Diagnostic Accuracy of the Desmopressin Stimulation Test in the Comprehensive Assessment of ACTH-Dependent Cushing's Syndrome: A Comparative Analysis with BIPSS and TSS.

BACKGROUND: Cushing's syndrome (CS) poses diagnostic challenges, particularly in distinguishing pituitary-dependent Cushing's syndrome, Cushing's disease (CD), from the ectopic ACTH syndrome (EAS). This study evaluated the diagnostic value of the desmopressin stimulation test (DST) in patients with ACTH-dependent CS in helping this discrimination. METHODS: Twenty-three ACTH-dependent CS patients underwent sequential DST, bilateral inferior petrosal sinus sampling (BIPSS), and transsphenoidal surgery (TSS). Two definitions of a positive DST results were applied. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and likelihood ratios. To avoid bias from predetermined criteria, we generated univariate receiver-operating characteristic (ROC) curves, plotting sensitivity against 1-specificity at various percentage cortisol and ACTH response levels. RESULTS: Against BIPSS, DST demonstrated robust sensitivity (Definition 1: 90.0%, Definition 2: 76.2%) and overall accuracy (Definition 1: 87.0%, Definition 2: 73.9%). PPV was high (Definition 1: 95.0%, Definition 2: 94.1%), but NPV indicated potential false negatives. Compared to TSS, DST showed good sensitivity (Definition 1: 90.9-77.3%) and PPV (100.0%) but limited NPV (16.7%). The likelihood ratios emphasized the diagnostic value of the test. Notably, against TSS, DST showed perfect discriminatory power (AUC 1.000 for percent ACTH, 0.983 for percent cortisol). CONCLUSION: The desmopressin test shows promise in accurately identifying the underlying cause of ACTH-dependent CS, potentially reducing the reliance on invasive procedures and providing a practical solution for managing complex cases. Further research with larger cohorts is required to validate the utility of the DST in routine clinical practice.

Usefulness of subtraction images for accurate diagnosis of pituitary microadenomas in dynamic contrast-enhanced magnetic resonance imaging.

BACKGROUND: Dynamic contrast-enhanced magnetic resonance imaging (MRI) is the modality of choice for the diagnosis of pituitary microadenomas; however, it may be associated with a relatively high false-negative rate, especially in small lesions. PURPOSE: To evaluate the usefulness of subtraction images for enhancing the visual detection of pituitary microadenomas. MATERIAL AND METHODS: In total, 50 patients with clinically established diagnosis hyperprolactinemia, acromegaly, and Cushing's disease were enrolled. Ten patients referred for brain MRI for reasons other than pituitary abnormality were selected as control group. Routine dynamic MRI of the pituitary gland and obtained subtraction MRI scans were scrutinized separately on different sessions by an experienced radiologist blinded to the study design and patient's data. The investigator's opinion on the presence or absence of a lesion and lesion size were collected. RESULTS: In patients with pituitary microadenoma, dynamic MRI images were reported positive in 42 (84%) patients and negative in 8 (16%). Subtraction images were described as positive in all patients (100%)-including all patients with negative dynamic MRI-and the difference was statistically significant (P=0.016). Undetected lesions on dynamic MRI had a mean size of 2.84 ± 1.79 mm (median= 2.20 mm, interquartile range=1.62-4.62 mm) and a significant inverse correlation was noted between lesion size and negative report of dynamic MRI (P=0.018). Brain MRI scans in the control group were reported negative for pituitary microadenoma in both dynamic contrast-enhanced and subtraction images. CONCLUSION: Subtraction images can successfully identify all lesions detectable with conventional dynamic MRI as well as improving visualization of lesions undetected on dynamic MRI, especially in small lesions.

Association of cumulative excess weight and waist circumference exposure with transition from metabolically healthy obesity to metabolically unhealthy.

BACKGROUND AND AIMS: The association between obesity severity and duration with the transition from metabolically healthy obese/overweight (MHO) phenotype to metabolically unhealthy obese (MUO) phenotype is not well understood. METHODS AND RESULTS: This study includes the Tehran Lipid and Glucose Study participants who were initially classed as MHO. Cumulative excess weight (CEW) and cumulative excess waist circumference (CEWC) scores, which represent the accumulation of body mass index and waist circumference deviations from expected values over time (kg/m2 ∗ y and cm ∗ y, respectively), were calculated until the transition from MHO to MUO or the end of follow-up. The sex-stratified association of CEW and CWEC with the transition from MHO to MUO was investigated by time-dependent Cox models, adjusting for confounders. Out of 2525 participants, 1732 (68.5%) were women. During 15 years of follow-up, 1886 (74.6%) participants transitioned from MHO to MUO. A significant association was found between CEW and CEWC quartiles with the development of MUO among women participants (fully adjusted hazard ratios in the fourth quartile of CEW and CEWC [95% (CI)]:1.65 [1.37-1.98] and [95% CI]: 1.83 [1.53-2.19]). There was no significant association between CEW and CEWC with the MHO transition to MUO among men participants. CONCLUSION: Over 15 years of follow-up in TLGS, general and central obesity accumulation was associated with the increased transition from MHO to MUO among women participants. More research with a larger sample size is needed to confirm and explain why the results are different for men and women.

Glycemic control improvement in individuals with type 2 diabetes with vitamin K2 supplementation: a randomized controlled trial.

PURPOSE: This study aimed to investigate the effects of vitamin K2 supplementation in the form of menaquinone-7 (MK-7) on glucose, insulin, and lipid metabolism in patients with type 2 diabetes mellitus (T2DM). METHODS: In this double-blinded, placebo-controlled, randomized trial, 68 insulin-independent people with diabetes received either 180 µg MK-7 twice a day or placebo for 12 weeks. We assessed fasting plasma glucose (FPG) and insulin concentrations (primary outcomes), glycated hemoglobin (HbA1c), insulin sensitivity indices, and lipid profiles (secondary outcomes) at baseline and end of the trial. RESULTS: At the end of the trial, FPG (effect size (ES) = - 0.68; p-adjusted = 0.031) and HbA1c (ES = - 0.36; p-adjusted = 0.004) were significantly lower in the vitamin K2 group compared with the placebo at the end of the trial. The number of participants achieved the target levels of glycemic control based on FPG, and HbA1c concentrations were significantly higher in the vitamin K2 group compared to the placebo group. Insulin concentrations (ES = - 0.29; p = 0.019) and homeostatic model assessment for insulin resistance (HOMA-IR) significantly decreased in the vitamin K2 group (ES = - 0.29; p = 0.019) compared to baseline, but their values were not significantly different compared to the placebo group at the end of the trial. No significant variation was observed in lipid profiles. CONCLUSION: Daily intake of 360 µg Vitamin K2 in the form of MK-7 for 12-weeks reduces FPG and HbA1c in patients with T2DM but does not have a lipid-lowering effect.

Burnout among healthcare professionals during COVID-19 pandemic: a cross-sectional study.

PURPOSE: To describe the prevalence of burnout among healthcare professionals dealing with COVID-19 patients and the associated factors. METHODS: In this cross-sectional survey, healthcare workers at six university-affiliated hospitals, who had been taking care of COVID-19 patients were studied. Age, gender, marital status, having children, hospital, job category, experience, and work load, as well as the level of burnout in each subscale were measured. RESULTS: 326 persons (53.0%) experienced high levels of burnout. The average score in emotional exhaustion, depersonalization and lack of personal accomplishment was 26.6, 10.2, and 27.3, respectively. The level of burnout in the three subscales varied based on the personal as well as work-related factors and gender was the only variable that was associated with high levels of all three domains. CONCLUSIONS: Burnout is prevalent among healthcare workers caring for COVID-19 patients. Age, gender, job category, and site of practice contribute to the level of burnout that the staff experience.

The relationship between sodium intake and some bone minerals and osteoporosis risk assessment instrument in postmenopausal women.

BACKGROUND: The results of the studies on the effects of sodium on bone metabolism have been inconsistent. There is no definitive answer to the question of whether sodium restriction can be associated with a lower incidence of osteoporosis. What reinforces the necessity of designing this study is the lack of findings with the approach of examining the effects of sodium on bone in our country. METHODS: This was a cross-sectional study conducted on 185 retired female teachers aged 45 to 70. Sodium intake was evaluated using two methods: A 24-hour recall and a 12-hour urine sample. To assess bone health, ORAI index was calculated for each individual. Urinary calcium, phosphorus, potassium and serum vitamin D and PTH were measured as laboratory variables. To compare the general characteristics of the participants across tertiles of urinary sodium, the analysis of variance (ANOVA) was used for quantitative variables and the Chi-square test for categorical variables. RESULTS: Phosphorous, calcium and potassium urinary excretion rate increased with the increase in urinary sodium (p<0.05). However, the changes in serum vitamin D, and PTH levels across tertiles of urinary sodium were not significant. Changes in urinary sodium levels were not significant (p=0.933) in ORAI groups (sorted by rating). The relationship between urinary calcium and sodium was apparent in low calcium intake (r=0.415, p<0.001), but not in higher calcium intake (r=0.144, p=0.177). CONCLUSION: Although urinary calcium and potassium increased with the increase in sodium intake, no relationship was found between sodium and ORAI.

Dermatological side effects of dipeptidyl Peptidase-4 inhibitors in diabetes management: a comprehensive review.

Dipeptidyl peptidase-4 (DPP-4) inhibitors are a class of drugs that enhance the incretin-insulin pathway and offer effective glycemic control in type 2 diabetes mellitus. However, these drugs may be associated with various dermatological side effects, ranging from mild to severe. This review article summarizes the current literature on the dermatological side effects of DPP-4 inhibitors, including bullous pemphigoid, severe cutaneous adverse drug reactions, fixed drug eruptions, and other mucocutaneous reactions. The review also discusses the possible mechanisms, risk factors, diagnosis, and management of these side effects. This review aims to increase the awareness and vigilance of healthcare providers in recognizing and managing the dermatological side effects of DPP-4 inhibitors and to emphasize the need for further research and surveillance to optimize diabetes care and patient safety.

Prevalence and associated factors of dyslipidemia in elderly people: Results from the Ardakan Cohort Study on Ageing, Iran.

BACKGROUND AND OBJECTIVE: Dyslipidemia is a major modifiable factor in elderly people. The study objective was to assess the prevalence and associated risk factors of dyslipidemia among the Iranian population aged over 50. METHODS: This population-based cross-sectional study is part of the Iranian Longitudinal Study on Ageing conducted in Ardakan, Iran. In total, 5,197 participants aged over 50 years old were included through a stratified random sampling method. Dyslipidemia was defined in compliance with the Adult Treatment Panel III criteria. The Chi-square and independent sample t-test were used to compare categorical and quantitative variables, respectively. A logistic regression analysis was applied to determine associated factors of dyslipidemia. RESULTS: The mean age of the participants was 62.24±7.52. The prevalence of dyslipidemia was 68.85%. High levels of total cholesterol, triglyceride, low-density lipoprotein, and low level of high-density lipoprotein were seen among 9.74%, 24.66%, 5.54%, 19.20% of the participants, respectively. In addition, 66.05% of the study participants were under the treatment of lipid-lowering medications. Among the possible investigated risk factors of dyslipidemia, male gender (odds ratio (OR) = 0.56, 95% confidence interval (CI): 0.47, 0.68), waist circumference (OR = 1.03, 95%CI: 1.02, 1.04), diabetes mellitus (OR = 2.28, 95%CI: 1.96, 2.66), and hypertension (OR = 1.59, 95%CI: 1.38, 1.83) showed a statistically significant association (p<0.05). CONCLUSION: Dyslipidemia is highly prevalent in Ardakan's older population. So, lipid management interventions are necessary for this population.

Effect of Biliopancreatic Limb Length on Weight Loss, Postoperative Complications, and Remission of Comorbidities in One Anastomosis Gastric Bypass: a Systematic Review and Meta-analysis.

Aimed to evaluate the effects of biliopancreatic limb (BPL) length on weight loss, postoperative complications, and remission of comorbidities in OAGB.. An extensive search was conducted in PubMed, Scopus, EMBASE, and Google Scholar databases to find related OAGB articles. Both BPL length < 200 cm (by - 17.79, 95% CI - 19.23, - 16.34) and BPL length ≥ 200 cm (by - 14.93, 95% CI - 15.66, - 14.20) significantly decreased BMI. Regarding the effect of BPL length on comorbidities and postoperative complications, it was shown that BPL length < 200 cm is safer and more effective. Therefore, standardization of BPL length < 200 cm is suggested. Bypassing ≥ 200 cm of the small bowel does not ameliorate weight loss or resolve comorbidities significantly, and it is related to more frequent postoperative complications and nutritional deficiencies. Registration number in PROSPERO: PROSPERO 2021 CRD42021225499.

Association of ideal cardiovascular health with carotid intima-media thickness (cIMT) in a young adult population.

Ideal cardiovascular health (CVH) is associated with a lower risk of developing cardiovascular diseases. This study aims to investigate the association of CVH metrics with carotid intima-media thickness (cIMT) as a marker of subclinical atherosclerosis in young adults. A cross-sectional study was performed on 1295 adults, average age of 29.7 ± 4.0 years, selected from the participants of the Tehran Lipid and Glucose Study. The participants were divided into three groups based on the overall CVH score: ideal, intermediate, and poor CVH. Multivariate-adjusted linear regression was used to determine the association of the CVH score with cIMT. Multivariate-adjusted odds ratios (ORs) were calculated for high cIMT (≥ 95% percentile). Also, the independent effects of each ideal CVH metric on cIMT were analyzed. The prevalence of ideal CVH was 6.4% in men and 12.4% in women, and mean cIMT was obtained 0.53 ± 0.09 mm in men and 0.57 ± 0.08 mm in women. A 1-point increase of the CVH score in men and women was associated with a cIMT decrease of 0.009 and 0.011 mm (men: Beta [SE] = - 0.009 [0.003]; women: - 0.011 [0.007], p < 0.001), rendering the ORs of 0.66 and 0.70 for having a high cIMT (≥ 95% percentile), respectively. Ideal blood pressure in both sexes and body mass index in women had significant inverse association with cIMT. There was an inverse graded association between the CVH score and cIMT among young adults, indicating that ideal CVH metrics were associated with better vascular health in this population.

Can fasting plasma glucose replace oral glucose-tolerance test for diagnosis of gestational diabetes mellitus?

BACKGROUND AND AIMS: Gestational diabetes mellitus (GDM) has high prevalence worldwide. This study aimed to evaluate the fasting plasma glucose (FPG) cutoffs at first prenatal visit and at 24-28th of gestational weeks to avoid obtaining full oral glucose-tolerance test (OGTT) in the diagnosis of GDM. METHODS: This study was a cross-sectional study conducted in Tehran, Iran during October 2016 and November 2017. All pregnant women reporting for the first routine prenatal visit before 20th week of gestational age were included in this study. Participants without overt diabetes mellitus at first prenatal visit, underwent OGTT at 24-28th of gestational weeks. RESULTS: Totally 952 pregnant women with mean age of 26.4 ± 14.1 years took part in this study. The prevalence of GDM was 12.7% (mostly diagnosed based on the FPG alone). FPG cutoffs 75 and 80 mg/dL at first prenatal visit and at 24-28th of gestational weeks can rule out the GDM with high sensitivity and negative predictive value, respectively. FPG cutoffs 85 and 90 mg/dL at first prenatal visit and at 24-28th of gestational weeks had high capacity, excellent specificity and positive predictive value in diagnosing GDM, respectively. CONCLUSIONS: Performing only the FPG and considering FPG cutoffs 75 and 80 mg/dL at first prenatal visit and at 24-28th of gestational weeks can be a useful tool predicting the incidence of GDM, respectively, and had similar diagnostic power.

Distress and depression among patients with diabetes mellitus: prevalence and associated factors: a cross-sectional study.

PURPOSE: This study aimed to validate the internal consistency of the Persian version of the diabetes distress scale-17 (DDS-17) and to investigate the prevalence of diabetes distress (DD), depression, and possible relevant factors. METHODS: This was a cross-sectional study on 820 diabetes patients (62.4 % females) in Tehran, Iran between January and June 2017. The Ethics Committee of Shahid Beheshti University of Medical Sciences approved the protocol. Patients filled out a demographic and health survey, DDS-17, the Beck Depression Inventory Second Edition (BDI-II) and the Summary of Diabetes Self-Care Activities Measure (SDSCA). DDS-17 consist of emotional burden, and physician, regimen, and interpersonal related distress. The correlation between DDS subscales and association between DDS and BDI-II or SDSCA scores were assessed using SPSS. RESULTS: The mean age was 58.91 ± 12.35 years. Majority of patients had high DD (37.2 %) and severe depression (38.7 %). The general and specific diets got the highest score in six SDSCA subscales. The Persian version of DDS-17 had excellent internal consistency with Cronbach's alpha coefficient of 0.924. The DDS score had significant relationship with socioeconomic level (p < .001), type of DM (p < .001), type of treatment (p < .001), glycemic control status (p < .001), complication (p < .001) and depression level (p < .001). The level of hemoglobin A1c was the most useful predictor of DDS score (p < .001). CONCLUSIONS: High prevalence of depression and distress in patient with diabetes calls for greater emphasizes on the importance of enhanced physicians and patients' knowledge in these areas.

Glycemic control and associated factors among Iranian population with type 2 diabetes mellitus: a cross-sectional study.

PURPOSE: Detection and modification of various factors such as life style, smoking and so on can significantly improve the glycemic control status. This study aimed to investigate glycemic control status and its relevant factors among patients with Type 2 DM. METHODS: In this cross-sectional study, the glycemic control status of patients with type 2 DM was investigated. In addition, relevant risk factors including demographic, clinical characteristics, self-care management behavior, medication adherence and laboratory data and their relationship with glycemic control status were assessed. Glycemic control status was defined as very good (HbA1c < 7%), good (HbA1c = 7-7.9%), poor (HbA1c = 8-9.9%) or extremely bad (HbA1c ≥ 10%). RESULTS: The present study included 562 patients (64.4% female). Most of the patients (37%) had poor glycemic control status. Microvascular complications especially diabetic neuropathy were the most common complications in our study. Glycemic control had significant relationship with level of education (p < .01) and occupation (p = .04). Among laboratory parameters, fasting plasma glucose (FPG) and total cholesterol levels were significantly lower in patients with desirable glycemic control (p < .05). The linear regression test showed that HbA1c had significant relationship with FPG (p < .01) and increasing one standard deviation in FPG can increase the level of HbA1c 0.014. CONCLUSION: Glycemic control status in our study was very low and FPG was the strongest predictor of glycemic control status. Some other factors were also associated such as education level, occupation, type of treatment, diastolic blood pressure, the lipid profile and aspartate transaminase.

Diagnostic Value of Erythrocyte Sedimentation Rate and C Reactive Protein in detecting Diabetic Foot Osteomyelitis; a Cross-sectional Study.

INTRODUCTION: Osteomyelitis is one of the complications of diabetic foot infection. The present study aimed to evaluate the diagnostic value of erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) in detection of osteomyelitis in patients with diabetic foot. METHODS: In this cross-sectional study, serum levels of ESR and CRP were measured for patients with diabetic foot referring to emergency department or endocrinology clinic and the screening performance characteristics of these markers in detection of osteomyelitis were calculated. The diagnosis of osteomyelitis was based on clinical examination and positive probe-to-bone test, which was confirmed by plain x-rays or MRI. RESULTS: 142 diabetic patients with an average age of 61.2 ± 11.8 years were evaluated (66.2 % male). The area under the ROC curve of ESR in detection of osteomyelitis in diabetic foot cases was 0.70 (95% CI: 0.62-0.79). The best ESR cut-off point in this regard was 49 mm/hour. Sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of ESR in 49 mm/Hour cut-point were 74.6% (95% CI: 62.9-83.9), 57.7% (95% CI: 45.5-69.2), 63.9% (95% CI: 52.5-73.9), 69.5 % (95% CI: 56.0-80.0), 1.8 (95% CI: 1.3-2.4) and 0.4 (95% CI: 0.3-0.7), respectively. The area under the ROC curve of CRP in detection of osteomyelitis was 0.67 (95% CI: 0.58-0.76). The best cut-off point for CRP in this regard was 35 mg/liter with sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios of 76% (95% CI: 64.2-85), 54.9% (95% CI: 42.7-66.6), 62.8% (95% CI: 51.6-72.8), 69.6% (95% CI: 51.7-80.8), 1.7 (95% CI, 1.3-2.2), and 0.4 (95% CI: 0.3-0.7), respectively. CONCLUSION: Based on the findings of ROC curve analysis, ESR and CRP had fair and poor accuracy, respectively, in detecting the diabetic foot cases with osteomyelitis.

Association between Serum Vitamin D Level and Echocardiographic Abnormalities in Patients with Thalassemia Major.

OBJECTIVES: Thalassemia major (TM) is one of the most common blood disorders with a high mortality rate due to cardiovascular disease. Vitamin D deficiency has been suggested to implicate in cardiac abnormalities. In this prospective study, we aimed to investigate the relationship between serum levels of vitamin D and tissue Doppler (TD) echocardiographic indices in thalassemia major patients. METHODS: A total of 81 TM patients, including 56 females and 25 males, with a mean age of 27.5± 6.8 years, were enrolled consecutively. Serum levels of vitamin D and other biomedical parameters were measured. Then, all patients were subjected to TD echocardiography. Correlations between the serum parameters and systolic and diastolic indices were examined. RESULTS: The serum level of vitamin D was correlated with systolic and diastolic indices such as the EF (r= 0.33, P= 0.003) and TD Imaging (TDI)-lateral (r= 0.31, P= 0.005). However, no correlations were observed between vitamin D deficiency and the LV septal and posterior wall thickness, TDIseptal, tricuspid regurgitation peak gradient (TRPG), pulmonary artery systolic pressure (PASP), deceleration time (DT), and propagation velocity (PVcm/s) indices. The results revealed also no linear correlations between serum vitamin D and albumin (r= -0.17, P= 0.06), ALP (r= -0.12, P= 0.14), T4 (r= -0.11, P= 0.16), as well as TSH (r= -0.10, P= 0.19). CONCLUSION: It seems that vitamin D deficiency in patients with TM is associated with systolic but not diastolic dysfunctions, possibly as consequences of related biochemical abnormalities.

Abdominal obesity phenotypes and risk of kidney function decline: Tehran Lipid and Glucose Study.

OBJECTIVE: Obesity and related health risk in different obesity phenotypes has always been a controversial subject. The present study was conducted with the aim of investigating the risk of kidney function decline (KFD) incidence in different abdominal obesity phenotypes. METHODS: In this prospective observational cohort study, 7002 individuals (56.1% female), aged ≥20 years, were followed for the incidence of KFD defined as 40% decline in eGFR. Abdominal obesity was defined based on waist circumference cut-offs ≥89/91cm for men/women, respectively. Metabolic health was defined as ≤1 criterion of the metabolic syndrome criteria, according to the Joint Interim Statement (JIS) definition. RESULTS: At baseline 4273 individuals (61.0%) were abdominally obese, among whom, 1188 (27.8%) belonged to the metabolically healthy abdominal obese (MHAO) phenotype. Totally, 251 incidences of KFD was indicated throughout the 12-year follow-up. After adjusting for the confounding variables, MHAO phenotype was not associated with increased risk of KFD in both males and females. Furthermore, results indicated that hazard ratios (HRs) for incidence of KFD did not increase in males with unhealthy obesity phenotypes. However, females with metabolically unhealthy abdominal obese (MUAO) phenotype had increased risk of KFD. CONCLUSION: Findings of this study indicated that MHAO phenotype was not associated with KFD incidence, regardless of the participants gender. Furthermore, MUAO phenotype was associated with higher risk of KFD only in females. Further studies with longer follow up and larger sample size are needed to shed more light upon the regarded relationship and the influential role of gender.

Does high-dose vitamin D supplementation impact insulin resistance and risk of development of diabetes in patients with pre-diabetes? A double-blind randomized clinical trial.

AIMS: The aim of this study is to evaluate the effect of high-dose vitamin D on insulin sensitivity and the risk of progression to diabetes. METHODS: In this double-blind, placebo-controlled randomized clinical trial adults with pre-diabetes and vitamin D deficiency were randomly assigned to either vitamin D3 or placebo. Fasting plasma glucose (FPG), 2-h oral glucose tolerance test plasma glucose (OGTT PG), Homeostatic Model Assessment of Insulin Resistance (HOMA-IR), and the rate of progression of glucose tolerance was compared. RESULTS: A total of 162 patients were randomized, from which 83 finished the 6-month follow-up (44 in intervention group and 39 in control group). In 6 months, serum 25-hydroxyvitamin D levels were significantly higher in the intervention group (36 ng/ml vs 16 ng/ml, P value < 0.001). There was no significant difference between FPG or 2H-OGTT PG in two groups. HOMA-IR score was significantly lower in the vitamin D group (2.6 vs. 3.1; P value = 0.04). The rate of progression toward diabetes was significantly lower in the intervention group (28% vs. 3%; P value = 0.002). CONCLUSIONS: In patients with pre-diabetes and hypovitaminosis D, high dose vitamin D improves insulin sensitivity and decreases risk of progression toward diabetes.

Comparison of the International Association of Diabetes in Pregnancy Study Group Criteria with the Old American Diabetes Association Criteria for Diagnosis of Gestational Diabetes Mellitus.

OBJECTIVES: This study aimed to assess the prevalence of gestational diabetes mellitus (GDM) based on two sets of criteria, namely the old criteria suggested in 2009 by the American Diabetes Association and new criteria of the International Association of Diabetes in Pregnancy Study Group. We also evaluated the predictive power of the risk factors of GDM. METHODS: Pregnant women from three outpatient clinics in Tehran, Iran, participated in this cross-sectional observational study. During the first perinatal visit, demographic data, medical histories, weight, and height of mothers were recorded. The mother's fasting glucose and glycosylated hemoglobin were measured. An oral glucose tolerance test was also performed. The prevalence of GDM, based on the two criteria, was estimated and its predictive factors were investigated. RESULTS: Of 1,117 pregnant women, 156 (15.6%) and 71 (7.1%) patients had GDM based on the new and old criteria, respectively. Multivariate analysis showed that older age at pregnancy (OR = 1.05; 95% CI: 1.006 - 1.107; P = 0.03), higher body mass index (OR = 1.2; 95% CI: 1.15 - 1.3; P < 0.001), family history of diabetes (OR = 1.97; 95% CI: 1.11 - 3.5; P = 0.02), and history of macrosomia (OR = 7.8; 95% CI: 1.96 - 30.9; P = 0.004) were independent predictive factors for GDM. CONCLUSIONS: Using the new criteria, the prevalence of GDM increases by 2.2 folds compared to the old criteria. Several factors can independently predict the occurrence of GDM.

Effect of Bedtime Melatonin Administration in Patients with Type 2 Diabetes: A Triple-Blind, Placebo-Controlled, Randomized Trial.

Melatonin is widely available as over the counter product. Despite promising effects of melatonin supplementation on glycemic control, there is a significant heterogeneity between studies. The current study aimed at determining the effect of melatonin on fasting blood glucose (FBG), insulin resistance/sensitivity indices, glycosylated hemoglobin A1c (HbA1c), and high sensitivity C-reactive protein (hs-CRP) among type 2 diabetes mellitus (T2D) population during 8 weeks in a randomized, triple-blind, placebo-controlled trial. Thirty four subjects with the mean age ± standard deviation of 57.74 ± 8.57 years and 36 subjects with the mean age of 57.61 ± 9.11 years were allocated to 6 mg nightly melatonin and placebo groups, respectively. Melatonin and placebo groups were matched by age, gender, body mass index, and duration of diabetes. Also, there was no significant difference in laboratory findings except for HbA1c, which was lower in the placebo group (7.00 ± 0.89% vs 7.60 ± 1.47%, P=0.042). After trial completion, the increase of serum levels of melatonin was greater in the intervention than the placebo group (3.38 ± 1.33 vs 0.94 ± 1.28 ng/L, P=0.192). Moreover, compared to placebo group, among melatonin users, homeostasis model assessment of insulin resistance (HOMA1-IR) tended to be unfavorable at the end of follow-up [-0.51 (-1.76-0.81) vs. 0.28 (-1.24-1.74), P=0.20]; the similar trend was also shown for insulin sensitivity index (HOMA1-S) [2.33 (-3.59-12.46) vs. -2.33 (-10.61-9.16), P=0.148]. No differences were observed in FBG, HbA1C, and hs-CRP changes between the trial groups. The current study did not support the improving effect of melatonin on glucose homeostasis.

Knowledge, Attitude, and Practice of Iranian Internists Regarding Diabetes: A Cross Sectional Study.

BACKGROUND: A number of studies investigated the general practitioners' and family physicians' knowledge, attitude, and practice (KAP) on diabetes. However, studies on internists' KAP on diabetes management are limited. This study aimed to investigate the Iranian internists' KAP on diabetes mellitus and its management. METHODS: A cross-sectional study was conducted on a random sample of internists who participated in the 26th annual congress of internists in Tehran, Iran. The level of KAP and affecting factor was evaluated by a validated instrument. RESULTS: One-hundred internists with the mean age of 41.98±9.26 years were evaluated. Totally, the physicians possessed 66.29%±19.5%, 50.44%±19.39%, and 64.5%±15.3% of the scores in KAP, respectively. The time since graduation in general medicine had significant negative correlation with their knowledge and practice, that was along with the subjects' age (P<0.05). The KAP level had not significant difference between subjects participated in a continuing medical education (CME) program during the last year compared to subjects did not participated (P>0.05). Attitude, and practice scores were significantly higher in physicians who were working at diabetes clinic (P<0.05), and attitude was more in physicians working at teaching hospitals compared to those who were not working (57.82 vs. 47.72, P=0.020). CONCLUSION: According to our results, subjects' age and time since graduation in general medicine and specialty were inversely correlated by knowledge and practice. So internists with older age seems to be in priority for educational programs. And holding CME programs in current forms seems to be not suitable to increase the KAP regarding diabetes.