High Incidence of Chronic Kidney Disease among Iranian Diabetic Adults: Using CKD-EPI and MDRD Equations for Estimated Glomerular Filtration Rate

Background@#To investigate the population based incidence rate of chronic kidney disease (CKD) and its potential risk factors among Iranian diabetic adults during over 14 years of follow-up. @*Methods@#Two different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] and Modification of Diet in Renal Disease [MDRD]) were applied for the calculating the estimated glomerular filtration rate (eGFR). Among a total of 1,374 diabetic Tehranian adults, 797 and 680 individuals were eligible for CKD-EPI and MDRD analyses, respectively. CKD was defined as eGFR lower than 60 mL/min/1.73 m2. Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for all potential risk factors. @*Results@#The incidence rates (95% CI) of CKD per 1,000 person-years were 43.84 (39.49 to 48.66) and 55.80 (50.29 to 61.91) based on CKD-EPI and MDRD equations, respectively. Being older, a history of cardiovascular disease, and having lower levels of eGFR were significant risk factors in both equations. Moreover, in CKD-EPI, using glucose-lowering medications and hypertension, and in MDRD, female sex and fasting plasma glucose ≥10 mmol/L were also independent risk factors. Regarding the discrimination index, CKD-EPI equation showed a higher range of C-index for the predicted probability of incident CKD in the full-adjusted model, compared to MDRD equation (0.75 [0.72 to 0.77] vs. 0.69 [0.66 to 0.72]). @*Conclusion@#We found an incidence rate of more than 4%/year for CKD development among our Iranian diabetic population. Compared to MDRD, it can be suggested that CKD-EPI equation can be a better choice to use for prediction models of incident CKD among the Iranian diabetic populations.

High Incidence of Chronic Kidney Disease among Iranian Diabetic Adults: Using CKD-EPI and MDRD Equations for Estimated Glomerular Filtration Rate

Background@#To investigate the population based incidence rate of chronic kidney disease (CKD) and its potential risk factors among Iranian diabetic adults during over 14 years of follow-up. @*Methods@#Two different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] and Modification of Diet in Renal Disease [MDRD]) were applied for the calculating the estimated glomerular filtration rate (eGFR). Among a total of 1,374 diabetic Tehranian adults, 797 and 680 individuals were eligible for CKD-EPI and MDRD analyses, respectively. CKD was defined as eGFR lower than 60 mL/min/1.73 m2. Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for all potential risk factors. @*Results@#The incidence rates (95% CI) of CKD per 1,000 person-years were 43.84 (39.49 to 48.66) and 55.80 (50.29 to 61.91) based on CKD-EPI and MDRD equations, respectively. Being older, a history of cardiovascular disease, and having lower levels of eGFR were significant risk factors in both equations. Moreover, in CKD-EPI, using glucose-lowering medications and hypertension, and in MDRD, female sex and fasting plasma glucose ≥10 mmol/L were also independent risk factors. Regarding the discrimination index, CKD-EPI equation showed a higher range of C-index for the predicted probability of incident CKD in the full-adjusted model, compared to MDRD equation (0.75 [0.72 to 0.77] vs. 0.69 [0.66 to 0.72]). @*Conclusion@#We found an incidence rate of more than 4%/year for CKD development among our Iranian diabetic population. Compared to MDRD, it can be suggested that CKD-EPI equation can be a better choice to use for prediction models of incident CKD among the Iranian diabetic populations.

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

Serum lipids during 20 years in the Tehran lipid and glucose study: prevalence, trends and impact on non-communicable diseases

Context: dyslipidemia, including elevated serum total cholesterol [TC], low density lipoprotein cholesterol [LDL-C], and triglycerides [TG], and low high density lipoprotein cholesterol [HDL-C] is a major modifiable risk factor for non-communicable diseases [NCDs]. This review summarizes many of the key findings on lipid measures in the Tehran lipid and glucose study [TLGS], a large scale community-based study with an approximately two decade follow-up

Evidence Acquisition: a systematic literature search was conducted using PubMed, Scopus, Web of Science databases, and the library of the Research Institute for Endocrine Sciences, using the following keywords: Lipid measures, lipid ratios, lipid profile, dyslipidemia, and "Tehran lipid and glucose study". Articles were categorized based on fields of prevalence, trends, and impact of lipid profile on incident NCDs and mortality

Results: Between 1999 - 2001, the prevalence of high risk lipids ranged from 14% [low HDL-C] to 17% [high LDL-C] among adolescents, although among adults the lowest and highest prevalence were observed for low HDL-C [19%] and high TG [28%]. Despite favorable trends for lipid parameters among adolescents, adults, and the elderly population, a considerable number of diabetic individuals, failed to achieve the optimum level of serum lipids. During follow-up, consumption of lipid lowering drugs increased from 1.5 to 9.0% and 3.7 to 11.4% among adult men and women, respectively. The association between different lipid parameters and related ratios for incident type 2 diabetes [T2D], hypertension, metabolic syndrome and cardiovascular diseases differed between genders. Interestingly, each 1-unit increase in TC/HDL-C increased risk of hypertension among women [odds ratio [OR]: 1.19, 95% confidence interval [CI]: 1.00 - 1.27] and T2D among men [OR: 1.27, 95% CI: 1.06 - 1.51]. Moreover, TC, LDL-C, non-HDL-C, Ln-TG, TC/HDL-C, and Ln- TG/HDL were inversely associated with non-cardiovascular mortality

Conclusions: despite high prevalence of high risk lipid profiles among the TLGS population at baseline, favorable trends were observed in levels of all lipid components, which might be attributable to increased consumption of lipid-lowering medications and improvement in the general knowledge of Iranians regarding limited consumption of hydrogenated oil. Considering the impact of lipid profiles on incident NCDs, more attention should be paid to at-risk groups for screening and treatment purposes

Blood pressure and hypertension: findings from 20 years of the Tehran lipid and glucose study [TLGS]

Context: hypertension [HTN] is a well-known modifiable risk factor for cardiovascular disease [CVD], chronic kidney disease and mortality. Positive effects of blood pressure [BP] lowering for prevention of CVD and death have been documented in several meta-analyses of randomized controlled trials

Evidence Acquisition: this review focuses on the key findings derived from the Tehran lipid and glucose study [TLGS] papers on different aspects of BP and HTN

Results: a prevalence of 23% for HTN has been reported in the TLGS population, aged >/= 20 years. Over a decade long follow-up, the crude incidence rate [95% CI] of new-onset HTN defined as systolic BP [SBP] >/= 140 mmHg and/or diastolic BP [DBP] >/= 90 mmHg, and not using antihypertensive medication was 33.63 [32.0 - 35.3] per 1000 person-years. Age, baseline SBP and body mass index were significant risk factors for development of isolated systolic HTN; regarding isolated diastolic HTN, baseline DBP and waist circumference were recognized as important risk factors whereas age, female gender and marriage were shown to be protective factors. SBP decreased significantly in both diabetic and non-diabetic participants; DBP showed a non-significant decrease in diabetic men and a statistically significant decrease in non-diabetic men. Among women, both those with and without diabetes [DM] generally experienced statistically significant decreases in DBP. Cox proportional hazard models showed that neither SBP nor DBP were associated with incident DM in the total population and in either gender, separately. All BP components were associated with CVD and all-cause mortality in the middle-aged population. Contribution of HTN to cerebrovascular events was also documented in the TLGS participants, aged >/= 50 years

Conclusions: several important findings regarding BP/HTN have been derived from the TLGS. According to data regarding the prevalence and incidence of preHTN and HTN and their contribution to cardiovascular morbidity and mortality in the TLGS population as a representative sample of Tehranian population, it is recommended that interventions be prioritized for lifestyle modifications for the prevention and appropriate management of preHTN/HTN

Does twice-weekly cabergoline improve anthropometrical and biochemical profiles in prediabetes? a randomized double-blind clinical trial pilot study

Dopaminergic signaling is one of the regulatory pathways being investigated for its implication in glucose metabolism. The aim of this study was to determine the effect of cabergoline on biochemical and anthropometric parameters in prediabetes stage [impaired fasting glucose and impaired glucose tolerance]. In this double blind, placebo-controlled, pilot study, 27 prediabetic adults were randomized to receive 0.25-mg cabergoline twice weekly for two weeks, followed by 0.5 mg twice weekly for next 14 weeks [n = 13] or placebo [n = 14]. All subjects were advised to follow a 500 kcal-deficit energy diet. Fasting plasma glucose [FPG], oral glucose tolerance, glycated hemoglobin [A1c], fasting, and 2-h insulin were measured at baseline and at 16-week follow-up. Homeostasis model assessment [HOMA] 2 was calculated to estimate steady-state beta-cell function, insulin sensitivity, and insulin resistance. Our results showed significant reductions in fasting [P = 0.004] and 2-h plasma glucose [P = 0.01] after treatment, and significant improvements in beta-cell function [P = 0.03] and insulin resistance [P = 0.04] in the cabergoline group. The trend of non-significant A1c changes was decreasing in the cabergoline group versus an increasing trend in the placebo group. All anthropometric parameters were similar between the two groups. Our results revealed that twice-weekly cabergoline could improve glucose metabolism in prediabetes stage. Larger studies of longer duration are warranted to investigate the effect of cabergoline in preventing progression of prediabetes to type 2 diabetes mellitus

Subclinical hypothyroidism and insulin resistance in polycystic ovary syndrome: is there a relationship?

Polycystic ovary syndrome [PCOS] is the most common hyperandrogenic disorder among women and is often defined as hyperandrogenic syndrome. These patients are at risk for oligo/amenorrhea, chronic anovulation, infertility, obesity, spontaneous abortion, insulin resistance, hyperinsulinemia and metabolic syndrome. Thyroid disorders especially hypothyroidism is more common in these people. In PCOS patients, subclinical hypothyroidism may aggravate insulin resistance. The goal was to find any relationship between subclinical hypothyroidism and insulin resistance in PCOS patients. In this prospective cross sectional study we included all PCOS patients coming to infertility clinic of Taleghani Hospital in 2010-2012 who had the criteria of Rotterdam for PCOS. Then the clinical examination was done for them and height, weight, body mass index and lab data were measured including thyroid hormone and biochemical profile. The data were analyzed by SPSS software version 20. Among 75 PCOS patients, 19 [25.5%] had subclinical hypothyroidism and 56 patients [74.4%] were euthyroid. The prevalence of insulin resistance was 22.7% and 77.3% of patients had no insulin resistance were normal. We could find no relationship between insulin resistance and subclinical hypothyroidism in PCOS patients

Long-term continuous methimazole or radioiodine treatment for Hyperthyroidism

There is no general agreement as to which treatment is best for hyperthyroidism. The objective of this study is to investigate the effectiveness of continuous methimazole [MMI] treatment and to compare the results of neuropsychological testing in patients receiving long-term continuous MMI to those on replacement thyroxine following radioiodine-induced [RAI] hypothyroidism. We enrolled 239 patients with diffuse toxic goiter who had recurrences of hyperthyroidism. Of these, 104 patients were randomized into two groups, MMI and treatment with thyroxine following RAI hypothyroidism. The remaining 135 patients voluntarily enrolled into either of the two groups. From all patients, 59 MMI-treated patients and 73 patients in the RAI group completed follow up. Thyroid function tests, serum lipids and lipoproteins, echocardiography, bone mineral density [BMD] and seven neuropsychology tests were performed at the final visit. In the RAI group compared to the MMI-treated group during a mean of 14 years follow up, there were more incidences of elevated TSH [> 5 mU/L; adjusted relative risk [RR] 1.23; 95% confidence interval [CI] 1.04-1.47], increased triglycerides [> 150 mg/dL; RR 2.20; 95% CI 1.34-3.62], HDL-C [< 40 mg/dL; RR 3.46; 95% CI 1.40 - 8.53], and early diastolic annular velocity [< 12.2 cm; RR 3.91; 95% CI 1.42-10.74], in addition to a decreased early diastolic to annular velocity ratio [< 6.7; RR 7.14; 95% CI 1.38-34.48]. The MMI group scored better in neuropsychology tests that included mood, direction, logical memory, repeated numbers, and intelligence quotient [IQ]. Long-term MMI treatment was superior to RAI therapy in patients with diffuse toxic goiter when mood, cognition, cardiac function and occurrence of thyroid dysfunction were compared

Prevalence of metabolic syndrome by the Adult Treatment Panel III, International Diabetes Federation, and World Health Organization definitions and their association with coronary heart disease in an elderly Iranian population

<p><b>INTRODUCTION</b>To determine the prevalence of the metabolic syndrome (MS) in an Iranian elderly population and show its association with coronary heart disease (CHD).</p><p><b>MATERIALS AND METHODS</b>This is a cross-sectional study on 720 Iranian men and women aged > or = 65 years who participated in the Tehran Lipid and Glucose Study (TLGS). Logistic regression analysis was used to estimate the odds ratio (OR) of developing CHD in model 1, an age-adjusted model; model 2, adjusted for age, smoking status, premature history of CHD and low-density lipoprotein (LDL) cholesterol; and model 3, adjusted for mentioned variables plus the MS components.</p><p><b>RESULTS</b>The prevalence of MS was 50.8%, 41.8% and 41.9% based on the Adult Treatment Panel (ATPIII), the World Health Organisation (WHO), and the International Diabetes Federation (IDF) definitions, respectively. The IDF definition showed high agreement with the ATPIII definition. Age-adjusted OR (95% CI) of the MS for CHD was 1.6 (1.2 to 2.2) by both the ATPIII and WHO definitions and 1.4 (1.0 to 1.9) by the IDF definition. IDF-defined MS lost its association with CHD in model 2. In model 3, obesity (WHO definition) and high blood pressure (ATPIII and WHO definitions) were associated with CHD.</p><p><b>CONCLUSIONS</b>In an elderly Iranian population MS is highly prevalent. ATPIII and WHO definitions seem to be more pertinent than IDF for screening CHD risk. None of these definitions showed association with CHD when considering their components.</p>

[Triglyceride/HDL- cholesterol ratio [TG/HDL- C] beside the total cholesterol is a predictor for coronary heart disease in an Iranian men population]

Triglyceride/HDL-cholesterol ratio [TG/HDL-C] has been shown as an indicator for metabolic syndrome [MetS]. This study aimed to detect the role of this ratio to predict coronary heart disease [CHD] outcome in an Iranian men population with high prevalence of MetS. 1824 men >/= 40 years old, free of clinical cardiovascular disease at baseline, were included in the study from February 1999 to August 2001. Serum level of total cholesterol [TC], HDL-C, TG, and risk factors of CHD; including age, systolic blood pressure, diastolic blood pressure, body mass index, diabetes, smoking and family history of cardiovascular diseases were measured at initial phase of study. During a median follow up of 6.5 years until March 2007, a total of 163 new CHD events occurred. According to a Cox proportional hazard modeling, after adjustment for TC and other risk factors, men in the top quartile of TG/HDL-C relative to first quartile had a significant hazard ratio [HR] of 1.85 [95% Cl, 1.07-3.17]. Combined HR for TC and TG/HDL-C [men in the top quartiles of both TC and TG/HDL-C relative to first quartiles] after adjustment for other risk factors was 6.13 [95% Cl, 2.37-15.86]. The evaluation of both TG/HDL-C ratio and TC should be considered for CHD risk prediction in Iranian male 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

[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