Investigation the role of gender on the HLA-DRB1 and -DQB1 association with type 1 diabetes mellitus in Iranian patients

Type 1 diabetes mellitus [T1D] is an autoimmune and multifactorial disorder. Subsequent analysis on human leukocyte antigen [HLA] region shows that HLA-DRB1 and -DQB1 genes have the strongest association with T1D. In this study, for the first time, we investigated the influence of gender on the HLA-DRB1 and -DQB1 association with type 1 diabetes mellitus in Iranian patients in order to determine gender dependent HLA heterogeneity in Iranian T1D patients. In this case control study, the HLA-DRB1 and -DQB1 typing were performed on 105 Iranian T1D patients and 100 healthy controls. The data were evaluated by using Fisher exact test. Our results indicate that DRB1*04:01, DQB1*03:02 alleles and DRB1*04:01-DQB1*03:02 haplotype were significantly more frequent in male T1D patients than females. Also, DRB1*03:01, DRB1*15:01, DQB1*06:01 alleles, DQB1*03:01/05:01 genotype, DRB1*03:01-DQB1*02:01 and DRB1*15:01-DQB1*06:01 haplotypes were significantly higher in female T1D group than males. Furthermore, our results showed that DRB1*04:01 and DQB1*03:02 alleles were significantly more frequent in male T1D patients 1-5 years old at onset than females with similar condition. The DRB1*03:01 allele and DRB1*03:01-DQB1*02:01 haplotype were significantly higher in female T1D patients 6-10 years old at onset than males with similar condition. The DRB1*15:01 allele and DRB1*15:01-DQB1*06:01 haplotype were significantly more frequent in female T1D patients 16-20 years old at onset than males with similar condition. Our findings suggest that gender has a significant influence on the distribution of HLA-DR and -DQ alleles, genotypes and haplotypes. Also, distribution of the HLA-DRB1 and -DQB1 alleles, genotypes and haplotypes vary based on the gender of T1D patients in different age at onset

[ influence of HLA-DRB1,-DQB1 genes on age at onset of type 1 diabetes in Iranian T1D patients]

Survey of the influence of HLA-DRB1,-DQB1 alleles, genotypes and haplotypes on age at onset of type 1 diabetes [T1D] in an Iranian population 105 Iranian T1D patients of different ethnic group and 100 ethnically, age and sex matched individuals were selected from Tehran's hospitals and HLA-DRB,-DQB typing was performed. According to the age at onset of T1D, the patients were divided into 4 groups [1-5, 6-10, 11-15, 16-20 years]. The frequency of susceptible and protective alleles, genotypes and haplotypes was calculated in each group. The data were evaluated by using fisher's exact test. Odds Ratio or relative Risk was measured for all samples. The results illustrated that the frequency of the HLA-DRB1*0401 allele decreased with increasing age, whereas the frequency of the HLA-DQB1*0201 allele increased with increasing age. The HLA-DRB1*0301 and HLA-DQB1*0302 alleles demonstrated the highest frequency in the 6-11 and 1-5 years age at onset group, respectively. HLA-DRB1*0401-DQB1*0302 haplotype had the most frequency among the 1-5 years age at onset group [p: 2x10-7, OR: 69.919] and the frequency of HLA-DRB1*0301-DQB1*0201 haplotype was the highest in the 6-11 years age at onset group among others [p: 2x10-6, OR: 6.243]. The current study indicated that HLA-DRB1,-DQB1 alleles, genotypes and haplotypes are associated with age at onset of type1 Diabetes in Iranian T1D patients. The individuals carrying alleles that are associated with younger age at onset should take care under preventive treatment

Insulinoma in Iran: a 20-year review

The time between onset of symptoms of insulinoma to diagnosis ranges from 10 days to more than 20 years. To help physicians make an earlier diagnosis, we defined the clinical, imaging and paraclinical characteristics of insulinoma in cases from seven referral hospitals in Iran over two decades. The medical records of 68 cases with biochemical or histological evidences of insulinoma were reviewed. More males were affected [53%]. The mean age at diagnosis was 39 +/- 15.3 years. The mean duration of symptoms was 39.9 +/- 59.3 months. Eighty-four% of patients had been initially misdiagnosed as cereberovascular accident [CVA], epilepsy, conversion disorder, and others]. Neuroadrenergic symptoms were observed in 89.6% and and neuroglycopenic symptoms in 97% of patients. Mean diameter of tumours was 2.9 cm [range, 1 cm to 8.5 cm]. Of 52 pathologically confirmed cases of insulinoma, 43 tumours [87.8%] were single and 49 [94.2%] were benign. Fifty-five patients had undergone surgery, with a successful outcome in 44 [80%]. The high incidence of neuroglycopenic symptoms suggest the clinical impression of insulinoma when patients present with a suggestive clinical syndrome. The clinical impression is essential to decrease the frequent delay in the diagnosis of insulinoma

Comparison of desmopressin [DDAVP] tablet and intranasal spray in the treatment of central diabetes insipidus

Desmoperssin is the drug of choice for treatment of central diabetes insipidus and most commonly it is used as intranasal spray. In this study, efficacy and side effects of oral desmopressin was compared with the intranasal spray. This study was before -after clinical trial on 14 outpatients [9 F, 5 M, age 14 -50 Y] with central diabetes insipidus who had been treated with intranasal spray of desmopressin previously. Weight, pulse rate and blood pressure [sitting -standing], biochemical profile, serum electrolytes, 24h urine volume, specific gravity of urine and LFT was measured before and after 1 month study. Starting dose for each patient was one oral tablet of DDAVP [0.1 mg] per 8 hours. Paired Samples T-Test was used for data analysis. No clinically significant changes were found as regard to weight, pulse rate, blood pressure, blood chemistry, electrolyte and urinalysis. Single reported adverse effect was headache [43%] in tablet group and dyspnea [7%] in spray group. Both dosage forms were able to control diurnal polyuria and nocturnal polyuria. The antidiuretic dose - equivalence ratio for intranasal to oral desmopressin was 1: 18. Spray was superior in terms of rapid onset of action and duration of antidiuretic action in 100% and 78% of cases [not significant], respectively. Tablets were more available and much more easily consumed as reported by patients, in 86% [P=0.0006]. Treatment with tablets offers a good alternative to the intranasal route, especially in patients with chronic rhinitis or common cold and similar conditions

[ effect of combination therapy with gliclazide and metformin in control of blood glucose of type 2 diabetics]

Background: gliclazide is a second generation sulfonylurea which its efficacy and safety in the treatment of diabetes has been established. Diamicron MR [30 mg] is a new formulation of gliclazide with modified release which offer once daily dosage administration. This study was designed to assess the effect of combination therapy with diamicron and metformin in the treatment of type 2 diabetes

Methods: 16 patients with type 2 diabetes [2 males, 14 females] more than 35 years old who despite treatment with glibenclamide and metformin had poor diabetes control participated in this clinical trial.HbA1c, lipid profile, liver and renal function tests at the end of study were compared with before

Results: no significant changes was found in FBS, BS2hpp, lipid profile and renal and liver function tests at the end of study. Patients' weight was stable during the study

Conclusion: regardless of well efficacy of diamicron in the treatment of new diabetics cases, it is not recommended for patients with poor diabetes control despite of combination therapy with metformin and glibenclamide