مجله غدد درون ریز و متابولیسم ایران
سال سیزدهم شماره 4 (پیاپی 58، آبان 1390)

Gestational diabetes mellitus (GDM) is a common complication of pregnancy that is associated with fetal and maternal adverse outcomes. These women are at higher risk for development of type 2 diabetes mellitus (T2DM) and metabolic and cardiovascular disease. Various results have been presented on the long term consequences of GDM. We aimed to compare the incidence of these metabolic disorders between women with previous GDM and those without any history of GDM. Three groups of non-diabetic women, aged 15-45 y who participated in first phase of Tehran Lipid and Glucose Study (TLGS) were selected; 1) women with previous GDM, 2) women with previous still birth or macrosomia and without any history of GDM, and 3) normal age-BMI matched controls. They were followed for an average of 9 years, for developing of type 2 diabetes mellitus, hypertension and dislipidemia. Cumulative incidence of T2DM in the GDM group was 3-fold higher than the control. Incidence rates of T2DM were not significantly different between women in MC-ST group and their controls; however the serum concentrations of FBS were significantly different between these two groups. There was no significant difference in the cumulative incidence of hypertension and dislipidemia between the case and control groups. Women with previous GDM are at an increased risk of developing T2DM later in life. It seems that GDM screening in pregnancy could identify women at risk of metabolic disease.

Diabetes is the most complicated disease, which often leads to some psychological disorders especially stress, anxiety and depression. Complete treatment of this disease requires psychological assessment and cognitive behavioral therapy. The purpose of this research was to study the effects of stress management training on glycemic control, stress, depression and anxiety on women with type 2diabetes. The sample consisted of 46 type 2 diabetic women, aged between 32-65 years, who were matched for age and the some other criteria considered in this study. They were randomly divided into two groups, the experimental (n=23) and the control (n=23). Using the DASS scale, depression, anxiety, and stress were assessed, and HbA1c levels for all patients were measured before the intervention. Then the experimental group underwent 12 sessions of stress management, based on the cognitive-behavior method 2 hours weekly, after which patients were again assessed for DASS and HbA1c and after 6 months as follow up period in both groups. There was a significant difference between experiental and control groups in HbA1C. The rate of HbA1C in experimental group significantly decreased compared to control (p<0.001). Also There was a significant difference between two groups in DASS scale scores (depression, anxiety, stress) and HbA1c test after final session of intervention and after the 6 month follow up (P<0.001). It is recommended to consider cognitive behavior therapy as an addition to treatment programs for type 2 diabetic patients.

This study was performed to determine the effects of supplementation of folate on indices of glycemic control, insulin resistance and lipid profile in in men with type 2 diabetes, under metformin (at least 1500mg daily) treatment.

This was a double-blind randomized controlled clinical trial, in which 68 men with type 2 diabetes participated with written consents. Patients were randomly divided in two groups; folic acid 5mg/day and placebo. All the patients received the tablets for 8 weeks. Anthropometric and nutrient intakes data were obtained from each patient, and baseline and 8th week fasting blood glucose, HbA1C, serum insulin, insulin resistance, serum total cholestrol, TG, LDL-C, HDL-C, serum folate and plasma homocysteine were measured.

Supplementation with folic acid led to 6.3 percent decrease in HbA1C (P=0.019), 9.5 percent decrease in fasting blood glucose (P=0.006), 15.1 percent decrease in serum insulin (P=0.028), 17.2 percent decrease in insulin resistance (P=0.043) and 20 percent decrease in plasma homocysteine (P<0.001), 18.4 percent increase in serum folate (P<0.001). No significant changes occurred in the placebo group (P>0.05).

A pharmacological dose of folic acid supplementation decreased plasma level of homocysteine and improved glycemic control, insulin resistance and folate levels, a finding which sugqests a safe and inexpensive therapy for lowering homocysteine and improving the overall management of diabetic patients.

Diabetes is a serious problem. Although physical activity is very useful for control of diabetes, motivating change in physical activity is very difficult. The aim of this study was to determine the effects of education, based on Health Promotion Model (HPM) in physical activity among diabetic women. In this clinical trial study, 80 women (40 patients in each groups) evaluated. All patients in the case group were educated for 1 session of group education, and 3 sessions of individual counseling with the 5 A’s method, based on HPM. Then patients in both groups, in the first, 3 and 6 months after education, were evaluated for changes and physical activity. Statistical tests included Repeated Measurement ANOVA, Mann-Whitney and Friedman with SPSS, version 16 were used for data analysis. The results of repeated measurement ANOVA showed that the effects of time-group interaction effects education were significant for physical activity in the case group, the difference between case and control groups in physical activity being significant. Three and six months after education, the case and control groups had progressive stages of change. Intervention with the Health Promotion Model increased physical activity and improved stages of change for physical activity behavior in diabetic women.

Streptozotocin-induced type2 diabetes causes functional and metabolic changes in some tissues and subsequently produces some intermediates and substances which enter the circulation. On the other hand, endurance training can modify the amount of these substances. In this study, the effects of diabetes and endurance training on resting levels of blood lactate and plasma calcitonin gene- related peptide (CGRP) were investigated. Fifty rats were divided into 4 groups including control nondiabetic (n=10) training nondiabetic(n=10) nontraining diabetic (n=15) and training diabetic. Diabetes was induced by feeding with high fat diet HFD and injecting STZ. The training groups underwent an endurance training program on treadmill. Blood Lactate concentration was measured by a lactate kit and plasma CGRP concentration was determined by enzyme immunoassay kit(EIA). In the control nondiabetic, training nondiabetic, nontraining diabetic control and training diabetic groups, the restig values of blood lactate were 2.4, 2.08, 4.5, 3.7(mmol/L) and plasma CGRP values were 0.40, 0.35, 4.9,3.0 (ng/ml), respectively. Resting levels of circulating lactate and CGRP were higher in diabetic subjects than in control nondiabetic rats and endurance training decreased resting value of blood lactate in diabetic rats but did not change the plasma CGRP. Thus, it seems that the role of endurance training in ameliorating diabetes is due to decreasing resting level of blood lactate, but not plasma CGRP.

Measuring food insecurity has been an ongoing challenge to researchers. This study was carried out to assess the validity of the Household Food Insecurity Access Scale (HFIAS) in measuring household food insecurity in an urban area of Varamin in 2009. In this cross-sectional descriptive study, 400 households from different parts of Varamin, a city south of Tehran, were selected by the multi stage cluster sampling method. Household food security was measured by the 9-item HFIAS questionnaire that asks whether a specific condition associated with the experience of food insecurity ever occurred during the previous 30 days. Based on the HAFIAS questionnaire score, households were categorized in 4 groups according to access to food; food secure, mildly, moderately and severely food insecure access. In the second stage of the study, 30 households were selected from each group. Food security was observed in 21% of households. Mildly, moderately and severely food insecure access was 46.5, 25 and 7.5 %, respectively. Based on the responses to the 9 questions of the HFIAS questionnaire, perceptions that food is of insufficient quality (72%), two main factors emerged from the rotated principal component factor including: 1) Insufficient food quality and 2) Insufficient food intake. Both factors explained 77.5 % of the total variance. HFIAS has good internal consistency (Cronbach’s α= 0.95). Food insecurity was observed in households in this urban area of Varamin. The HFIAS measurement instrument shows acceptable validity and reliability in measuring food insecurity among households.

Mesenchymal stem cells (MSCs) derived from bone marrow are multi potent cells that have the capacity to trans-differentiate into a variety of cell types including insulin islet cells. However the efficiency is low. The aim of this study is to explore the potential of Marrow and Umbilical cord vein MSC to differentiate into functional islet like cells in vitro.

BM-MSCs and UC-MSCs were obtained from healthy donors and were cultured. MSCs with high CD90, CD73, CD105, CD44 and very low CD34 and CD45 expression were differentiated into Islet-like cells, under defined conditions. Insulin and c-peptide positive cells were evaluated with immune-florescence and insulin release after glucose challenge was tested by ELISA. QRT-PCR was done to detect expression of insulin, Glut2, Nkx6.1 and Nkx2.2 at mRNA level.

Our results showed that only BM-MSC can be differentiated to insulin secreting cells. About 15.8%±2.6 and 13.5%±5.5 of cells were positive for insulin and c-peptide, respectively. Our results revealed that expression of Insulin and Glut2 upregulated 20 fold changes at mRNA level. However they were not functional when treated by different concentration of glucose.

Our results showed that only Human BM-MSCs, compared to umbilical cord vein MSCs, are able to differentiate into insulin producing cells in vitro.

Esophageal cancer is one of the most common cancers in Iran and has a high mortality rate. The aim of this study was to assess the association between folate and vitamin B12 intake and risk of squamous-cell carcinoma of the esophagus cancer. In this case-control study, cases (n=47) were patients diagnosed with squamous-cell carcinoma of the esophagus (SCCE) in main hospital Kurdistan and controls (matched with cases by age and sex) were patients with acute non-cancer diseases at the same hospitals (n=96). Demographic data and physical activity were collected using questionnaires. A semi-quantitative food frequency questionnaire used for nutritional information and folate and vitamin B12 intake were calculated with Nutritionst IV (N4). Thirty eight percent of cases and 40% of controls were males. Mean age of cases and controls were 58±18 and 58±17 years respectively. Mean folate intake among cases was 152.1 μg/day, which was less than in the controls. After adjustment for confounders, folate intake was inversely related with SCCE (OR=0.03, 95% CI 0.00, 0.12). The association between vitamin B12 intake and SCCE was not significant (p=0.46). Folate intake was inversely related with SCCE: however, there was not a significant association between vitamin B12 intake and SCCE.

Metabolic dyslipidemia and elevated oxidative stress are very common in patients with diabetes and metabolic syndrome. The aim of this study was to investigate the effects of melatonin, on the plasma lipid profile and levels of MDA in tissues of fructose fed rats. Twenty-four male Wistar rats were divided into three groups: 1. controls that received normal chow and tap water. 2. fructose group that received chow +10% fructose solution in drinking water. 3. The melatonin group that received chow +10% fructose solution+ daily injection of 10 mg/kg (BW) melatonin (ip). After 8 weeks, plasma concentrations of triglycerides (TG), Total cholesterol (TC), low density lipoprotein(LDL), high density lipoprotein (HDL), and MDA in the tissues were measured and the Atherogenic index(AI) was calculated. The fructose fed rats showed significantly higher levels of TG, (p=0.01) compared to control rats, not in the melatonin group. HDL concentrations showed significant decrease in fructose rats, but not in the melatonin group. TC and LDL did not change significantly.AI increase in fructose rats(p=0.00) and decrease in melatonin treated rats(p=0.01). The fructose fed rats had higher MDA values compared with controls and melatonin administration decreased MDA values in heart, kidney and liver tissue. Melatonin intake can regulate metabolic dyslipidemia and decrease MDA levels in fructose fed rats.

Very few studies have been done with regard to the gender differences of the immune system in responding to exercise, which generally do not control women’s period cycle. Considering that levels of sex hormones differ during the menstrual cycle this study investigates the influence of gender differences on the response of IL-6, IL-15, cortisol and sex hormone to a single session of circuit resistance exercise in both male and female elite Handball players, while controlling CHECK on the women menstrual period cycles. The participants of the study were 12 elite Handball players, 5 men and 7 women. The circuit resistance exercise included 10 min warming, performing chest press, leg press, leg press, abdominal crunch, literal pull down, leg extension in 3 sets with 10 repetitions with 60% 1RM and 10 min cooling down. Pre, immediately and 2 hours post exercise, the blood samples were collected in order to measure IL-6, IL-15, cortisol, testosterone and estrogen levels. Results indicated that IL-6 concentration was different in the two groups after the exercise, which showed an increase in men and a decrease in women. There was no significant difference between the two groups IL-15 levels, but significant difference was observed between the two groups in cortisol, testosterone and estrogen levels. A single session of circuit resistance exercise resulted in different responses in the Immune system of men, in comparison with women.

Preimplantation genetic diagnosis (PGD) is the method of diagnosis of genetic disorders in the primary embryo. There are various ethical considerations for this technique. This study was designed to review ethical issues regarding PGD systematically. A comprehensive online search was done of data bases, books and websites and all eligible articles and documents retrievied were reviewed thoroughly and systematically. There are different ethical, legal and moral views and opinions about PGD in various religions cultures and different countries. In some countries such as Germany, there are rigid regulations about PGD indications that have strictly restricted its application while in other countries there are no special regulations for control or application of this technique. The same goes for different religions. Some religions have strict orthodox perspectives about application of this technique and do not permit their followers to use this new technology or permit it only for very limited cases. Some others like Islam have more flexible view and perspective and permit application of this technology for human health. Practical specific instructions and regulations should be developed worldwide for use of this method and its indications and the implementation of these instructions should be monitored precisely to avail of its potential benefits, and prevent any diversion and immoral use of these technologies, to preserve human dignity.