People with impaired glucose tolerance and impaired fasting glucose are similarly susceptible to cardiovascular disease: a study in first-degree relatives of type 2 diabetic patients.

BACKGROUND/AIMS: To compare the cardiovascular disease (CVD) risk factors between subjects with impaired fasting glucose (IFG) and those with impaired glucose tolerance (IGT) in the first-degree relatives (FDR) of type 2 diabetic patients. METHODS: A cross-sectional study, conducted between 2004 and 2006 in 1,893 (1,412 females and 481 males) FDR of type 2 diabetic outpatients of the Isfahan Endocrine and Metabolism Research Center. In all participants, blood pressure, weight, height, waist circumference, serum lipids and HbA1c were measured and a standard 75-g 2-hour oral glucose tolerance test was performed. The diagnosis of IGT, IFG and diabetes was made according to American Diabetes Association criteria. RESULTS: Isolated IGT and isolated IFG, and both IFG and IGT were observed in 8.8%, 17.4% and 11.2% of subjects, respectively. In comparison to subjects with normal glucose levels and tolerance (control group): the mean waist circumference was significantly higher in both IFG and IGT groups; BMI, HDL-c and LDL-c in the IFG group; and triglycerides in the IGT group. The means of all studied CVD risk factors were significantly higher in the IGT+IFG group than the control group, except for blood pressure, HDL-c and HbA1c. No significant differences were found regarding CVD risk factors between IFG and IGT groups. CONCLUSIONS: The prevalence of IFG and IGT is high in FDR of type 2 diabetic patients. CVD risk factors are similar in these 2 groups and higher than in the control group. More attention should be paid to screening and treatment of this high-risk population.

Permanent and transient congenital hypothyroidism in Isfahan-Iran.

OBJECTIVES: To determine the prevalence of permanent and transient congenital hypothyroidism (CH) in Isfahan, Iran. METHODS: In 256 primarily diagnosed CH patients identified through the neonatal screening programme from May 2002 to February 2005, treatment was discontinued for 4 weeks and T4 and thyroid stimulating hormone (TSH) were measured. Permanent or transient CH was determined from the results of the thyroid function tests and the radiologic findings. Patients with TSH levels >6 (mIU/l) were diagnosed with permanent CH. RESULTS: Results were available from 204 patients, of whom 122 patients were diagnosed with permanent CH (59.8%) (prevalence 1:748 births), and 82 with transient hypothyroidism (prevalence 1:1114). Permanent CH was associated with higher initial TSH levels than transient hypothyroidism (P < 0.05). The most common aetiology of CH was dyshormonogenesis. CONCLUSION: The rates of both permanent and transient CH in our study were higher than the comparable worldwide rates. The transient group had low T4 levels, suggesting that iodine contamination should be investigated. The aetiology of CH was also different from that recorded in many other studies.

Prevalence of polycystic ovary syndrome in reproductive-aged women with type 2 diabetes.

BACKGROUND: Women with polycystic ovary syndrome (PCOS) are at higher risk of type 2 diabetes and cardiovascular disease. The present study was conducted to investigate the prevalence of PCOS in type 2 diabetic patients. METHODS: Type 2 diabetic women (n = 157) of reproductive age were selected by a convenience sampling method. PCOS was confirmed using the clinical diagnosis criteria proposed in 1990 by the National Institute of Child Health and Human Development Conference of PCOS. The diabetic patients were divided into two groups according to the presence of PCOS. Baseline demographic characteristics were obtained by questionnaire, and body weight, height, waist circumference, blood pressure and some biochemical indices were measured in both groups. RESULTS: The prevalence of PCOS was high (8.3%, 95% confidence interval 4.5-13.4%) in these type 2 diabetic women. The onset of diabetes occurred at a lower age in the PCOS group, who also displayed significantly greater waist circumference and body mass index (p<0.05). No difference in lipid profile, glycosylated hemoglobin or blood pressure was observed between the two groups. CONCLUSIONS: PCOS is highly prevalent in type 2 diabetic patients. Hence, focusing the treatment on insulin sensitizers in these patients should improve both the metabolic and non-metabolic complications of PCOS.

Seasonal variation in the incidence of congenital hypothyroidism in Isfahan, Iran.

OBJECTIVE: To evaluate the seasonal variations in the incidence of congenital hypothyroidism (CH) in the screening program of CH in Isfahan, Iran. METHODS: In this study, we compiled the data obtained retrospectively from CH screening results of 113282 neonates from 17 maternity hospitals in Isfahan, Iran from June 2002 to December 2005. The seasonal variation in the incidence of CH, as well as its monthly incidence was analyzed using all the diagnosed cases of CH. RESULTS: From the 113282 neonates referred for CH screening, 358 neonates were diagnosed with CH, showing an overall incidence of 3.1/1000 live birth. There was no significant difference in the seasonal variation of CH (p=0.5). According to the monthly distribution analysis, the incidence of CH was higher in the second month of summer (Mordad) and lower in the last month of autumn (Azar)(p=0.04). CONCLUSION: The high incidence of CH in Mordad, the second month of summer, supports the hypothesis that certain environmental factors such as intrauterine viral infections (which commonly exhibit seasonal variations in incidence), exposure to chemical compounds, differences in climate and so forth, may play a role in the etiology of this disorder. Awareness of the monthly distribution of CH incidence could help us identify associated environmental factors and aid in the development of preventative strategies. Further, it would for the appropriate allocation of resources within the screening programs.

High frequency of IgM antiphospholipid antibodies in young Iranian patients with stroke.

OBJECTIVE: To investigate the presence of IgG and IgM types of anticardiolipin (aCL) and antiphospholipid (aPL) antibodies in younger Iranian patients with ischemic stroke. METHODS: Both IgG and IgM types of aPL (cardiolipin, anti phosphatidyl inositol, anti phosphatidyl serine, anti phosphatidic acid and beta 2-glycoprotein I [B2-GPI]) and aCL alone (cardiolipin and B2-GPI) were measured in 117 patients with ischemic stroke (aged <45 years) during an 18-month period from September 2002 to March 2004 in Al-Zahra Hospital, Isfahan, Iran. The demographic, clinical, and laboratory characteristics of patients with a positive titer were recorded. RESULTS: Seven men and 16 women (23 patients, 19.6%) had increased IgG types of aPL antibodies. Increased titers of IgM and IgG were found in 19 (82.6%) and 6 (26%) patients for aPL antibodies and in 15 (83.3%) and 8 (44.4%) cases for aCL alone. CONCLUSION: Despite European studies, high titers of IgM aPL antibodies found in a large number of patients can be caused by the presence of unknown triggering factors (infections or poisons), that are more prevalent in developing countries compared to developed countries. This hypothesis remains to be investigated further.

Effect of stress management training on glycemic control in patients with type 1 diabetes.

AIMS: In this study, the effect of stress management training on glycemic control has been investigated in type 1 diabetic patients. METHODS: The participants were 60 type 1 diabetic patients (aged 16-30). 30 Subjects attended in 3-month stress management training classes during which the prescribed insulin remained constant, but the remainder 30 ones did not. HbA1 from all patients were measured before and after the intervention. Besides, in order to assess the ways of coping, every patient completed a questionnaire and the scores were compared between two groups. RESULTS: Trained patients showed significantly improved ways of coping. HbA1 changed from 11.7+/-2.9 and 10.9+/-2.1 before training to 8.5+/-1.7 and 10.3+/-2.1 after intervention in trained and control groups respectively and the changes were significant in study group (P<0.001). In addition, the difference between means of HbA1 of two groups was statistically significant at the end of the study (P<0.001). CONCLUSIONS: Results show a clinically significant beneficial effect of stress management training on glycemic control among type 1 diabetic patient. It is recommended to consider this type of training as an addition to the treatment program in type 1 diabetic patient.

Cerebral vein and sinus thrombosis in Isfahan-Iran: a changing profile.

OBJECTIVES: This study was performed to investigate the clinical presentation and predisposing factors for cerebral vein and sinus thrombosis (CVST) in Isfahan, Iran. METHODS: Data from the records of all patients with CVST referred to the largest tertiary-care hospital of Isfahan during a five-year period (1997 to 2001) were extracted and reviewed. RESULTS: The number of cases with CVST diagnosed annually was 6, 9, 11, 14 and 15 patients, respectively. Thirteen men and 42 women were diagnosed to have CVST with the mean age of 35.1 +/- 3.8 and 28.7 +/- 1.3 years, respectively. Headache was the most frequent complaint (95%) and 63% of patients had focal neurological symptoms, including seizure (58%). Among possible predisposing factors, oral contraceptive pill was the most prevalent one, which was used by 38.1% of affected women for a period of as short as 1-3 months. Anticardiolipin antibodies were detected in 14% of patients. CONCLUSIONS: It seems that the annual incidence of CVST is increasing in Isfahan, perhaps due to more extensive intake of oral contraceptive pills and usage of more accurate modern diagnostic tools. The use of oral contraceptive pills was the most frequent predisposing factor; infections and postpartum factors were infrequently observed. Despite other reports from the Middle East, Behçet's disease is not a principal risk factor for CVST in Isfahani patients.

Visual acuity in an Iranian cohort of patients with type 2 diabetes: the role of nephropathy and ischemic heart disease.

BACKGROUND: The aim of this study was to investigate the risk factors of low vision in type 2 diabetic patients and the prevalence of ischemic heart diseases and nephropathy for different visual acuities. METHODS: In this cross-sectional study, data from 738 type 2 diabetic patients including evidences for nephropathy and ischemic heart disease, demographic characteristics, blood pressure and body mass index were collected, and then patients were divided into 3 groups based on their best corrected visual acuity in the better-seeing eye. Analysis of variance was used to compare basic characteristics according to different levels of visual acuity. RESULTS: The prevalence of blindness and low vision was 5.5% and 13.3% respectively, and as age, duration of diabetes, systolic blood pressure and body mass index increased, the visual acuity decreased. The prevalence of hypertension and obesity in patients with visual disabilities was significantly higher than in patients with not impaired visions (p = 0.008 and p = 0.02, respectively). We also found that with greater decline in visual acuity, the prevalence of neph-ropathy and ischemic heart diseases increased. CONCLUSIONS: The factors related to retinopathy play a role in affecting the degree of visual impairment in diabetic patients. Therefore, controlling risk factors can be useful in decreasing impairment of vision and blindness.

Relationship between gamma-glutamyl transferase and glucose intolerance in first degree relatives of type 2 diabetics patients.

BACKGROUND: Considering that serum gamma-glutamyl transferase (GGT) activity could reflect several different processes relevant to diabetes pathogenesis and the increasing rate of type 2 diabetes worldwide, the aim of this study was to assess the association between serum GGT concentrations and glucose intolerance, in the first-degree relatives (FDR) of type 2 diabetic patients. METHODS: In this descriptive study, 30-80 years old, non diabetic FDRs of type 2 diabetic patients were studied. Serum GGT was measured by enzymatic photometry method in all studied population. The relationship between GGT and glucose intolerance status (normal, prediabetic and diabetics) was evaluated. RESULTS: During this study 551 non-diabetic FDRs of type 2 diabetic patients were studied. Mean of GGT was 25.3 ± 12.1 IU/L. According to glucose tolerance test, 153 were normal and 217 and 181 were diabetic and prediabetic respectively. Mean of GGT in normal, prediabetic and diabetic patients was 23.5 ± 15.9 IU/L, 29.1 ± 28.1 IU/L and 30.9 ± 24.8 IU/L respectively (p = 0.000). The proportion of prediabetic and diabetic patients was higher in higher quartile of GGT and there was a significant correlation between GGT and BMI, HbA1c, FPG, cholesterol, LDL-C, and triglyceride (p < 0.05). There was a significant relation between GGT and area under the curve (AUC) of oral glucose tolerance test (p = 0.00). CONCLUSIONS: Measurement of GGT in FDRs of type 2 diabetic patients may be useful in assessing the risk of diabetes; those with chronically high levels of GGT should be considered as high risk group for diabetes.

Stressful life events, education, and metabolic syndrome in women: are they related? A study in first-degree relatives of type 2 diabetics.

BACKGROUND: Some reports show that the prevalence of metabolic syndrome is higher in poorly educated women. In our opinion, one probable reason for this is that these women experience more stressful events in their lives. We investigated the association between major stressful life events and the prevalence of metabolic syndrome and the effect of education on this relationship in women. METHODS: This cross-sectional study included 35- to 55-year-old women who were first-degree relatives of type 2 diabetics. They were questioned about stressful events in their lives, their physical activities, and basic characteristics. In addition waist circumference, blood pressure, fasting blood sugar, triglyceride, total and high-density lipoprotein cholesterol (HDL-C) were measured. Metabolic syndrome was defined according to Adult Treatment Panel III (ATP III) criteria, and the number of stresses was compared between two groups of participants with and without metabolic syndrome. RESULTS: Among the 351 study participants, the prevalence of metabolic syndrome was 28.9%. The mean number of stresses in the metabolic syndrome group was higher than in the nonmetabolic syndrome group at 3.82 ± 2.67 and 3.14 ± 2.35, respectively (P = 0.036). The prevalence of metabolic syndrome in subjects with eight or more stressful life events (46%) was greater compared to those who had experienced less than eight stresses (23.4%; P = 0.017). The relationship between stressful life events and the prevalence of metabolic syndrome was independent of the low level of education, but the prevalence of poorly educated women was associated with the number of stresses. CONCLUSION: Considering the probable association between stress and prevalence of metabolic syndrome, which itself increases the risk of cardiovascular diseases, educating high-risk people to cope with stresses may be beneficial in reducing the incidence of cardiovascular diseases and preventing the onset of metabolic syndrome.

High prevalence of goiter in an iodine replete area: do thyroid auto-antibodies play a role?

INTRODUCTION: Despite long standing iodine supplementation in Iran the prevalence of goiter remains high in some areas. This may suggest that causes other than iodine deficiency, such as autoimmune thyroid diseases, should also be considered. We therefore assessed the prevalence of anti-thyroid antibodies in children living in an inland area in Iran and correlated these findings with prevalence of goiter within this region. METHODS: In a cross-sectional study, 1948 students were selected by multistage random cluster sampling from the 108 primary schools (age, 7-13 year-old) of the urban and rural areas of Semirom. After obtaining written consent from their parents, the children were examined by endocrinologists for goiter grading. Grade 2 goitrous children (108 cases) were compared with non-goitrous children (111 children as control group) for anti-thyroid antibodies. RESULTS: Overall, 36.7% of 1948 students had goiter. The mean urinary iodine excretion level was 1.49+/-0.7 micromol/L. This was within normal limits. Of 219 children studied, 4.3% presented with subclinical hypothyroidism, and 7.3% had positive anti-thyroid antibodies. There was non-significant difference of positive thyroperoxidase antibody (anti-TPO) (Odds Ratio= 3.2, p= 0.13) but significant difference of anti Tg between goitrous and non goitrous children (Odds Ratio: 5.6, 95% CI: 1.18-26.0, p: 0.015). CONCLUSION: This study suggests that autoimmunity may be one of the mechanisms responsible for goiter persistence after iodine replenishment in this iodine deficient region, but the role of other factors should also be considered.

Rate of recalls in congenital hypothyroidism based upon a regional survey in Isfahan, Iran, using serum T4 and TSH analyses: comparison of two different recall methods.

AIMS: To evaluate and compare the recall rate in congenital hypothyroidism screening project in Isfahan, first using an approach involving measures of both TSH and T4 and then using TSH alone. METHODS: From June 2002 to January 2005, serum TSH and T4 level of referred neonates were measured at 3rd to 7th day of birth through venous sampling. If neonates' serum TSH was >20 mIU/l or T4 was <6.5 microg/dl by the first protocol, or TSH was >20 mIU/l by the second protocol, they were recalled. TSH and T4 were measured using an immunoradiometric assay and radioimmunoassay, respectively. Neonates with TSH > 10 and T4 < 6.5 on their second measurement were considered as congenitally hypothyroid. RESULTS: Serum T4 and TSH of 29,425 neonates by first and 57,235 neonates by second recall approach were measured. Recall rate was higher in the first protocol (2.2% vs. 0.6%, p < 0.05). Most of the recalled neonates in the first protocol were recalled for low T4 level (p < 0.05). The prevalence of CH was 1 in 350 livebirths. CONCLUSION: Although the recall rate was in the acceptable range by either approach, the TSH alone protocol seems to be a more sensitive and practical approach with the least recall burden and considering the high prevalence of CH in our region merit adaptation of widespread screening for CH using TSH measurements from heel stab blood spotted on filter paper.

Does bromocriptine improve glycemic control of obese type-2 diabetics?

BACKGROUND: Various oral hypoglycemic agents have already been administered to type-2 diabetic patients to normalize their plasma glucose concentrations but they have not had complete and sustained success. In recent years, bromocriptine has been tried with controversial results. In present study, the effect of bromocriptine on glycemic control was evaluated in obese type-2 diabetic patients. METHODS: In a double-blind placebo-controlled clinical trial, 40 obese patients with type-2 diabetes (aged 32-70 years) were randomly allocated to the two treatment groups. The first group received bromocriptine (2.5 mg daily) for a total of 3 months. The second group received placebo. They had been uncontrolled on fixed doses of glibenclamide or its combination with metformin in the 3 months before enrolling in the study. The fasting plasma glucose (FPG) level and glycosylated hemoglobin (HbA1) were measured and body mass index (BMI) was calculated before and 1, 2 and 3 months after treatment. RESULTS: The FPG level decreased in the bromocriptine-treated group from 10.59 +/- 0.42 to 9.06 +/- 0.41 mmol/l (mean +/- SEM; p < 0.01), whereas in the placebo group it was not changed, 10.69 +/- 0.52 and 10.6 +/- 0.57 mmol/l, respectively. The HbA1 concentration was reduced in the bromocriptine-treated group from 9.9 +/- 0.3 to 9.5 +/-0.2% (p = 0.06), whereas it increased in the placebo-treated group from 10.2 +/- 0.3 to 11.3 +/- 0.6% (p < 0.05). The differences in HbA1 (1.8%, p < 0.01) and FPG (1.55 mmol/l, p < 0.05) levels between the bromocriptine and placebo groups at 3 months were significant. No changes in body weight or BMI occurred during the study in either placebo- or bromocriptine-treated group. CONCLUSION: The data further support the contention that bromocriptine improves glycemic control in obese type-2 diabetic patients, although the mechanism of action remains to be determined.

Prevalence of polycystic ovary syndrome in girls aged 14-18 years in Isfahan, Iran.

OBJECTIVE: To determine the prevalence of clinical polycystic ovary syndrome (PCOS) in 14- to 18-year-old high school girls in Isfahan, Iran. METHODS: In this cross-sectional study, 1,000 high school girls (14-18 years old) were selected by multi-stage random sampling from different high schools in Isfahan. Following physical examination, a single physician recorded the presence of hirsutism, severe acne, androgenic alopecia, menstrual dysfunction and obesity using a validated questionnaire. Clinical PCOS was diagnosed if menstrual dysfunction and clinical hyperandrogenism were detected. RESULTS: Clinical PCOS was present in 30 (3%), hirsutism in 60 (6%), menstrual dysfunction in 74 (7.4%) and severe acne in 47 (4.7%) of the population studied. CONCLUSION: The prevalence of clinical PCOS in our study population was similar to those of other studies; however, the prevalence could have been higher with hormonal assessment.

Prevalence of congenital hypothyroidism in Isfahan, Iran: results of a survey on 20,000 neonates.

AIMS: To evaluate the prevalence of congenital hypothyroidism (CH) in a screening program performed for the first time in Isfahan, Iran. METHODS: From May 2002 to December 2002, T4 and TSH serum concentrations of 20,000 3- to 7-day-old newborns, born in all 17 hospitals of the city, were measured by radioimmunoassay and immunoradiometric assay, respectively. The newborns with abnormal screening results (TSH >20 mIU/l, T4 <6.5 microg/dl and based on the weight) were re-examined. RESULTS: Of 531 recalled subjects (recall rate 2.6%), 54 were confirmed to be hypothyroid, showing a prevalence of 1:370 for CH. CONCLUSION: Considering the high frequency of CH, the necessity of implementing a routine screening program in the healthcare system of Isfahan Province is emphasized.