effect of quality of care on cardiovascular risk factors in newly diagnosed diabetic patients

In this study, we evaluated the quality of care and control of cardiovascular risk factors in newly diagnosed diabetic patients, identified during diabetes screening program, 1 year after diagnosis. In this prospective study, 83 newly diagnosed diabetic patients identified at screening in Isfahan, were studied. Height, weight, blood pressure, plasma glucose, lipids, and hemoglobin A1c [HbA1c] of these patients were measured 2 times, first at the time of diagnosis and then 1 year later, and the results were compared between two groups, with and without regular course of treatment. Nearly 46.99% and 53.1% of the studied patients have regular and irregular course of treatment. After 1 year, significant improvement in the mean of plasma glucose, cholesterol, triglyceride, low density lipoprotein [LDL], high density lipoprotein and HbA1c was seen in patients with regular course of treatment except for blood pressure [P < 0.05]. Frequency of controlled cardiovascular risk factors including fasting plasma glucose, HbA1c, cholesterol and LDL was significantly improved in patients with regular course of treatment [P < 0.05]. Mentioned changes were not seen in patients with irregular course of treatment. The findings of the current study demonstrated that though diabetes screening program result in earlier diagnosis of patients with type 2 diabetes, but it seems that regular follow-up and proper management of newly diagnosed patients is crucial for appropriate glycemic and metabolic control and preventing its related micro and macrovascular complication

Why 24-h urine albumin excretion rate method still is used for screening of diabetic nephropathy in Isfahan laboratories?

The first step in diagnosis of diabetic nephropathy is measurement of albumin in a spot urine sample. The aim of this study was assessment of the accuracy of urinary albumin to creatinine ratio [UACR] in random urine specimens [RUS] for microalbuminuria and macroalbuminuria screening in Iranian diabetic patients. A total of 200 diabetic patients participated to our study. 24 h timed urine specimens followed by RUS were collected. 24-h urine albumin excretion [24-h urinary albumin excretion [UAE]] and UACR in RUS were measured. Data were analyzed by Pearson's correlation, receiver operating characteristic [ROC] curve and McNemar test. A total of 165 patients finalized the study. Pearson's correlation of coefficient for 24-h UAE versus UACR was 0.64. The area under ROC curve for UACR was 0.83 in microalbuminuria and 0.91 in macroalbuminuria. The cutoff point of 30 mg/g in UACR method had 86% sensitivity and 60% specificity for microalbuminuria screening and cut-off point of 300 mg/g had 75% sensitivity and 99% specificity for macroalbuminuria screening respectively. UACR in RUS showed acceptable performance as a screening test for diagnosis of both micro and macroalbuminuria in Iranian diabetic patients

Challenges of training diabetes nurse educator in Iran

The purpose of this study was to describe the first attempts and performance of health system in Iran in training specialist nurses in the field of diabetes- related care and education. This was a qualitative content analysis. Three diabetes management planners in the Ministry of Health and Medical Education, three provincial executive authorities of diabetes in the health system and ten nurses who worked as diabetes nurse educators [DNEs] participated in this study. Data obtained through semi-structured faceto-face interviews, a focus group, existing documents, field notes, and multiple observations. Data analysis was guided by the conventional approach of qualitative content analysis. Three major themes and six sub-themes were emerged through data analysis. Main themes were: [a] decentralization diabetes nurse educator training without any management [stop education due to transition training responsibility to provincial health authorities and lack of supervision of managers on training]; [b] try to reform nursing education infrastructures [try to train qualified educators who were candidate for teaching to DNEs, try to reform undergraduate nursing curriculum]; [c] failure of DNE curriculum [lack of consistency between content and timing with the curriculum objectives and lack of attention to learn evaluation process]. The findings of this study reflected the failure and multiple challenges in educating nurses working in diabetes units. Despite the fact that important roles were defined for nurses in the action plan for preventing and controlling diabetes, any specific action was not done in preparing nurses for these roles.

cross-sectional study on food patterns and adiposity among individuals with abnormal glucose homeostasis

Dietary habits play an important role in the prevention of chronic disease; however, few studies have assessed the major dietary patterns in Middle Eastern countries. This study identifies major dietary patterns among Iranian people with abnormal glucose homeostasis. This cross-sectional study was conducted at the Diabetes Research Center, Isfahan, Iran among 425 subjects with abnormal glucose homeostasis. Patients were of ages 35 - 55 years and had family histories of diabetes. We assessed dietary intake by the use of a food frequency questionnaire [FFQ] that contained 39 food items. General obesity was defined as a BMI > 30 kg/m[2] and central obesity was defined as waist circumference [WC] > 88 in women and WC > 102 in men. Five major dietary patterns were revealed by factor analysis: 'western', 'healthy', Vegetarian', 'high-fat dairy', and 'chicken and plants'. Those in the top tertile of the 'western pattern' had greater odds for general [OR = 1.73; 95% Cl = 1.07 - 2.78] and central obesity [OR = 2, 95% Cl = 1.24 - 3.22], however these associations were not significant after adjustment for confounding variables. The 'high-fat dairy pattern' was associated with greater odds of general obesity only after adjusting for confounding variables [OR = 1.73; 95%CI = 1.01 -2.96]. The dietary pattern characterized by high intake of hydrogenated fat and sugar was shown to be positively associated with a risk of general and central obesity, however further prospective studies are required to confirm our findings

Hearing impairment in congenitally hypothyroid patients

Thyroid hormone is necessary for normal development of the auditory system. The aim of this study was to investigate the rate of hearing impairment in congenitally hypothyroid [CH] patients, and its relation with factors such as CH severity and age at starting treatment, during CH screening program in Isfahan. Hearing acuity was assessed in two groups of children with [94 patients aged 4 months - 3 years] and without CH [450], between 2000-2006. Otoacostic emission [OAE] was performed by a two step method. After two tests without OAE signals bilaterally, they were referred for auditory brainstem response [ABR] test. Subjects with both OAE and ABR abnormal test results were considered to have hearing problem. Obtained data was compared in case and control group and also CH patients with and without hearing impairment. Three [3.2%] of patients and 1 of control group [0.2%] were diagnosed with sensorineural hearing loss. The rate of hearing loss was not different significantly in two studied groups [P>0.05]. There was no difference between age of starting treatment and first T4 and TSH level in CH patients with and without hearing loss [P>0.05]. CH neonates with hearing impairment had thyroid dyshormonogenesis according to the follow up results. The rate of hearing loss was low among our studied CH patients. It may be due to proper management of CH patients. In view of the fact that all CH neonates were dyshormonogentic and considering the relation between certain gene mutations and hearing impairment in CH patients, further studies with larger sample size, with regard to different etiologies of CH should be investigated to indicate the possible gene mutations related to hearing loss in CH

Normal values of thyroid gland in Isfahan, an iodine replete area

Because of different values of thyroid volume in different populations, and the effects of different trace element and geographic substances on thyroid volume, we decided to evaluate thyroid volume and its determinants using ultrasound in healthy adults of Isfahan, a centrally located city in Iran, an iodine replete area. In a cross-sectional study, 1500 healthy adults were enrolled by cluster sampling. Serum TSH level and morning urine iodine level were measured. Thyroid exam was performed according to WHO criteria and history of previous or present thyroid disease was taken. If all the mentioned results were normal they were considered clinically normal. One third of these normal subjects referred for thyroid ultrasonography. If ultrasonography of thyroid parenchyma texture was normal, and there was no nodule by sonography [thyroid incidentaloma], thyroid volume was measured using ellipsoid formula [XxYxZx[PI]/6]. Correlation between thyroid volume and age, sex, BMI, TSH level and urinary iodine concentration [UIC] was determined by Pearson correlation coefficient, t-Test and Kolmogorov-Smirnov. Thyroid volume more than 97% of this population was considered as goiter sonographically. Data expressed asonean +/- SD, unless otherwise stated. We finally studied 200 subjects [123 Males, 77 females, average age: 37.27 +/- 11.80 Years]. The overall thyroid volume was 9.53 +/- 3.68 ml. Males thyroid volume [10.73 +/- 3.44 ml] was significantly higher than the females one [7.71 +/- 2.63 ml] [P<0.001]. The thyroid volume ranges were 3-23.9 ml, 3.6-23.9 ml and 3-14.3 ml in all, males and females, respectively. Thyroid volume values more than 97 percentile of this reference range were 10.14 ml, 11.48 ml and 8.37 ml in all, males and females respectively, and were considered goiter sonographically. Thyroid volume had a positive correlation with age [r = 0.163, P = 0.022], but did not have correlation with serum TSH, UIC, and BMI, in both sexes. There was a strong correlation between thyroid volume, and height and body surface area [r = 0.48, P<0.001]. It was documented that thyroid volume is higher in male sex and increases with age, and have a positive correlation with body surface area and height