metabolism of carbohydrates. The muscle is the major site of GLUT4 and cell line models, to explore GLUT4 behaviors under new therapeutic approach, such as herbal components, should be evaluated. Here, C2C12 cell line is evaluated for GLUT4 translocation from intracellular compartment into the cell membrane. Materials and Methods: C2C12 cell lines were cultured and differentiated into myotubes. Cinnamon/Turmeric-water soluble extract (CWE and TWE) were prepared and differentiated myotubes were exposed to the 100, 1000 μg/ml CWE, 100 μg/ml TWE or dimethylsulfoxide for 3 hours. Intracellular/cytoplasmic membrane compartments were separated using ultracentrifugation. GLUT4 percentages quantities were measured using western blotting. Data analysis of 3 sample sizes was done by comparing mean±SD of GLUT4 quantities and independent samples t-test. Results: CWE enhances GLUT4 translocation from intracellular compartment into the cytoplasmic membrane its effect is also dose-dependent meaning that 1000 μg/ml concentration has a more potent effect than 100 μg/ml (p<0.05). However, 100 μg/ml TWE had a reverse effect (p<0.05). Conclusion: Here we have shown that C2C12 is a good model for exploring GLUT4 changes under the effect of herbal extract. Induction or blockade of GLUT4 maybe under control of different signals transduction pathways. Furthermore, although turmeric ingredients are declared to have somewhat anti-diabetic effects, here we have shown that such effect is not applied via TWE effects on GLUT4 intracellular compartments movement into the cell membrane.

---

Objective: Diabetes Mellitus as the most common metabolic disease of human has wide range of oral consequences such as oral infections which could make changes in the properties of saliva. The purpose of this study was to compare the amount of salivary IgA in diabetic and non-diabetic patients. Materials and Methods: In this case-control study, the population consisted of 40 persons including 20 diabetic and 20 non-diabetic subjects. All of them had not eaten, drunk or smoked at least 90 minutes before sampling. Sampling launched and the salivary IgA was measured with nephelometric procedure with Minineph kit (Minineph TM Human Kit, Binding Site Ltd, Birmingham, UK).The data were statistically analyzed by T-test and chi-square using SPSS software. Results: In 70% of the case group, salivary IgA was higher than the normal (>37.6mg/dl) but none were higher than normal in the non-diabetic (control) group and this difference was statically significant (p=0.009). IgA and age (p=0.303), and IgA and sex (p=0.0398) had no significant correlation on both case and control group. Conclusion: Salivary IgA of diabetic patients is higher than the non-diabetics (p=0.009).