مجله غدد درون ریز و متابولیسم ایران
سال بیست و دوم شماره 5 (پیاپی 113، آذر و دی 1399)

Previous studies have not investigated the association of concomitant changes in obesity indicators with diabetes in prediabetic patients. This study aimed to identify the patterns of changes in the abdominal obesity indices over time in prediabetic patients and to predict high-risk individuals for the future risk of diabetes development.

This prospective 16-year cohort study was conducted among 1228 prediabetic individuals during 2003-2019. The subjects were followed-up over time, and changes in their abdominal obesity indices were evaluated. The hidden Markov model (LMM) was used for data analysis.

The LMM identified three hidden states, depending on changes in the abdominal obesity indices: low risk of diabetes development; moderate risk of diabetes development; and high risk of diabetes development (19%, 45%, and 36%, respectively). The probability of progression from moderate to low- and high-risk groups was 0.34 and 0.02, respectively, and the probability of staying in high- and moderate-risk groups was 0.98 and 0.78, respectively.

Based on our long-term evaluation of patterns of changes in the abdominal indices, we classified prediabetic individuals into high, moderate, and low risk groups of diabetes development in the future. Due to the low probability of transition from the high risk to the low risk group in prediabetic patients, it is necessary to consider weight control as an important preventive factor in diabetes progression.

Perceived social support can influence various aspects of the physical and psychological health of diabetic patients. This study aimed to evaluate the health-related quality of life (HRQOL) of adults with type 2 diabetes with different levels of perceived social support.

This cross-sectional study was conducted on 336 adults with type 2 diabetes, participating in the Tehran Lipid and Glucose Study (TLGS). Data on the perceived social support and HRQOL were collected using the Multidimensional Scale of Perceived Social Support (MSPSS) and the Health-Related Quality of Life Scale (SF-12v2), respectively. Data analysis was performed using the analysis of covariance and logistic regression analysis.

There were no significant differences between women and men in terms of perceived social support scores, except for the family subscale, which was higher in men than women (24.1±4.8 vs. 23.0±5.4). The HRQOL scores of the participants with low levels of perceived social support were significantly lower in the two subscales of role emotional and mental health in men and in the majority of physical and psychological subscales in women as compared to their counterparts with high levels of perceived social support. After adjusting for the effects of confounding variables, the probability of poor physical and psychological QOL in women with low levels of perceived social support was 1.93 and 2.59 times higher than women with high levels of perceived social support, respectively.

The findings of the present study indicated a gender-specific pattern in the relationship between the perceived social support and HRQOL in patients with type 2 diabetes. A relationship was observed between low perceived social support and poor HRQOL in men only in the psychological health dimension and in women in both physical and psychological health dimensions.

Microalbuminuria is an independent risk factor for cardiovascular disease and is associated with all-cause mortality. The present study aimed to investigate the possible association between different types and amounts of dietary protein and microalbuminuria among Iranian adults participating in the Tehran Lipid and Glucose Study (TLGS).

Adults (1192 men and women; aged 19-86 years) participating in the sixth phase of TLGS (2014-2017), who had complete nutritional data with known urinary microalbumin levels, were included in the present study, according to the inclusion criteria. The dietary intake was assessed using a validated Feed Frequency Questionnaire (FFQ). Demographic variables, anthropometric indices, blood pressure, and biochemical data were also measured. To estimate the odds ratio (OR) of microalbuminuria (urinary microalbumin level: 20-200 mg/L), a logistic regression analysis adjusted for the confounding variables was performed.

The mean (±SD) of the participants’ age and body mass index at baseline were 44.96±14.00 years and 27.81±4.97 kg/m2, respectively. The prevalence of microalbuminuria in the study population was 14.4%. After adjusting for the confounding variables, the OR of microalbuminuria did not show a significant relationship with the protein intake. The adjusted ORs and 95% confidence intervals for microalbuminuria in the third tertile of total protein intake, animal protein intake, and plant protein intake were 1.08 (0.57-2.05), 1.19 (0.67-2.09), and 1.02 (0.56-1.88), respectively.

In the present study, there was no significant association between the total protein and plant protein intake and microalbuminuria. The animal protein intake increased the risk of microalbuminuria, although this relationship was not statistically significant.

It is well established that stress or the use of sulpiride, an antipsychotic, disrupts the reproductive system. Translocator protein (TSPO) in the mitochondrial membrane of steroidogenic tissues, such as gonads, is involved in the regulation of steroid hormone production by transporting cholesterol into the mitochondria. The present study aimed to investigate the effects of stress and sulpiride on changes in TSPO gene expression and testicular histology.

In this experimental study, 42 adult male Wistar rats were randomly divided into two groups, receiving saline and sulpiride (4 mg/kg, intraperitoneally). Each group was divided into three subgroups: control, psychological stress, and physical stress. Physical stress (electricity current: -0.5 Hz, -2 mA, -48v) or psychological stress (observation of rats under physical stress) was induced using a communication box for 14 days. At the end of the treatment period, the relative expression of TSPO gene in the testis was assessed by real-time quantitative reverse transcription PCR (qRT-PCR) and measurement of testicular histomorphometric indices and serum testosterone concentration. Data were analyzed by one-way ANOVA and Tukey’s test in SPSS.

Stress caused testicular tissue damage and significan  decrease in the TSPO expression and testosterone, compared to the control group (physical stress P…., psycologic stress P…). Besides reducing the number of germ cells drastically, sulpiride administration led to the destruction and disruption of the epithelium of seminiferous tubules, increased interstitial space of the testicular tissue, and further reduction of TSPO and testosterone.

Both physical and psychological stress led to testicular damage, besides decreasing the TSPO expression and serum testosterone concentration. Sulpiride administration mainly increased the adverse effects of stress on reproduction system, suggesting the side effects of this drug.

Polycystic ovary syndrome is very common among Iranian women. Patients with this syndrome are more likely to see general practitioners than gynecologists. This study aimed to investigate the level of knowledge and clinical management of general practitioners regarding the diagnosis and treatment of this syndrome.

This cross-sectional study was performed using the convenience sampling method among 198 general practitioners, attending one of the annual general practitioner conferences. The questionnaire (16 questions) was designed as a key feature test for a hypothetical patient with polycystic ovary syndrome. After the validity and reliability tests, it was distributed among the conference attendants.

The response rate of the participants was 79.2% in the study. Only one-third of the participants showed appropriate diagnostic performance, and only one-fourth showed good performance in requesting appropriate diagnostic tests. Also, only one-third of the practitioners provided accurate information for the patients about lifestyle changes and weight loss as the best treatment method.

The results of this study showed that general practitioners dealing with polycystic ovary syndrome patients do not have the appropriate clinical knowledge and performance. Since the prevalence of this syndrome among Iranian women is relatively high, retraining through training packages or retraining courses seems necessary for general practitioners.

The financial consequences of the increasing prevalence of diabetes show that diabetes is one of the main challenges of healthcare systems. This study aimed to investigate the direct costs imposed on insurance companies and patients by the delivery of first-level services to patients with type 2 diabetes, who were covered by health insurance and social security insurance plans in Ilam, Iran, in 2019.

In this descriptive analytical study, the population included all patients with type 2 diabetes, who had available electronic records in comprehensive health centers and were covered by the insurance companies of Ilam. The data collection tool was a checklist, and data analysis was performed in SPSS version 20. Inferential statistics, including independent t-test and one-way analysis of variance, were measured, and descriptive statistics, including mean and standard deviation, were calculated.

A total of 800 patients entered this study, 71.4% of whom were female. The mean age of male and female patients was 59.42 and 54.97 years, respectively. The average annual direct cost was estimated at 62,742,383 Rials per person; the highest cost was related to hospitalization (49,794,297 Rials) (79.3%), and the lowest cost was related to imaging (673,148 Rials) (1%). There was no significant relationship between the direct costs and gender, age, marital status, education, occupation, duration of disease, body mass index (BMI), type of insurance, or blood pressure (P<0.05).

According to the findings of this study, diabetes imposes a significant financial burden on the healthcare system, including significant hospitalization and medication costs. The majority of patients were covered by health insurance, and the financial burden was significant for individuals and governments. Therefore, elimination of predisposing factors for the disease and optimal management can reduce the imposed costs on healthcare systems.

Thyroid cancer is one of the most common malignancies of endocrine glands, causing carcinomas, such as papillary, follicular, medullary, and anaplastic thyroid carcinomas. Due to the significance of thyroid carcinomas, identification of the main signaling pathways and  the affecting mutations has been considered by researchers. Further studies on the dysregulation of oncogenes in signaling pathways have also revealed the feedback mechanisms between oncogenes/tumor suppressor genes and miRNAs. Considering the importance of thyroid carcinoma and the important role of miRNAs, this review study aimed to introduce the main signaling pathways and the most important modified miRNAs along with an explanation for the mechanism of their functions. Generally, Changes in the main PI3K, MAPK, and TGFβ signaling pathways alone or in combination, depending on the type and severity of cancer, have essential roles in thyroid cancer initiation and progression. Dysregulation of miRNAs and the signaling pathways, based on oncogene/tumor suppressor gene feedback mechanisms, can be an aggravating factor for the thyroid cancer process. Given the confirmed role of miRNAs in tumorigenesis and our current knowledge of miRNA-related cancers, miRNAs can be used as potential biomarkers for therapeutic purposes, as well as prognostic and diagnostic agents for cancer progression.

Thyroid disorders and gestational diabetes are the most common endocrine disorders during pregnancy. Given the important role of thyroid hormones in glucose metabolism and homeostasis, it seems that thyroid disorders can have significant effects on glucose metabolism and insulin secretion and may contribute to gestational diabetes. This review aimed to investigate the association between gestational diabetes and subclinical hypothyroidism in pregnancy.

The results of previous studies on the relationship between hypothyroidism and gestational diabetes are inconsistent. Evidence suggests an association between thyroid autoimmune disorders and gestational diabetes.

Considering the differences in race, geographic region, genetic factors, environmental factors, diagnostic criteria for gestational diabetes, and the cut-off thresholds for thyroid function during pregnancy in different studies, it is not possible to confirm the association between gestational diabetes and hypothyroidism in pregnancy.