Comparison of Diabetic Ketoacidosis Characteristics During- and Before the COVID-19 Pandemic.

Background: Despite evidence about the relationship between diabetic ketoacidosis (DKA) and infectious diseases, our knowledge of DKA during the coronavirus disease 2019 (COVID-19) pandemic remains unclear. Objectives: This study aimed to compare the DKA situation among individuals with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) during the COVID-19 pandemic compared to pre-pandemic. Methods: This retrospective-longitudinal study included individuals with T1DM and T2DM hospitalized with newly diagnosed DKA before (March to August 2018 and 2019) and during (March to August 2020 and 2021) the COVID-19 pandemic. Demographics, the frequency of new-onset diabetes mellitus (DM) and new-onset DKA, days of hospitalization, DKA severity, laboratory tests, and mortality were assessed. Results: Of 162 patients with DKA, 139 patients were newly diagnosed. The frequency of individuals with new-onset DM had increased during the pandemic compared to pre-pandemic (P = 0.047). Moreover, new-onset DKA was higher in 2020 and 2021 versus 2019 and 2018 (P = 0.002). Significantly, there were no T2DM patients with DKA in pre-pandemic, but DKA admissions in people with T2DM increased in 2021 (P < 0.001). The severity of new-onset DKA had increased during the pandemic compared to pre-pandemic (P = 0.000). However, there was no significant difference between pre-and the pandemic regarding mortality (P = 0.981). Additionally, hospitalization length (P = 0.043) and mortality (P = 0.038) were higher in patients with T2DM compared to T1DM. Conclusions: During the COVID-19 pandemic, the frequency of DKA and its severity was higher than in pre-pandemic, and COVID-19 can be more life-threatening in patients with T2DM. Therefore, healthcare providers should be alert to DKA, especially in patients with T2DM.

Investigation of Association Between Insulin Injection Technique and Blood Glucose Control in Patients with Type 2 Diabetes.

Background: The appropriate insulin injection skill is essential for optimal blood sugar control in patients with diabetes. However, the art of insulin injection is still not well understood in numerous medical centers. Objectives: This study was designed to determine the association between appropriate insulin injection and blood glucose control in patients with type 2 diabetes in Yazd, Iran. Methods: This cross-sectional study was conducted on 301 patients with type 2 diabetes who referred to Diabetes Research Center in Yazd within August 2020 to February 2021. Based on simple random sampling, the subjects with inclusion criteria, such as age >18 years, using an insulin pen for at least 3 months, and self-injection, were selected. The insulin injection technique was evaluated by a 13-item researcher-made questionnaire. The total score of this questionnaire was 26, and its validity and reliability were confirmed. The data were analyzed using SPSS software (version 20). Results: The mean age of the participants was 59.83 ± 10.26 years, and 60.1% had primary school or less education. Most participants (87%) used a needle more than five times, and almost half of them (53.5%) did not rotate the injection sites properly. The patients who reported pain during injection had statically lower injection scores than others (17.90 vs. 19.38, P = 0.001). There was a significant negative correlation between insulin injection score with fasting blood sugar (ß = -0.232, P < 0.001), two-hour postprandial glucose (ß = -0.164, P = 0.005), and hemoglobin A1c (HbA1c) level (ß = -0.263, P < 0.001). Conclusions: None of the patients in this study fully followed the principles of a proper injection, which can lead to pain during injection, lipohypertrophy, hyperglycemia, and increased HbA1c levels.

Maternal thyroid function test level during the first trimester of pregnancy at a center Yazd, Iran: A cross-sectional study.

BACKGROUND: Thyroid dysfunction is associated with negative pregnancy outcomes. There is a lack of reliable information on thyroid hormones in Iranian pregnant women, especially in Yazd. OBJECTIVE: To determine the safe thyroid hormone levels in women of Yazd and also the first trimester-specific reference ranges for serum thyroid-stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3). MATERIALS AND METHODS: In this cross-sectional study, the serum of 1,148 women in the first trimester of pregnancy was analyzed. Thyroid function tests (TSH, T4, T3) were measured through radioimmunoassay (RIA) [immunoradiometric (IRMA) for TSH]. The study was conducted in Yazd, from September 2018 to November 2019. Reference intervals were defined as the 5 th , 50 th , and 95 th percentiles. RESULTS: The mean age of the participants was 28.78 ( ± 5.86 yr) (range: 15-45 yr). The thyroid hormones reference intervals in the first trimester were TSH (0.2-3.8 mIU/l), T4 (7.45-12.75, µ g/dl), and T3 (100-217 ng/dl). CONCLUSION: The results of the present study determined a local thyroid function measurement in the first trimester of pregnancy at a center of Yazd, Iran. This could facilitate the decision-making of maternal TSH level during the first trimester of pregnancy.

Evaluation of hyperprolactinemia risk factors in infertile women referred to Yazd Infertility Center: A cross-sectional study.

BACKGROUND: Hyperprolactinemia is one of the most common causes of infertility in women. The prevalence of pituitary tumors is 25-30% among infertile participants with hyperprolactinemia. OBJECTIVE: The aim of this study was to describe the causes of hyperprolactinemia in infertile women referred to Yazd Infertility Center. MATERIALS AND METHODS: This cross-sectional study was conducted with 182 infertile women with hyperprolactinemia who were referred to Yazd Infertility Center from February 2018 to October 2019. Serum prolactin was assessed by the human prolactin ELISA kit according to the Padtan Gostar Isar protocol. The age, duration of infertility, causes of hyperprolactinemia, and type of infertility treatment were noted. The MRI findings were added. RESULTS: The mean age of participants was 28.9 ± 0.36 yr and the prolactin level was 76 ± 8.97 ng/ml. The etiology of hyperprolactinemia among the study participants was 35 participants (19.2%) with pituitary adenoma, 47 participants (25.8%) with polycystic ovary syndrome, 14 participants (7.7%) with pituitary adenoma and polycystic ovary syndrome, and 86 participants (47.3%) with idiopathic hyperprolactinemia. The results of this study showed that there was no statistically significant difference between the mean prolactin levels in participants with different causes of hyperprolactinemia (p = 0.31). CONCLUSION: Idiopathic hyperprolactinemia and polycystic ovary syndrome are the most common reasons for hyperprolactinemia.

Behavioral and familial predictors of diabetes mellitus in adults aged 20-69 in Yazd, Iran during 2014-2015.

INTRODUCTION: The present study aimed to assess the behavioral and familial predictors of diabetes mellitus as well as their interaction in the risk of diabetes mellitus type2. METHODS: The present cross-sectional study was conducted using the Yazd health study (YaHS) data which was collected in 2013-14. Statistical population of this study consisted of all 9340 individuals aged between 20 and 69 in Yazd City. Logistic regression was used to determine behavioral factors and family history of diabetes and their interaction in the risk of diabetes. RESULTS: In the present study, age, family history of type 2 diabetes, waist-to-hip ratio, BMI, educational level, physical activity and smoking were considered as the risk factors for type 2 diabetes.There was a significant interaction(negative interaction) between family history of diabetes and other risk factors only for BMI, so that the risk of developing type-2 diabetes was lower in the presence of two risk factors- family history of diabetes and BMI- than the risk of diabetes in the presence of each of these factors. CONCLUSION: Results of the present study suggested that despite the consideration of family history as an independent risk factor for type 2 diabetes, if it was used as a tool to raise the awareness and sensitivity in people with type 2 diabetes, it would reduce the risk of developing this type of diabetes in people who had other risk factors for type 2 diabetes.

Serum osteoprotegerin in relation to metabolic status, severity, and estimated risk of subsequent coronary heart disease.

BACKGROUND: Osteoprotegerin (OPG), a key factor in bone remodeling and vascular calcification, has been suggested to be associated with cardiovascular events. This study sought to assess the relationship between plasma OPG, anthropometric, metabolic status, severity and extent of coronary artery calcification, and the two-year recurrence risk of coronary event in patients with coronary heart disease (CHD). METHODS: A total of 155 consecutive patients with symptoms suggestive of CHD were enrolled in this cross-sectional study. Blood samples were taken for laboratory tests. Coronary angiography and cardiac CT scan were performed to assess the severity and extent of involved vessels. Two-year risk of subsequent CHD was estimated based on the computational Framingham risk prediction model. RESULTS: OPG level was in direct linear association with age (ß = 0.38, p < 0.001), waist to hip ratio (ß = 0.17, p < 0.05), hs-CRP (ß = 0.17, p < 0.05), systolic and diastolic blood pressure (ß = 0.17, p < 0.05; ß = 0.23, p < 0.01), and HbA1c (ß = 0.17, p < 0.05). After age-sex adjustment, only HbA1c (ß = 0.15, p < 0.05) was a significant indicator of serum OPG. OPG showed significant linear association with the coronary calcium score (CCS), and the number of involved vessels even after adjustment for age, sex, diabetes, blood pressure, and markers of bone-calcium metabolism (ß = 0.27, P < 0.05; ß = 29, P < 0.01). There is a significant positive association between two-year risk of subsequent CHD and serum OPG in females (ß = 0.45, P < 0.01) but not in males. CONCLUSION: Increased OPG is independently associated with the severity and extent of CHD. This study also proposes OPG as a potential marker in predicting the risk of subsequent CHD, in females.