The product of triglycerides and glucose in comparison with fasting plasma glucose did not improve diabetes prediction

AIMS

Previous study has reported that triglycerides-glucose (TyG) index, a product of triglycerides and fasting plasma glucose (FPG), might be useful in the prediction of incident type 2 diabetes (T2D). We evaluated the ability of the TyG index compared to FPG and OGTT as possible diabetes predictor in nondiabetic first-degree relatives (FDRs) of patients with T2D.

METHODS

A total of 1,488 FDRs without diabetes of consecutive patients with T2D 30-70 years old (361 men and 1,127 women) were examined and followed for a mean (SD) of 6.9 (1.7) years for diabetes incidence. We examined the incidence of diabetes across quartiles of the TyG index and plotted a receiver operating characteristic (ROC) curve to assess discrimination. At baseline and through follow-up, participants underwent a standard 75-g two-hour oral glucose tolerance test.

RESULTS

During 10,124 person-years of follow-up, 41 men and 154 women developed T2D. Those in the top quartile of TyG index were 3.4 times more likely to develop T2D than those in the bottom quartile (odds ratio 3.36; 95 % CI 1.83, 6.19). On ROC curve analysis, a higher area under the ROC was found for FPG (76.2; 95 % CI 71.9, 80.6), 1-hPG (81.0, 95 % CI 77.2, 84.9) and 2-hPG (76.5; 95 % CI 72.3, 80.8) than for TyG index (65.1; 95 % CI 60.5, 69.7).

CONCLUSIONS

TyG index is predicted T2D in high-risk individuals in Iran but FPG, 1-hPG and 2-hPG appeared to be more robust predictor of T2D in our study population.

Progression from optimal blood glucose and pre-diabetes to type 2 diabetes in a high risk population with or without hypertension in Isfahan, Iran

AIM

To estimate the progression rates from normal glucose tolerance (NGT), isolated impaired glucose tolerance (IGT), isolated impaired fasting glucose (IFG) and combined IFG/IGT to type 2 diabetes (T2D) in a high risk population with and without hypertension (HTN) in Isfahan, Iran.

METHODS

During a mean (SD) follow-up period of 6.8 (1.7) years, 1489 non-diabetic first-degree relatives of patients with T2D with or without HTN were followed for the occurrence of T2D. At baseline and through follow-ups, participants underwent a standard 75g 2-h oral glucose tolerance test. Blood pressure was measured by standardised protocols and HTN was defined according to the criteria of the JNC7.

RESULTS

The progression rate (95% confidence interval) from NGT, isolated IFG, isolated IGT, and combined IFG/IGT to T2D was 10.0 (4.3, 19.6), 21.7 (9.5, 42.3), 28.2 (12.3, 54.7) and 64.7 (41.0, 96.4) per 1000 person-years in participants with HTN and 3.1 (1.5, 4.7), 16.3 (10.3, 24.2), 25.9 (17.0, 37.7) and 57.9 (46.1, 71.7) per 1000 person-years in participants without HTN based on 10,134 person-years of follow-up. Compared with individuals with NGT and without HTN, individuals with NGT and HTN, isolated IFG, isolated IGT, and combined IFG/IGT with or without HTN at baseline were more likely to progress to T2D. Compared with participants without HTN, individuals with concomitant HTN were not significantly more likely to progress to T2D.

CONCLUSIONS

Compared with individuals without HTN, the presence of NGT, isolated IFG, isolated IGT, and combined IFG/IGT with concomitant HTN was not associated with higher likelihood of progression to T2D in high-risk individuals in Iran.

Impacts of insulin infusion protocol on blood glucose level and outcomes in acute coronary syndrome patients with diabetes mellitus

BACKGROUND

Acute coronary syndrome is the most common disease in the world. Several studies suggest that hyperglycemia is associated with poor clinical outcomes in patients with coronary artery disease. The aim of this study was to investigate the impact of insulin infusion protocol and conventional therapy on the blood glucose level and outcomes in acute coronary syndrome patients with diabetes mellitus.

MATERIALS AND METHODS

We studied 64 patients (32 in each group) with acute coronary syndrome and acute myocardial infarction, who were admitted to the coronary care unit in a hospital in Isfahan, Iran in 2012. Inclusion criterion was blood sugar (BS) of more than 180 mg/dl on admission. Patients in the intervention group received insulin with East Jefferson insulin infusion protocol for at least 4 h, and in the control group, the subjects received subcutaneous insulin (conventional therapy) for at least for 48 h. Independent t-test, Student's t-test, and Chi-square test were used to analyze the data.

RESULTS

Groups were matched for baseline characteristics. Blood glucose was significantly reduced in the two groups (P < 0.001), and the mean blood glucose level in the interaction group was significantly less than in the control group (P = 0.0002). Hypoglycemia was 31.2% and 25% in the intervention and control groups, respectively. The frequency of hypoglycemia did not differ significantly between the two groups (P = 0.75). Time to reach target insulin level differed between the two groups (4.75 h in the intervention group and 36.93 h in the control group; P < 0.001).

CONCLUSIONS

Our research showed that use of insulin infusion protocol is better in maintaining glycemia control compared to subcutaneous sliding scale method. The protocol allows nurses to commence and maintain the infusion more effectively and safely compared to the traditional method.

Low-density lipoprotein cholesterol and metabolic syndrome in an Iranian high-risk population

AIM

Currently, one study support the hypothesis that low-density lipoprotein cholesterol (LDLC) is associated with metabolic syndrome (MetS) independent of pre-existing components of MetS. In this study we further evaluated the ability of the LDLC to predict prevalence and incidence of MetS in an Iranian high-risk population.

MATERIALS AND METHODS

We analyzed baseline (n=3396) and 7-year follow-up data (n=865) in first-degree relatives (FDR) of consecutive patients with type 2 diabetes 30-70 years old. We used logistic regression to estimate the odds ratio (OR) for prevalent MetS, and Cox proportional hazard models to estimate hazard ratio (HR) for incident MetS across quartiles of LDLC and plotted a receiver operating characteristic (ROC) curve to assess discrimination.

RESULTS

The highest quartile of LDLC compared with the lowest quartile was associated with MetS in both the prevalent (OR 1.39, 95% CI 1.13, 1.70) and incident in unadjusted models (HR 1.24, 95% CI 1.03, 1.49). Adjusted for age, gender and pre-existing components of MetS attenuated association for both prevalent (OR 1.15, 95% CI 0.83, 1.59) and incident MetS (HR 1.13, 95% CI 0.93, 1.38). The area under the ROC was 52.8% (95% CI 50.7, 55.0) for prevalent and 51.8% (95% CI 47.2, 56.3) for incident MetS.

CONCLUSION

The results of this study highlight that LDLC level is not a robust predictor of MetS, independent of age, gender or the pre-existing components of MetS, in high-risk individuals in Iran.

Iranian risk model as a predictive tool for retinopathy in patients with type 2 diabetes

OBJECTIVE

Diabetic retinopathy (DR) is the leading cause of blindness in patients with type 1 or type 2 diabetes. The gold standard for the detection of DR requires expensive equipment. This study was undertaken to develop a simple and practical scoring system to predict the probability of DR.

METHODS

A total of 1782 patients who had first-degree relatives with type II diabetes were selected. Eye examinations were performed by an expert ophthalmologist. Biochemical and anthropometric predictors of DR were measured. Logistic regression was used to develop a statistical model that can be used to predict DR. Goodness of fit was examined using the Hosmer-Lemeshow test and the area under the receiver operating characteristic (ROC) curve.

RESULTS

The risk model demonstrated good calibration and discrimination (ROC area=0.76) in the validation sample. Factors associated with DR in our model were duration of diabetes (odds ratio [OR]=2.14, confidence interval [CI] 95%=1.87 to 2.45); glycated hemoglobin (A1C) (OR=1.21, CI 95%=1.13 to 1.30); fasting plasma glucose (OR=1.83, CI 95%=1.28 to 2.62); systolic blood pressure (OR=1.01, CI 95%= 1.00 to 1.02); and proteinuria (OR=1.37, CI 95%=1.01 to 1.85). The only factor that had a protective effect against DR were body mass index and education level (OR=0.95, CI 95%=0.92 to 0.98).

CONCLUSIONS

The good performance of our risk model suggests that it may be a useful risk-prediction tool for DR. It consisted of the positive predictors like A1C, diabetes duration, sex (male), fasting plasma glucose, systolic blood pressure and proteinuria, as well as negative risk factors like body mass index and education level.

Adherence to statin therapy in patients with type 2 diabetes: An important dilemma

BACKGROUND

Despite the importance of patients' adherence to their drug treatments for achieving desired therapeutic goals and the proven role 3-hydroxy-3-methylglutaryl coenzyme A inhibitors (statins) for the health status of patients with cardiovascular diseases, there is not enough information regarding diabetic patients' adherence to statin therapy in developing countries. In this clinical study we aimed to assess the adherence of diabetes type 2 patients to statin therapy in a research based community clinic in Iran.

MATERIALS AND METHODS

In this prospective clinical study which was done at Isfahan Endocrinology and Metabolism Research Center, 204 diabetic type 2 patients under treatment with statin were interviewed twice and their demographic data (age, gender, body mass index, education), statin information (type, dose) and their serum lipid profile were recorded. Three months after the initial visits, patients were assessed using pill counting method and according to patients' self-reporting and also assessed low-density lipoprotein (LDL) cholesterol goal attainment <100 mg/dl.

RESULTS

Adherence rate was 79.7% and 69% according to pill counting and self-reporting among study population. Moreover, 68.4% of patients achieved their LDL cholesterol goal of <100 mg/dl and adherent patients reached therapeutic goal significantly more than those who were considered non-adherence to statin therapy (P < 0.01).

CONCLUSION

Adherence to statin therapy, as reflected by pill count method, is significantly related to LDL cholesterol goal achievement in patients with diabetes and dyslipidemia. Pill count method can be used to identify patients who are nonadherent to statin therapy and at high risk for failure to attain LDL cholesterol goals.

Enhanced Cellular Cytotoxicity and Antibacterial Activity of 18-β-Glycyrrhetinic Acid by Albumin-conjugated PLGA Nanoparticles

The aim of the present work was to encapsulate 18-β-Glycyrrhetinic acid (GLA) in albumin conjugated poly(lactide-co-glycolide) (PLGA) nanoparticles by a modified nanoprecipitation method. Nanoparticles (NPs) were prepared by different drug to polymer ratios, human serum albumin (HSA) content, dithiothreitol (as producer of free thiol groups) content, and acetone (as non-solvent in nanoprecipitation). NPs with a size ranging from 126 to 174 nm were achieved. The highest entrapment efficiency (89.4±4.2%) was achieved when the ratio of drug to polymer was 1:4. The zeta potential of NPs was fairly negative (-8 to -12). Fourier transform infrared spectroscopy and differential scanning calorimetry proved the conjugation of HSA to PLGA NPs. In vitro release profile of NPs showed 2 phases: an initial burst for 4 h (34-49%) followed by a slow release pattern up to the end. The antibacterial effects of NPs against Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa were studied by microdilution method. The GLA-loaded NPs showed more antibacterial effect than pure GLA (2-4 times). The anticancer MTT test revealed that GLA-loaded NPs were approximately 9 times more effective than pure GLA in Hep G2 cells.

Effect of metformin on thyroid stimulating hormone and thyroid volume in patients with prediabetes: A randomized placebo-controlled clinical trial

BACKGROUND

The people with prediabetes have insulin resistance (IR). IR may affect thyroid function, size and nodules. We investigated the effects of metformin on the thyroid gland in prediabetic people.

MATERIALS AND METHODS

In a randomized, double-blind placebo-control clinical trial, 89 people with prediabetes, aged 18-65 years were studied for 3 months. They were divided into two, metformin (n = 43) and placebo (n = 46) treated groups. Serum thyroid stimulating hormone (TSH) was measured and thyroid nodules and volume was studied by ultrasonography. The data were compared between and within groups, before and after the study.

RESULTS

Mean of the baseline characteristics in metformin and placebo-treated groups had no statistically significant difference. At the end of the study, serum TSH was not significantly different between the two groups. However, if the TSH range was divided into two low normal (0.3-2.5 μU/ml) and high-normal (2.6-5.5 μU/ml) ranges, significant decrease was observed in metformin-treated group with a high-normal basal serum TSH (P = 0.01). Thyroid volume did not change in metformin-treated group. However, in placebo-treated group, the thyroid was enlarged (P = 0.03). In 53.9% of participants, thyroid nodule was observed. There was just a decrease in the volume of small solid (not mixed) nodules from median of 0.07 ml to 0.04 ml in metformin-treated group (P = 0.01).

CONCLUSION

In prediabetic people, metformin decreases serum TSH, only, in those people with TSH >2.5 μU/ml and reduces the size of small solid thyroid nodules. It also prevents an increase in the thyroid volume.

Vitamin C may have similar beneficial effects to Gemfibrozil on serum high-density lipoprotein-cholesterol in type 2 diabetic patients

Objective:

Type 2 diabetes mellitus (DM-T2) is commonly associated with increased triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) and low high-density lipoprotein cholesterol (HDL-C) levels. Fibrates like gemfibrozil are frequently used in diabetic patients to decrease TG and increase HDL-C levels. We compared the efficacy of Vitamin C, an antioxidant vitamin, with gemfibrozil on serum HDL-C in diabetic patients.

Methods:

Type 2 diabetic patients, referred to our out-patient clinic were randomly divided into three groups. After 1 month of lifestyle and diet modifications, groups A, B, and C were prescribed 1000 mg Vitamin C, 600 mg gemfibrozil and combination of both, respectively. Before the study initiation and after 6^th week of drug prescription, the blood samples were taken and analyzed for total cholesterol (Total-C), HDL-C, TG, fasting blood sugar (FBS), and hemoglobin A1c (HbA1c) levels.

Findings:

Sixty-seven patients entered, and 50 patients (18 male, 32 female) finished the study. Overall, serum HDL-C increased significantly from 39.8 to 45.2 mg/dL in the participants (P = 0.001). HDL-C increased 6.3, 4.4 and 5.0 mg/dL in groups A, B and C, respectively (related significances were 0.017, 0.022 and 0.033, respectively). Significant decrease of serum TG and Total-C occurred in gemfibrozil and combination groups, but not in Vitamin C group. Changes in serum HDL-C between three groups were not significant (P = 0.963). We found a significant decrease in TG and Total-C in the groups B and C (P < 0.05), but no significant changes of TG, Total-C, LDL-C, FBS and HbA1c in group A (P > 0.05).

Conclusion:

The results demonstrated that Vitamin C may have beneficial effects on HDL-C in diabetic patients without significant effects on plasma glucose or other lipid parameters; however, its role for the treatment of low HDL-C patients should be evaluated in larger studies.

Evaluation of peripheral arterial disease in prediabetes

BACKGROUND

The prevalence of prediabetes in the world continues to increase. These patients have elevated the risk of atherosclerosis. The current study was designed to assess the prevalence of peripheral arterial disease (PAD) and its related risk factors in prediabetes patients.

METHODS

This was the case-control study in which 135 adults in three groups: Diabetes, prediabetes, and normal were studied. We evaluated the prevalence of PAD through the measurement of ankle-brachial index (ABI). All the patients were interviewed about demographic and medical data, including age, sex, disease duration, body mass index, hypertension (HTN), fasting blood glucose, hemoglobin A1C (HbA1C), lipid profile, and medication use.

RESULTS

The prevalence of PAD in diabetes patients was higher than the normal group (8.5%vs. 0.0%) (P < 0.05), but the differences between prediabetes compared with diabetes and normal group were not significant. The mean level of ABI in normal, prediabetes, and diabetes group was (1.11 ± 0.11), (1.09 ± 0.12), and (1.05 ± 0.03) respectively (P < 0.1). There were marginally significant differences of ABI observed between the normal group and the diabetes group. The observed differences between groups in the ABI were significant after adjusting the effects of age and sex (P < 0.05). There was an association observed between ABI and HbA1C in diabetes patients (r = 0.249, P < 0.01) and a significant association seen between PAD and HTN in the prediabetes group (P < 0.01).

CONCLUSIONS

Peripheral arterial disease is common in asymptomatic diabetes and prediabetes patients. Management of hypertensive prediabetes patients and early detection of PAD in this group as well as in asymptomatic patients is important.

Retinopathy risk factors in type II diabetic patients using factor analysis and discriminant analysis

INTRODUCTION

Diabetes is one of the most common chronic diseases in the world. Incidence and prevalence of diabetes are increasing in developing countries as well as in Iran. Retinopathy is the most common chronic disorder in diabetic patients.

MATERIALS AND METHODS

In this study, we used the information of diabetic patients' reports that refer to endocrine and metabolism research center of Isfahan University of Medical Sciences to determine diabetic retinopathy risk factors. We used factor analysis to extract retinopathy's factors. Factor analysis is using to analyze multivariate data, in which a large number of dependent variables summarize into the fewer independent factors. Factor analysis is applied, in both diabetic and nondiabetic patients, separately. To investigate the efficacy of factor analysis, we used discriminant analysis.

RESULTS

We investigated 3535 diabetic patients whose prevalence of retinopathy was 53.4%. Six factors were extracted in each group (i.e. diabetic and nondiabetic groups). These six factors were explained 69.5% and 69.6% of total variance in diabetic and nondiabetic groups, respectively. Using original variables such as sex, weight, blood sugar control method, and some laboratory variables, the correct classification rate of discriminant analysis was identified as 67.4%. However, it decreased to 49.5% by using extracted factors.

DISCUSSION

Retinopathy is one of the important disorders in diabetic patients that involves a large number of variables and can affect its incidence. By the method of factor analysis, we summarize diabetic retinopathy risk factors. Factor analysis is applied separately, in two diabetic and nondiabetic group. In this way, 10 variables were summarized into the six factors. Discriminant analysis was used to investigate the efficacy of factor analysis.

CONCLUSION

Although factor analysis is a powerful way to reduce the number of variables, in this study did not worked very well.

Evaluating the efficacy of Salsalate on prediabetic and diabetic patients with fatty liver: A randomized clinical trial

Objective:

Nearly two-third of the patients with type 2 diabetes have degrees of fatty liver; this may induce some side effects in them. This study aimed to find effect of salsalate on treatment of steatohepatitis and correlation of fatty liver with metabolic syndrome in the setting of impaired glucose metabolism.

Methods:

In a double-blind randomized trial within two distinct groups, i.e., recently diagnosed diabetics and prediabetic cases allocated in two arms of the intervention to receive 3 g salsalate or placebo. All cases underwent glucose and lipid level studies and liver ultrasound study.

Findings:

Out of 46 patients with diabetes, 34 (74%) had fatty liver in ultrasound; this ratio was 75% in 113 prediabetic cases. Relative frequency of fatty liver stages did not differ between diabetics and prediabetics. Within diabetics, mean aspartate aminotransferase (AST) level of fatty liver cases (23 ± 7 IU/dl) was higher than others (18 ± 3 IU/dl) (P < 0.05). Changes in transaminase levels following intervention did not significantly differ, comparing drug and placebo arms in two subgroups.

Conclusion:

According to the findings, if diabetes could be assumed as the logical consequence of prediabetic state, it seems that fatty liver did develop before this preliminary status. In this study, salsalate could not change biochemical markers of fatty liver significantly.

Reform in medical and health sciences educational system: a Delphi study of faculty members' views at Shiraz University of Medical Sciences

Despite the strengths in the Iranian medical and health sciences educational system, areas in need of improvement have been noted. The purpose of this study was to understand the views of faculty members at Shiraz University of Medical Sciences about current and future needs for medical and health sciences education, with the goal of improving the quality of the educational system. The data were collected using a Delphi consensus method. Analysis of the findings identified the following key themes among the factors likely to contribute to medical and health sciences education and training: adding and/or increasing student numbers in higher degrees in preference to associate degrees; providing more interactive, student-centred teaching methods; improving the educational content with more practical and research-based courses tailored to society's needs; and an emphasis on outcome-based student evaluation techniques. These changes aim to respond to health trends in society and enhance the close relationship between medical education and the needs of the Iranian society.