مجله غدد درون ریز و متابولیسم ایران
سال هفتم شماره 4 (پیاپی 28، زمستان 1384)

The aim of the current study was to ascertain which impaired glucose homeostasis at baseline is predictive of conversion to type 2 diabetes in an Iranian non-diabetic population. This is a population-based cohort study conducted in 4134 non-diabetic residents of Tehran (the capital city of Iran), aged over 20 years, from 1999 to 2004. Fasting plasma glucose and glucose levels after ingestion of 75 g glucose were measured at baseline (1999-2001) and at follow up (2002-2004) with mean follow up duration of 3.4 years. ADA 1997 and 2004 criteria were used to determine the glucose tolerance status of the participants at baseline and follow up. Using ADA 1997 criteria, the cumulative incidence of diabetes for participants with IFG and IGT, isolated IGT and isolated IFG was 32.3, 10.7 and 9.5% respectively compared with 1.2% for those with normal glucose tolerance at baseline. After application of the new criteria the corresponding incidence rates were 24.8, 6.5 and 5.9% vs. 0.7%. In multivariate logistic regression analysis, the odds ratio for incident diabetes was 1, 6.5(2.5-16.7), 7.7(4.7-12.6) and 28.9(15.6-53.5) in subjects with normal glucose, isolated IFG, isolated IGT and both IFG and IGT respectively using ADA 1997 criteria. The corresponding odds ratios after application of the new criteria were 1, 4.6(2.5-9.0), 6.8(3.6-12.9) and 27.1(15.5-47.5) respectively. In addition to fasting and 2-hour glucose (p<0.001), the waist-to-hip ratio was an important risk factor for developing diabetes (p<0.01). Both isolated IFG and isolated IGT, and especially combined IFG and IGT, based on either the new or previous ADA criteria are strong predictors for development of type 2 diabetes.

There are significant correlations between the mental health status of individuals and non-communicable mental or physical diseases. Epidemiological data regarding mental health indices plays an important part in the planning and designing of mental health programs. This study was conducted to evaluate the general mental health status of inhabitants in an area of Tehran as part of the TLGS.

In this cross-sectional study, 927 residents (20 years and older) of a specific area were randomly selected. Subjects completed the demographic data forms alongwith the General Health Questionnaires (GHQ), validated for the Iranian population. A cut off of 6 and above was used as threshold to identify the group suspected of having psychiatric disorders. To compare the scores of total GHQ and subscales between different demographic variables, the Chi square, Mann whitney and Kruskal wallis test were used. Logistic regression was used to identify variables related to the group that scored above threshold.

The total sample studied consisted of 927 adults, of whom 401 (43.3%) were males and 526 (56.7%) females. Among them 489 (52.8%) were suspected of having psychiatric disorders. Mean score of total GHQ was 7.0±5.4 and regarding the subscales of the questionnaire including physical symptoms, anxiety and sleep disorders, social dysfunction and depression, mean scores were 1.2±1.7, 1.7±2.0, 3.4± 2.0, 0.75±1.4 respectively and the median of mentioned subscales were 0, 1, 3 and 0 respectively. Frequency of women suspected of mental disorders was significantly higher than that of men (59.7% vs. 43.6%, p<0.001).

Taking into consideration the sample group and the method of gathering data, the frequency of those suspected of having psychiatric disorders in our study was higher as compared to other studies. Since mental health plays an important role in health promotion and community development, as well as the financial and psychological burden of illnesses, inplementation of policies in regard to implementation of related programs for prevention especially in women, seems vital.

Glutamic acid decarboxylase (GAD) catalyzes the conversion of glutamic acid to -aminobutyric acid (GABA). GAD65 isozyme is present in the pancreatic ß-cells. In the prediabetes period and during the ß-cell destruction, GAD is released as an autoantigen and anti-GAD autoantibodies appear in serum. Islet Cell Autoantibodies(ICAs) including anti-GAD are detectable in serum of diabetic patients up to 10 years before appearance of diabetes symptoms. This is an important predictive marker for diagnosis of prediabetic patients, especially in the first-degree relatives of diabetic patients for genetic factors. Anti-GAD is an important marker for detection of ß-cells destruction. The patients with high titers of anti-GAD have a worse disease prognosis and are in greater need of insulin injections. This survey is a case-control study aimed at detection of anti-GAD presence in sera of type 1 diabetic patients and their first-degree relatives and comparison with healthy individuals. Fifty type 1 diabetic patients with mean age of 12.24 ± 6.2 years and mean disease duration of 34.5 ± 8.4 months, 35 first-degree relatives and 50 normal individuals without familial diabetes were included in the study all the individuals were chosen by a random sampling method. The values of fasting blood sugar were determined in first-degree relatives and controls and all were found to be normal. The values of anti-GAD were determined by ELISA method. Median values of anti-GAD in cases and controls were 28, (range: 5-2700) ng/ml and 2, (0-10) ng/ml, respectively. The anti-GAD titers were significantly higher in patients than in normal individuals and relatives together (p<0.0001). Median value of anti-GAD in first-degree relatives was 7, (0-950) ng/ml. There was a significant statistical difference between anti-GAD titers in first-degree relatives and controls, (p<0.01). There was a significant difference between mean value of age and diabetes duration in anti-GAD positive and anti-GAD negative patients, (p<0.05). There was a negative correlation between anti-GAD and age, diabetes duration, disease beginning age of patients, (r= -0.155,-0.158,-0.036), respectively. By increasing of anti-GAD in diabetic patients and their first-degree relatives it may be concluded that measurement of anti-GAD is an important and beneficial tool for detection and diagnosis of prediabetic and diabetic patients.

Elevated level of serum homocysteine, as an independent risk factor for cardiovascular diseases, has been reported in hypothyroid patients. Considering the effect of levothyroxine on lowering homocysteine levels in these patients, and the fundamental role of folate in the metabolic cycle of homocysteine, this study was performed to compare the level of homocysteine in patients with hypothyroidism following treatment either with levothyroxine alone or in combination with folic acid. In this double-blind clinical trial study, 60 hypothyroid patients were randomly divided into two groups (n=30 each), and both were treated with 50-100 ‌µg of levothyroxine, with conjunction of an additional 1 mg folic acid (cases) or placebo (controls). The level of fasting homocysteine, folic acid, and vitamin B12 was measured and compared in all participants at the beginning of the study and after TSH levels were normalized. The level of homocysteine in the case group was decreased from 15.77±6.33 µmol/L to 10.8±3.54 µmol/L (p<0.001), and was also decreased in the control group from 15.69±6.4 µmol/L to 13.9±6 µmol/L (p=0.03). The difference in the mean serum homocysteine level between 2 groups was statistically significant at the end of the study (p=0.0165). Although the level of homocysteine was decreased in both groups, it was lowered to a greater extent in the group who received levothyroxine and folic acid. It seems that using folic acid in conjunction with levothyroxine can lower the potential harmful effects of homocysteine, which may even be exerted over a short-time period more efficiently.

Hypothyroidism is a common disease in Iran. It can interfere with the normal function of some of the systems in the human body one of the symptoms it is associated with is hoarseness, a of dysfunction that may occur in such patients. This study has been performed to determine the details of voice disorders in hypothyroidism. Hypothyroidism was confirmed in fifteen patients examined by an endocrinologist, using hormone laboratory tests. In all patients T4 level was less than 5 mg[d] and TSH level was over 10 mu/L. the vocalization and speech quality of all the cases were recorded and analyzed using the MDVP program by Visipitch system. The result of this study indicates that the majority of cases suffer from some degrees of dysphonia dryness of pharynx & larynx, hoarseness & the feeling of having a lump in their larynx are among the common complaints of these patients. Fundamental frequency (FO) in their voices with mean & SD (200  47 Hz) indicates a meaningful difference with normal values (P<0/01). Jitter parameter in studied patients with mean & SD (1/79  1/31) also indicates a meaningful difference with normal values (p<0/01). This is also the case with the Shimmer parameter in the studied patients with mean & SD (6/15  4.66) implying a meaningful difference with normal values (p<0/01). This study indicates that voice problems are very common in hypothyroidism.

Concidering complications of pyelonephritis in the mother and fetus such as septic shock, anemia, low birth weight, etc., recognition of these risk factors may be helpful in early and effective treatment.The purpose of this study is to determine frequency of diabetes in pregnant women with pyelonephritis and compare it with diabetes prevalence in pregnant women without pyelonephritis. This survey was conducted as a cross-sectional study on 250 pregnant women whose final diagnosis based on ICD 10–CM codes was pyelonephritis and 250 pregnant women whose diagnosis was not pyelonephritis, in the Emam Khomeini hospital of Ahwaz and these findings was analyzed statistically. In 250 pregnant women with pyelonephritis, 27 cases and in 250 pregnant women without pyelonephritis, 18 cases had diabetes. Of these 27 cases (10.8%), 13 cases (5.6%) had Gestational Diabetes Mellitus (GDM) and 13 cases (5.2%) had overt diabetes. In the control group, 13 cases (5.2%) had GDM and 5 cases (2%) had overt diabetes (p=0.86), (p=0.04). The prevalence of Gestational diabetes in pregnant women with pyelonephritis compared to the frequency of Gestational diabetes in pregnant women without pyelonephritis had no significant difference (p= 0.86) but, the prevalence of overt diabetes in case and control groups showed significant difference (p=0.04).

To determine the effects of long term moderate fat diet (30% of energy from fat) vs low fat (20% of energy from fat) diet on metabolic risks. A randomized, prospective 14-month trial on overweight and obese patients, a total of 89 overweight and obese men and women. Intervention: (1) Moderate-fat diet (30% of energy), (2) Low fat diet (20% of energy). Main Outcome Measurements: Change in body weight, waist circumference, LDL-C, HDL-C, total cholesterol, triglyceride, systolic and diastolic blood pressure. 45 subjects on a moderate fat diet and 44 subjects, on a low fat one were studied. Characteristics of all randomized participants were similar in both groups. After 7 months the moderate and low fat diets had similar effects on cardiovascular risks. The moderate fat diet was more successful after 14 months in reducing weight (-5.0±2.5 kg in the moderate group vs –1.2±1.1 kg in the low fat one p<0.0001), waist circumference (-5.5±2.4 cm in the moderate group vs – 2.3±1.3 cm in the low fat one p<0.0001), and other cardiovascular risk factors as well(LDL, triglycerides, total cholesterol, systolic blood pressure). A moderate fat diet, controlled for energy intake long term might have more beneficial effects on cardiovascular risk factors as compared to a low-fat diet.

Back pain (BP) is a common symptom among the general population,particularly in the elderly subjects. It is the most common feature of osteoporosis (OP) as well as a symptom of vertebral fracture (VF). In elderly women it may be a heralding symptom of OP and possibly a presenting feature of VF. The present study was designed to determine the frequency of low bone mass in postmenopausal women presenting with BP. 155 postmenopausal women with BP were studied. Bone mineral density (BMD) was measured with use of dual enegy x-ray absorptiometry (DXA) with a single Norland Excell densitometer. BMD was determined in the femoral neck (FN) and L2-L4 region of lumbar spine (LS). T-score and Z-score at both regions were determined. Frequency of OP and osteopenia at the FN and LS regions were detrmined according to WHO criteria. Patients with inflammatory musculoskeletal diseases, inflammatory back pain, infectious, or malignant spinal diseases, and history of rheumatic diseases or spinal surgery were excluded. Chi square and t tests were used for comparisons. The mean age and the mean menopausal duration of patients were 64±8 and 16±9 years respectively. Sixty-three percent of patients were 60 years or over. The mean BMD at the LS and FN were 0.70±0.13 gr/cm-2 and 0.79±0.18 gr/cm-2 respectively. The proportion of OP at the FN and LS were 30% and 56% respectively. The combined prevalence of OP at both FN and LS was 61.5%. The proportion of patients with Z-score < -1 and < -2 at the LS were 40% and 22% and at the FN were 37% and 11% respectively. In patients, aged 70 years and over, compared with patients below 70 years the BMD was decreased by 14% at the FN and 10% at the LS (P<0.02 and P<0.001 respectively). Menopausal duration of over than 10 years was associated with 5.6 fold risk of OP. The results of this study indicate that, the majority of postmenopausal women with BP are osteoporotic or osteopenic at the LS or FN. So they are at increased risk of future vertebral or femoral neck fractures.

Type 1 diabetes mellitus is an autoimmune disorder which is associated with different organ specific autontibodies including anticardiolipin antibody (ACLA). The association of ACLA with diabetes has not been widely reported. The aim of this study was to determine the prevalence of ACLA IgG and IgM and evaluation of their possible association with other auto-antibodies, duration of disease and status of control of blood glucose in type 1 diabetes patients. In a cross sectional study, 48 patients with type 1 diabetes in Bandar Abbas were compared with 41 age & sex matched healthy persons for the presence of ACLA (IgG and IgM), Rheumatoid Factor (RF) and Anti Nuclear Antibody. The mean age of diabetic patients was 20/5 ± 10 years. High titers of ACLA (IgG and/or IgM) were more common in type 1 diabetic patients than in healthy controls (18% vs. 0%, p<0.01) with no significant difference between males and females (4 and 12% respectively). Unlike ACLA IgG, the mean value of serum ACLA IgM was significantly higher in type 1 diabetic patients than in controls (6.8±2.8 vs. 4.5±2.4 GPLU/ml). Among type 1 diabetic patients, those with high titers of ACLA (ACLA+) were older and had higher age of onset of diabetes than those with normal titers, but there were no difference in duration of diabetes or level of HbA1c between them. No significant difference was observed in the prevalence of ACLA+ or the mean values of ACLA IgG and IgM between recently (< 1 years) and previously (> 1 years) diagnosed diabetic patients. ACLA+ patients were also more likely to show positive RF than the ACLA- group(25 vs. 0%). The relatively high prevalence of ACLA (+) in type 1 diabetic patients and its association with other autoantibodies may reflect an abnormal immunologic response in some stages of type 1 diabetes. ACLA might be added to the list of autoantibodies that should be measured in type 1 diabetes patients.

Despite documented studies, the exact role of stress in diabetes is still unclear. In the present study the effect of chronic psychological stress on insulin release from rat pancreatic islets has been investigated. Male Wistar rats were divided into two equal groups of control and stressed (n=8/group). The animals of the stressed group were exposed to restraint stressors (1 hour twice daily) for 15 and 30 consecutive days. At the beginning and end of the experimental periods the animals were weighed and blood samples were taken to determine the basal plasma levels of glucose, insulin and corticosterone. Following this, the pancreatic islets of 5/group of the above animals were isolated and the static release of insulin in the presence of different glucose concentrations (2.8, 5.6, 8.3, 16.7 mM) was assessed. The results showed that in the stressed group fasting plasma glucose levels on the 15th day were significantly increased compared to those of the control group. However there was no significant increase on the 30th day. Fasting plasma insulin showed a significant decrease on the 15th and 30th days of the experiment in the stressed group. Stressed rats showed significantly higher basal plasma corticosterone levels, only on the 15th day, as compared to the controls. Insulin secretion from islets of the stressed group, in response to increasing concentrations of glucose, showed significant increase on the 30th day of the experiment compared to the control group. The results suggest that chronic psychological stress could increase response of pancreatic β cells to glucose and thus, low insulin levels of the stressed animals, in vivo, could be explained by reason(s) other than the reduction of insulin release capacity of pancreatic β cells.

Following confirmation of the role of HDL-C role in cardiovascular disease, its measurement has become a fixed requirement by physicians. Today serum HDL-C is measured using different methods from simple outdated precipitation methods to the latest of homogenous assays used for HDL-C determination. However, the precision, accuracy and performance, standardization, and evaluation for those methods are controversial. This paper briefly discusses the methodology of various HDL-C determination methods e.g ultra centrifugation, electrophoresis, precipitation and homogenous assays, and advantages of homogenous methods. Human expertise, time consuming and high cost instrumentation of ultra centrifugation, quantitative electrophoresis, nuclear magnetic resonance and chromatographic methods are key factors that make the methods undesirable for clinical laboratories. Precipitation and manual separation steps of non homogenous HDL-C determination methods, reduces their precision, and causes them to be replaced by more precise methods such as homogenous assays however more time is needed for their costs to be more competitive.