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

Diabetes mellitus: findings from 20 years of the Tehran lipid and glucose study

Context: we summarized findings from Tehran lipid and glucose study [TLGS] about different aspects of type 2 diabetes [T2D] over the span of nearly 2 decades

Evidence Acquisition: a review was undertaken to retrieve papers related to all aspects of T2D from the earliest date available up to January 30, 2018

Results: an annual crude incidence rate of 10 per 1000 person-years of follow-up was found for T2D in adult participants. Overall incidence rate of pre-diabetes/T2D was 36.3 per 1000 person-years or about 1% each year among youth. Diabetes was associated with increased risk of CVD[hazard ratio [HR]: 1.86, 95% confidence interval [95% CI]: 1.57 - 2.27] and mortality [HR: 2.56; 95% CI: 2.08 - 3.16] in the total population. Compared with non-diabetic men and women, their diabetic counterparts survived 1.4 and 0.7 years shorter, respectively, during 15 years of follow-up. Wrist circumference, hyperinsulinaemia, 25-hydroxy vitamin D and increase in alanin aminotranferase provided incremental prognostic information beyond the traditional risk factors for incident T2D in adults. Using decision tree algorithms, a number of high risk groups were found for incident T2D. A probability of 84% was found for incidence of T2D among a group of men with fasting plasma glucose [FPG] > 5.3 mmol/L and waist to height ratio [WHtR] > 0.56, and women with FPG > 5.2 mmol/L and WHtR > 0.56

Conclusions: original TLGS studies have contributed greatly to clarify important evidence regarding the epidemiology and risk factors for T2D among Iranian population

Metabolic syndrome in normal-weight Iranian adults

This study provides the first reported estimates of the prevalence of the metabolic syndrome in a normal-weight Iranian population. In this population-based cross-sectional study, the study population consisted of a representative sample of 1 737 males and 1 707 females aged >/= 20 years with normal body mass index [BMI] [18.5-24.9 kg/m [2] for both genders]. The metabolic syndrome was defined according to the Adult Treatment Panel III guidelines. We present means and proportions, and multivariate odds ratios that quantify the association between metabolic syndrome and normal BMI quartiles, controlling for age, physical activity, smoking and education. The overall prevalence of the metabolic syndrome in normal-weight men and women were 9.9% and 11.0% [P=0.2] respectively. Men had a lower BMI than women, while their waist circumference [WC] was higher. The prevalence of high WC and low high-density lipoprotein cholesterol [HDL-C] was higher in women, while high blood pressure, high triglyceride levels and having at least one metabolic risk factor were more prevalent in men. Individuals in the highest category of normal BMI had significantly higher odds for being at risk for metabolic syndrome compared to those in the first category [OR: 5.21 for men and 2.15 for women]. There was an increasing trend in odds for having all the metabolic syndrome components except for high fasting blood sugar [FBS] and high WC in men. Women showed a similar increasing trend except for high FBS across normal BMI quartiles. The prevalence of the metabolic syndrome in normal-weight Iranian adults is relatively high. Therefore, interventions for prevention of cardiovascular disease could be considered in this population

[Association of liver enzymes with incident type 2 diabetes: Tehran lipid and glucose study]

Non- alcoholic fatty liver disease [NAFLD] is a pathogenic factor of insulin resistance and type 2 diabetes. On the other hand, the circulating liver enzymes including Aspartate aminotransferase [AST], Alanin aminotranferase [ALT] and Gamma glutamyl transferase [GGT] are commonly elevated in asymptomatic patients with NAFLD. As a nested case-control study, AST, ALT, GGT as well as classic diabetes risk factors, homeostatic model assessment of insulin resistance[HOMA- IR] and C-reactive protein [CRP] were measured in 133 non-diabetic subjects at baseline [68 cases and 65 controls]. Conditional logistic regression was used to calculate the odds ratio [OR] of diabetes associated with different hepatic markers. We used factor analysis for clustering of classic diabetes risk factors. In Univariate analysis, both ALT and GGT were associated with diabetes with ORs of 3.07 [1.21-7.79] and 2.91 [1.29-6.53], respectively. After adjustment for CRP and insulin, ALT and GGT were still predictive of incident diabetes. When the model was further adjusted for anthropometric, blood pressure and metabolic factors resulted from factor analysis [full model], only ALT was independently associated with diabetes [OR=3.06 [1.01-9.26]]. No difference was found between the area under the receiver operating characteristic curves of the models with and without ALT [0.820 and 0.802 respectively, P=0.4]. ALT is associated with incident type 2 diabetes independent of classic risk factors. However, its addition to the classic risk factors does not improve the prediction of diabetes

[Seasonal variation of serum lipids in adults: Tehran lipid and glucose study]

a variety of studies have noted seasonal variation in blood lipid levels, yet the mechanism for this phenomenon has not been clear. This leads to significant difference in prevalence of lipid disorders in different seasons. A cross sectional study conducted on 6894 individuals [2890 men and 4004 women] aged 20-64 years who participated in the 1st phase of Tehran Lipid and Glucose study from March 1999 to September 2001. The mean level of plasma lipid values was compared between seasons by ANCOVA after adjustment for age, physical activity, smoking, BMI and waist-to-hip ratio. The sex specific prevalence of lipid disorders in summer and winter was calculated. 58% of participants were women. The mean age of men and women was 38.3 +/- 11.3 and 39.4 +/- 11.6 respectively [P=0.13]. There was a significant seasonal variation in serum total cholesterol, LDL-C and HDL-C in men [P<0.05] with a peak in winter and a trough in summer [P<0.05]. In women, only triglyceride levels showed significant seasonal variation characterized by increase in summer and decrease in winter [P<0.05]. In men, there was 26.2% increase in prevalence of hypercholesterolemia [>240 mg/dl] in winter compared to summer [P<0.05]. The corresponding increase in level of high risk LDL-C [>/= 160 mg/dl] was 26.7% and 24.9% in men and women respectively [P<0.05]. There was 23.8% decrease in the prevalence of hypertriglyceridemia [>200 mg/dl] in winter compared to summer in women [P<0.001]. This study confirms seasonal variation in blood lipid levels and suggests greater amplitude in seasonal variability in men than women. On the other hand, the increase in the prevalence of high risk LDL-C in both genders in winter should be considered in patients screening and follow-up strategies

Anthropometric parameters as helpful factors for prediction of type 2 diabetes onset, Tehran lipid and glucose study

The aim of this study was to determine the best Anthropometric indices for prediction of the risk of type 2 Diabetes in lower and higher 60 years old population in Tehran. As a prospective study among 4479 non-diabetic men and women over 20 years from the participants of Tehran Lipid and Glucose Study [TLGS] who had complete data of blood pressure, plasma glucose in the fasting state and 2 hours after ingestion of 75 g glucose [2-hPG] as well as fasting serum lipids, anthropometric measurement including body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHR] and demographic data at baseline and were followed for a mean duration of 3.6 years. Subjects reevaluated for measurement of fasting Glucose and 2-hPG at follow-up. Diabetes and its associated risk factors were defined according to the ADA criteria. Different measurements of general and central obesity were defined based on the WHO criteria. Logistic regression analysis with stepwise conditional method was used to estimate the Odds Ratio [OR] with 95% CI. A total of 166 new cases of type 2 diabetes [3.7%] were diagnosed during 3.6 years of follow-up, with an approximately one percent per year incidence rate [men=3.7% and women =3.7%, P= 0.95]. Diabetic subjects of follow-up were significantly more obese than nondiabetics considering their BMI, WC and WHR. In subjects aged< 60 years high WC was a predictor of diabetes only in model 1 and 2, while general obesity and high WHR predicted diabetes risk in all the 3 models. In these 3 models the OR of general obesity were 5.3 [2.9-9.5], 3.4[1.8-6.3], 2.4[1.1-5.1] and the OR of high WHR were 3.5[2.1-5.8], 3.4[1.4-5.8] and 2.6[1.3-4.9], respectively. In subjects aged >/= 60 years general obesity predicted diabetes only in models 1 and 2, while high WHR was a predictor of diabetes risk only in model 1. In this age group, high WC predicted diabetes in all models 1, 2, 3 with the OR of 4.6 [2.3-4.1], 4.5 [2.3-8.9] and 3.8 [1.8-7.7], respectively. General obesity and high WHR in young Iranian subjects [< 60years] and high WC in older ones [>/= 60 years] are the important anthropometric indices for prediction of type 2 diabetes. Age should be considered when using different anthropometric indices for predicting the risk of type 2 diabetes

[Autoimmune thyroid disease in type 1 diabetic patients in the south of Iran [Bandar Abbas]]

Background: diabetes type 1 is an autoimmune disease that is associated with other autoimmune disorders like Hashimoto thyroiditis. The purpose of this study was to determine the prevalence of autoimmune thyroid disease [ATD] in type 1 diabetic patients in the south of Iran [Bandar Abbas]

Methods: a cross-sectional study, was conducted 48 type 1 diabetics and 41 age and sex matched healthy controls were evaluated for the presence of ATD. Blood sample were collected from all of the subjects for the measurement of thyroid autoantobodies [anti thyroid peroxidase [anti-TPO] and anti thyroglobulin [anti-TG]], T3, T4, TSH, RT3U and HbA1c

Results: prevalence of positive anti-TPO and anti-TG was 29 % and 29% respectively in diabetic patients and 2% and 7% respectively in control group [P<0.05]. The prevalence of ATD [positive anti TPO or anti TG] in diabetic patients and control subjects was 35% and 7% respectively [P<0.05]. The prevalence of positive anti TPO and anti TG was higher in girls. There was no association between the prevalence of positive autoantibody and duration or age of onset of diabetes. 17.6% of diabetic patients with positive autoantibody had thyroid dysfunction [subclinical hypothyroidism and hyperthyroidism]

Conclusion: regarding high prevalence of ATD in type 1 diabetic patients in Bandar Abbas [approximately 1 out of 3 patients], screening for ATD and thyroid dysfunction is recommended for all type 1 diabetic patiens and in those with positive autoantibody consecutively