[Evaluation and prevention of diabetic neuropathy]

Diabetic neuropathy is an incapacitating disease that afflicts almost 50 percent of patients with diabetes. A late finding in type 1 diabetes, diabetic neuropathy can be an early finding in non insulin-dependent diabetes. Diabetic neuropathies are divided primarily into two groups, sensorimotor and autonomic. Patients may acquire only one type of diabetic neuropathy or may present with combinations of neuropathies, such as autonomic neuropathy or distal symmetric polyneuropathy, the latter of which the most common form. Motor deficits, orthostatic hypotension, silent cardiac ischemia, hyperhidrosis, vasomotor instability, gastroparesis, bladder dysfunction, and sexual dysfunction can also result from diabetic neuropathy. Strict control of blood sugar, combined with proper daily foot care, is essential to avoid the complications of this disorder. With the potential to afflict any part of the nervous system, diabetic neuropathy should be suspected in all patients with type 2 diabetes as well as patients who have had type 1 diabetes for over five years. Although some patients with diabetic neuropathy notice few symptoms, upon physical examination mild to moderately severe sensory loss may be noted by the physician. Idiopathic neuropathy has been known to precede the onset of type 2 diabetes

[Prevalence of lower limb amputation in patients with diabetic foot ulcer in Imam Khomeini and Shariati Hospitals, 1979-2001]

Diabetes Mellitus is a common disorder with numerous disabling complications, which can be largely prevented by simple, inexpensive interventions. The prevention of diabetic foot ulceration [DFU] is especially important because besides the morbidity and mortality it entails time and a heavy financial burden. In order to study the prevalence of lower limb amputations, this study was designed in patients admitted with diabetic foot ulcerations. This retrospective descriptive study was carried out at Imam Khomeini and Dr. Shariati University Hospitals in Tehran. Data pertaining to 28 1 patients admitted between 1979 and 2001 for treatment of diabetic foot ulceration was collected and analyzed using SPSS software. Over the 22-year period of the study, 28l patients [61% men and 39% women] were hospitalized for DFU. The overall lower limb amputation rate was 30%. Mean hospital stay was significantly longer in patients who eventually underwent amputation than in those who did not. The rate of lower limb amputation secondary to DFU is higher in Iran than the global average. This necessitates greater attention and better planning with regards to the prevention and treatment of DFU

[Distribution of lipid disorders in the inhabitants of Tehran University of medical sciences]

Introduction: hyperlipidemia is a major cardiovascular risk factor. This survey has been performed to determine the prevalence of hyperlipidemia in the 17th zone of Tehran

Methods: 1573 individuals 25-64 aged were recruited from the inhabitants of the 17th zone of Tehran through one stage cluster sampling. Standard questionnaires were filled out for all of the participants. Lipid profile was categorized according to the NCEP:ATP III criteria

Results: 59% had ideal cholesterol levels, 27.1% borderline and 13.9% had high cholesterol levels. Hypercholesterolemia was more prevalent in women than men. 55% had ideal LDL-cholesterol level. Prevalence of hyper-LDL [>160mg/dl] was 2.3%. Hyper LDL was more prevalent in women than men [p<0.001]. Prevalence of hypo-HDL was 13.8% and it was more common in men than women [p<0.001]. 33.4% had high triglyceride levels

Conclusion: prevalence of dyslipidemia in this area of Tehran is not as high as that obtained from other urban studies. This fact should be considered in the future interventional programs which focus on noncommunicable disease management

[Evaluation of obesity and overweight and their changes pattern among 25-64 aged inhabitants of Tehran University of medical sciences population lab region]

Background: obesity and overweight, as the most common metabolic disorders, are great health problem during recent decades. Obesity takes a role as independent or concordant risk factor for many diseases. So, it has a considerable share in burden of morbidities and mortalities. Urbanization and its consequences in increasing of incomes and per capita energy uptake, besides the notable reduction in physical activities are the main causes of increased rates of obesity in developing countries. This survey has been conducted to evaluate the obesity and overweight status and their pattern among the inhabitants of 25-64 aged in 17th zone of Tehran, selected as Population Lab region

Methods: this study is a part of the Cardiovascular Risk Factors Survey in the Population Lab region. This survey has been designed and conducted based on MONICA/WHO project. A total of 1573 people have been recruited and assessed on age, weight, height, waist and hip circumferences. Body mass index [BMI], waist circumference [WC] and waist-to-hip ratio [WHR] were determined for comparing between groups

Results: there was a significant difference in mean BMI between two sexes [26.13 kg/m2 in men vs. 28.86 kg/m2 in women]. As well, WC and WHR were diverse between men and women [WC: 91.70 cm vs. 89.15 cm WHR: 0.91 vs. 0.85, respectively]. Obesity prevalence was 18.6% among men and 38.3% among women. Prevalence of high WC and abnormal WHR were higher among women than men

Conclusion: these results revealed that prevalence of obesity among adults was very high. The prevalence in women was more than two times than in men. This finding may be in part because of little physical activity and high proportions of carbohydrates intake instead of protein in daily energy uptake and also because of physiological differences among women. Proper and effective planning to achieve applied strategies for improving the social knowledge and awareness and also improving the life style and nutrition status of the people is highly necessitated

Metabolic and clinical effects of Ramadan fasting in patients with type 2 diabetes

To evaluate the effects of fasting on anthropometric indices and carbohydrate and lipid metabolism in patients with type II diabetes. Design: Observational non-interventional study. Place and Duration of Study:: Diabetes clinic, Shariati Hospital, Tehran, Iran during Ramadan 1419 [winter 1998-99]. Patients and Fifty-seven volunteers with type II diabetes underwent anthropometric and biochemical evaluation before and on the 14th and 28th days of Ramadan. Biochemical markers were measured by standard laboratory methods and anthropometric indices by WHO criteria. Statistical analysis was done by ANOVA for repeated measurements and Friedman's two-way ANOVA using SPSSv6 software. Daily cholesterol intake increased in all subjects [p<0.03]. Body mass index increased in women [p<0.03], but BMI and waist-hip ratio both decreased in men [p<0.01]. Blood pressure, fasting blood glucose and serum fructosamine did not change during the study. Plasma insulin [p<0.05], C-peptide [p<0.01] and insulin resistance [p<0.01] decreased only in men. Total and LDL cholesterol increased significantly in all subjects during the study. Ramadan fasting does not alter carbohydrate metabolism or tissue insulin sensitivity in patients with type II diabetes given appropriate dietary education and rescheduling of oral hypoglycaemic medication. Lipid profile is unfavourably altered due to changes in both diet and biochemical response to starvation