GABRIC Diabetes School: an innovative education centre for people with diabetes

Diabetes prevalence and deaths attributable to diabetes continue to rise across globally. Diabetes Self-Management Education and Support [DSME/S] is a critical resource designed to help people with diabetes [PWD] successfully selfmanage their disease; however, its utilization is too low. In the Islamic Republic of Iran, there are currently limited structured educational programmes and no national standards for DSME/S protocol. In response to this, the GABRIC Diabetes Education Association [GDEA] has been developed as a school for diabetics, which has a comprehensive DSME/S programme for PWD with 18 distinct courses on 5 levels for 8 target groups. In addition, GABRIC has developed a database registry with more than 100 000 members throughout the country, of whom 95% are diabetic with a proportion of 82% Type 2 diabetes and 13% Type 1 diabetes. The success of the GABRIC school model results is yet to be investigated through study trials, and offers a fruitful line of research

Body composition in healthy obese/overweight and normal weight subjects compared to patients with metabolic syndrome

Background: According to previous studies, patient with metabolic syndrome [MetS] are different in terms of body composition from healthy subjects. The purpose of the present study was to determine the body composition of healthy obese/overweight patients and compared them with those having MetS

Methods: A case-control study was conducted on both men and women aged 20 to 55 years, who were selected using sequential sampling method, based on the inclusion and exclusion criteria, from those referred to an endocrinology and the diabetes clinic affiliated to Tehran University of Medical Sciences. One hundred and forty seven subjects were enrolled in the study and divided into three groups, including 49 with MetS, 49 obese/overweight subjects without MetS, and 49 were normal weight subjects. Body composition was measured for all subjects using bioelectrical impedance analysis. NCEP ATP III was the criterion for definition of Mets

Results: No significant differences were found between the study groups in terms of demographic variables. The mean of the waist circumference [WC] was higher in MetS patients [P < 0.05] as compared with the control groups. Obese/overweight group had higher percentage of body fat and lower fat free mass than normal weight group [P < 0.05]

Conclusion: Obese/overweight patients with and without MetS had significantly higher fat mass and WC than normal weight controls, while only WC was higher in MetS group as compared with obese/overweight patients without MetS. Therefore, reduction in body fat and WC should be emphasized in patients with MetS

Association of Vaspin with Metabolic Syndrome: The Pivotal Role of Insulin Resistance

BACKGROUND: Previous studies evaluating the relationship between serum vaspin concentrations and metabolic syndrome (MetS) have yielded contrasting results. Additionally, contribution of general and abdominal obesity, chronic inflammation, and insulin resistance to this relationship remains unknown. METHODS: In a cross-sectional setting, we investigated the association between vaspin and MetS in 145 subjects ranging from normoglycemia to type 2 diabetes. Vaspin concentrations were measured using enzyme-linked immunosorbent assay. RESULTS: Women had 29% higher vaspin concentrations compared with men. Subjects with MetS (51% of all participants) had higher vaspin concentrations (P=0.019 in women and P<0.001 in men). In logistic regression, vaspin significantly predicted raised fasting plasma glucose (P<0.001), and raised triglycerides (P<0.001) after controlling for age in both sexes. Moreover, vaspin was the significant predictor for reduced high-density lipoprotein cholesterol and raised waist circumference in women and men, respectively. Considering MetS as a whole, vaspin predicted MetS even after adjustment for age, medications, diabetes, total cholesterol, and waist circumference in both sexes (odds ratio [OR], 3.88; 95% confidence interval [CI], 1.36 to 11.05; P=0.011 for women; OR, 3.16; 95% CI, 1.28 to 7.78; P=0.012 for men). However, this relationship rendered nonsignificant after introducing homeostasis model assessment of insulin resistance (HOMA-IR) in women (P=0.089) and high-sensitivity C-reactive protein (P=0.073) or HOMA-IR in men (P=0.095). CONCLUSION: Vaspin is associated with some but not all components of MetS. Vaspin is a predictor of MetS as a single entity, independent of obesity. This relationship is largely ascribed to the effects of insulin resistance and chronic inflammation.

Response: Association of Vaspin with Metabolic Syndrome: The Pivotal Role of Insulin Resistance (Diabetes Metab J 2014;38:143-9)

No abstract available.

[Correlation between parathormone and coronary artery calcium scoring and coronary artery disease]

It has been shown that coronary artery calcium scoring [CACS] can be used as a diagnostic method in coronary artery disease [CAD]. The relationship between CACS and calcium metabolism in the body has been shown. The arterial calcification is an organized process similar to bone formation which is controled by parathormone [PTH]. The relationship between PTH as an osteoregulatory factor and CACS has been also indicated. In this study, we tried to assess the value of serum PTH and CACS in patients planned to undergo coronary angiography [CAG] in order to find a simple, cost-benefit, noninvasive way, for ruling in/out obstructive CAD. In a cross sectional study in Imam Khomeini hospital in 1390, CACS by using non-enhanced multi detector computed tomography [MDCT] and measurement of serum level of PTH, Calcium and Phosphate were done in 178 patients suspected to CAD which were scheduled to undergo coronary angiography serum PTH was measured by immuno-radiometric assay [IRMA] and serum Ca and Phosphate were measured by spectrophotometry methods. Of 178 Patients, 50 patients were females and 126 patients were male. Mean age of them was 56.2 +/- 11.6. The correlation coefficient between CACS and Gensini score [0.507, P<0.001], PTH [0.037, P=0.693], Ca [0.062, P=0.499] and Phosphate [0.061, P=0.506] were obtained. The level of serum PTH in the patients with and without coronary artery disease were 21.8 +/- 11.6 pg/dl, 23.2 +/- 11.5 pg/dl [P=0.427] respectively. Our study showed association between CACS and CAD that was statistically significant while no relationship was found between PTH, CACS and CAD.

[Relationship between advanced glycation end-products with the severity of chronic heart failure in 85 patients]

Advanced glycation end-products [AGEs] came up with the recent researches regarding new biomarkers for the diagnosis of heart failure. AGEs are the end products of non-enzymatic glycation and oxidation of proteins, lipids and nucleotides during Maillard biochemical reaction. Although it has been known that AGEs have a role in the pathogenesis of chronic heart failure [CHF], information regarding its role and its pathogenetic mechanism is very limited. The aim of this study was to find any relationship between AGEs with the etiology and severity of chronic heart failure. This study is a prospective cross sectional study that enrolled 85 patients with chronic heart failure. Measurement of left ventricle ejection fraction [LVEF] was done by echocardiography. Blood samples were collected for measuring AGEs just before or after echocardiography assessment [in the same session]. Measurement of AGEs was done by the enzyme-linked immunosorbent assay [ELISA] method. The relationship between AGEs with the severity of CHF and as well as the etiology of CHF were evaluated via SPSS-15. Of 85 patients 48 [56.5%] patients were male and 37 [43.5%] were female; Mean +/- SD of their ages was 55.8 +/- 13.4 years old [ranges from 27 to 84 years]. Correlation coefficient between LVEF and AGEs was 0.269 [P = 0.013]. Mean of AGEs in patients with and without ischemic etiology of their heart failure were 16.8 +/- 9.8 microg/ml and 11.6 +/- 7.3 microg/ml, respectively. Although trend was in favor of ischemic heart failure, the difference between two groups was not statistically significant [P = 0.141]. According to this study the rate of AGES could be helpful in the diagnosis and assessment of severity of CHF. Based on our findings, higher blood levels of AGEs in the ischemic CHF cases, also it could be concluded that in the future this marker may be used for etiologic differentiation of heart failure syndrome

effects of liver dysfunction on serum lipoprotein levels in patients with cirrhosis and chronic hepatitis

The liver plays a main role in the production and metabolism of lipoproteins, and then impaired lipid metabolism is often seen in patients with liver cirrhosis and chronic hepatitis [CH]. As a result, plasma lipid levels could be as useful indicators of liver function and patient's prognosis especially in liver cirrhosis. We measured the lipoprotein levels in 77 consecutive patients with liver cirrhosis and CH. 47 men [61%] and 30 women [39%] with mean age 43years [SD=16.4] and mean BMI 26[SD=4.2] have been recruited as patients group. Child score and MELD scale was determined in patients group. The control group was age and sex matched with patients group. In case group, the levels of HDL LDL, TG, and total cholesterol were significantly lower than control group [p <0.0001]. In patients with cirrhosis, the levels of LDL, HDL and total cholesterol were progressively lower when comparing patients in Child class A with patients in class C [p<0.0001].This difference was more significant in LDL and total cholesterol and between upper Child scores similarly decreasing in LDL, HDL, and total cholesterol level was observed when MELD score increased [P<0.0001]. There is a correlation between plasma lipid levels and liver function, so it may be mentioned as an accessible and reliable indicator of liver function in cirrhotic and CH patients