Comparison between diabetes incidence using different cut points of IFG in Tehran

In 2003 the American diabetes Association [ADA] recommended that the definition of impaired fasting glucose [IFG] be changed from 110-125 to 100-125 mg/dL. This study examined the effect of different cut points for IFG on the incidence of diabetes in Tehran's urban population. From among the participants of the Tehran Lipid Glucose Study, after excluding subjects aged < 20 years, those with known or newly diagnosed type 2 diabetes, and those with missing values of weight, height, or other variables or lost to follow-up, data of 4728 subjects was used in this cohort study. They were followed for diabetes incidence [based on fasting plasma glucose [FPG] and glucose tolerance test] for 3.6 years. Participants were divided into different groups: Normoglycemia <100, original-IFG 110-125, added IFG 100-110 and the new IFG 100-125 mg/dL, groups. Odds ratios of diabetes incidence after adjustment for relevant confounders were calculated. The median age of participants was 42.9 +/- 13.7y and 59.1% [n=2916] were female. The prevalence of original-IFG, added IFG and new IFG were 3.7% [n=183], 11.8% [n=584], and 15.5% [n=767], respectively. After a mean follow-up duration of 3.6 years, 188 cases [3.8%] of incident diabetes were diagnosed. Diabetes incidence in the nor-moglycemia, original-IFG, added IFG and new IFG groups, were 1.8% [n=76], 26.2% [n=48], 11% [n=64], 14.6% [n=112], respectively. Odds ratio for diabetes incidence after adjustment for age, sex and other relevant confounders for the original-IFG, added IFG and new IFG groups, compared to the normoglycemia group as the reference, were 11.45 [95% confidence interval [CI], 7.45-17.57], 4.73 [95% CI, 3.28-6.8], 6.32 [95% CI, 4.51-8.5], respectively. The new IFG [100-125 mg/dL] is not superior to the original IFG [110-125 mg/dL] in terms of predicting forth-coming diabetes in Tehranian adults

[Prevalence of obesity in subjects aged 50 years and over in Tehran]

Overweight and obesity are major health problems affecting communities worldwide and the prevalence is rapidly rising. Although the prevalence of obesity in Iran has been reported, there are no data available on the prevalence of these factors in individuals aged over 50 years, individuals who are naturally more prone to cardiovascular diseases and death. This study aims at determining the prevalence of overweight and obesity in this high risk age group. In this investigation, data for 3391 individuals aged >/= 50 y, participants of the Tehran Lipid and Glucose study, was collected and assessed. Overall 1566 men [46.2%] and 1825 women [53.8%] were studied. The mean age for women was 59.8 +/- 7.2y and that for men was 62 +/- 7.9y. Average weight for males was 73 +/- 11.9 kg. and for females was 68.6 +/- 11.8 kg. On the whole prevalence of abnormal BMI [>/= 25 kg/mg2] was 73.3% [CI 95%, 71.8-74.8%]; of these 44.1% [CI 95%, 42.4-45.8%] were overweight and 29.2% [CI 95%, 27.7-30.8%] were obese. Percentages for overweight were 82% and 63.2% for women and men respectively. To conclude the prevalence of obesity and overweight in those aged over 50 years are rapidly rising. It is highly recommended that interventions for lifestyle changes be implemented in this high risk age group

[Population attribtable risk for diabetes associated to obesity in Iranian adults]

Excess weight is a well known risk factor for Type 2 diabetes mellitus. Several studies have estimated the population attributable risk of diabetes associated with overweight and obesity in developed countries. However, little evidence exists regarding the contribution of excess weight to diabetes in the Middle East countries. This study aimed at quantification of the impact of overweight and obesity on a population level in Iran. Using data of a population-based short-term cohort study in Iran, which began in 1998 with 3.6-year follow-up, we calculated the adjusted odds ratios [OR] and population attributable risks [PAR] of developing diabetes, i.e. the proportion of diabetes that would have been avoided had overweight and/or obesity not been present in the population. Results: Of the 4728 subjects studied, during the 3.6- year follow-up period, 3.5% [n=164] developed diabetes. This proportion was 1.3%, 3.2%, and 7.0% for the normal, overweight, and obese subjects, respectively. When compared to normal BMI, the adjusted ORs for incident diabetes were 1.78 [95% confidence interval [CI] 1.05 to 3.02] for overweight and 3.61 [95% CI 2.13-6.10] for obesity. The adjusted-PAR was 23.8% for overweight and 37.6% for obesity. Relatively feasible lifestyle changes of preventing overweight and obesity could substantially lower population diabetes incidence

[Assessing the prevalence of intra-and-extra cranial arteries stenosis in diabetic patients with hypertension by transcranial doppler sonography]

Stroke is one of the most common causes of mortality and morbidity worldwide. In addition to the effects of some risk factors like old age, hypertension, hyperlipidemia and smoking, the prevalence of this disorder is twice as high in diabetic as compared to nondiabetic patients. The purpose of this survey to detect asymptomatic intracranial stenosis and to determine its risk factors in hypertensive diabetic patients aged over 50 years using Transcranial Doppler Sonography[TCD]. Diabetic patients aged over 50 years with hypertension and no previous history of cerebrovascular problems were invited, and initially a questionnaire on demographic information, smoking, history of hyperlipidemia, duration of diabetes and hypertension and physical exams was completed. Then evaluation of peak systolic flow velocity [PSV] in middle cerebral [MCA] internal carotid [ICA] and vertebral arteries [VA] was done by TCD, PSV >/= 120 cm/sec for MCA and ICA and PSV >/= 100 cm/sec for VA over 50% stenosis of arterial wall diameter was classified [defined] as significant stenosis,. Student t test, analyze of variance and non parametric tests were used for data analysis. Overall 108 patients with mean age 62.51 +/- 7.90 years were studied, of which 22 [20.3%] patients [11male, 11 female] had stenosis and 34 [31.4%] stenotic arteries were also detected; 7 out of 22 patients [32%] had multiple stenosis. Mean durations of hypertension in these two groups were 5.36 +/- 1/7and 3.07 +/- 0.39 years respectively [P = NS], and mean durations of diabetes were 14.09 +/- 1/8 and 8.15 +/- 0/72 years respectively [P< 0.01]. Of 22 [41%], 9 had hyperlipidemia, with 6 of them having multiple involvement, whereas only 1 out of 13 patients without hyperlipidemia had multiple stenosis. [P<0/003]. More than 20% of our patients had significant but asymptomatic cerebral artery stenosis; 30% of patients had multiple artery Involvement. There was no relation between occurence of stenosis and age, sex or duration of hypertension, but there was a significant relation between prevalence and multiplicity of stenoses and the duration of diabetes and also the presence of hyperlipidemia. Periodic evaluation of cranial vessels hence, in aged diabetic patients with risk factors of atherosclerosis using TCD is recommended

[Causes and clinical presentations of hypoglycemia in patients with low blood glucose admitted to the emergency ward]

Hypoglycemia is a medical emergency with severe side effects and also nonspecific symptoms. This survey aims at determining the causes and symptoms of hypoglycemia in patients with low blood glucose admitted to the emergency ward, approaches for prevention in hypoglycemia and decrease of further side effects are proposes. All patients with symptoms of hypoglycemia and blood glucose less than 45 mg/dl admitted to the emergency ward, between 2002 and 2003, were included in this survey. Initially a questionnaire on demographic information, coexisting disorders and drug history was completed, physical exam was done and 10 ml venous samples were obtained for CBC, liver and renal function tests. Hormonal assay and 72 hour fasting assessment was done. 89 patients with a mean age of 66.73 +/- 14.91 were included 53% females and 47% males [P= NS]. 86.5% were diabetic and 13.5% nondiabetic [P< 0.001]. Common causes were: drugs [36.3%], renal failure [23%], sepsis [14.3%] and medical mismanagement [11%]. The most common symptoms in diabetic and nondiabetic patients were adrenergic + norglycopenic 50.6% and 58.3%, norglycopenic 46.8% and 41.7%, and adrenergic 2.6% and 0% respectively [P=NS]. Drugs were the most common cause of hypoglycemia, although medical mismanagement was also observed in 11% of patients. Education not only for patients but also for medical groups is the basis of prevention. High percentage of patients had norglycopenic symptoms due to long durations of diabetes and old age as an independent risk factor, drugs should hence be used contiously in older patients also training physicians especially for geriatric groups is recommended