Management goal achievements of diabetes care in Iran: study profile and main findings of DiaCare survey.

Aim: This paper presented the methodology and main findings of a population-based survey to determine diabetes care status among type 2 diabetic subjects in Iran. The current study assessed treatment goal achievements in type 2 diabetics, diabetes care service utilization, prevalence of diabetes complications, and psychological effects of diabetes in a representative sample of Iranian population in urban and rural areas. Materials and Methods: This nationwide study was conducted between 2018 and 2020 as the observational survey entitled "Diabetes Care (DiaCare)". We studied a representative sample of participants with type 2 diabetes, aged 35-75 years, living in urban and rural areas in all thirty- one provinces of Iran. Data were collected by an interviewer in a form of a questionnaire that includes demographic and socioeconomic status, family and drug history, lifestyle, and self-reported psychological status according to a Patient's Health Questionnaire (PHQ). Management goal achievements, diabetes care service utilization, diabetes complications and psychological effects of diabetes were also assessed. Physical measurements were measured based on standard protocol. Fasting blood glucose (FBG), HbA1c, lipid profile, and also urine albumin to creatinine ratio were obtained from all participants of the study. Results: Overall, 13,334 people with type 2 diabetes in 31 provinces of Iran completed the survey (response rate: 99.6%). In total 13,321 participants, 6683(50.17%) women and 6638(49.83%) men were included in our analysis. Thirteen recruited patients refused after the consenting process and did not respond. The mean age (SD) of total participants was 54.86 ± 9.44 years and 71.50% were from the urban areas. 13.66% of diabetic patients had achieved the triple target of management [controlled HbA1c, blood pressure, and Low-Density Lipoprotein-Cholesterol (LDL-C)] in the whole country. While 28.74% of people had controlled HbA1c and 33.40% of them had controlled FBG. Diabetic subjects living in rural areas had less controlled HbA1c (23.93 vs. 29.48), controlled FBG (29.50 vs. 34.20) and controlled triple targets (10.45 vs. 14.32) than those living in urban areas. Diabetic neuropathy and diabetic foot were more common in women than men, while end-stage of renal disease (ESRD) was more common in men than women. Conclusions: This population-based study provided representative information about diabetes care in Iran. The high prevalence of diabetes and low proportion of diabetes control in Iran implies that it is necessary to identify factors associated with poor treatment goal achievements. Besides, general improvements in management and care of diabetes are mandatory.

Epidemiology of diabetes in Iran: A scoping review of studies published during 2015-2019.

Background: Proper synthesis of existing epidemiologic studies on diabetes in Iran can guide future research efforts. We aimed to conduct a comprehensive scoping review on all research articles that investigated any aspect of diabetes epidemiology in Iran during 2015-2019. Methods: This work was conducted as a part of the Iran Diabetes Research Roadmap and completed under Arksey and O'Malley's framework for scoping reviews. The Scopus and PubMed databases were searched on Feb 15th, 2020. Eligible document types on diabetes epidemiology in the Iranian population, in Persian or English, that published during the 2015-2019 period underwent eligibility assessment. A total of 315 relevant articles were included and further analysis was performed on the original studies (n = 268). Through classifying them into six domains: Diabetes incidence; the prevalence of diabetes and associated factors; the incidence/prevalence of complications/comorbid conditions; mortality/survival; burden; and prediction modeling. Results: In total, 64 (20.3%) papers were published in Q1 journals, and 40 (12.6%) were international collaborations. No clear annual trend was present in the number of published primary or secondary articles, the portion of papers published in Q1 journals, international collaborations or relative domain proportions. Few review articles were found on prediction modeling, mortality or burden (excluding global studies). Conclusions: Our findings show a minor portion of works on diabetic epidemiology in Iran meets the quality standards of Q1 journals. Researchers have neglected some critical subjects and have occasionally fallen for common pitfalls of epidemiologic research. In particular, adhering to established guidelines can help authors implement rigorous methods to develop, validate, and deploy practical clinical prediction models. Researchers should prioritize investigating longitudinally collected data that aid in measuring disease incidence and enable casual inference. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-022-01094-0.

The global scientific publications on gut microbiota in type 2 diabetes; a bibliometric, Scientometric, and descriptive analysis.

Background: Modifying gut dysbiosis has achieved great success in managing type 2 diabetes mellitus (T2DM) and also T2DM affected the gut microbial composition. Objectives: To determine the research trend of scientific publications on the relationship between gut microbiota and T2DM through a bibliometric and descriptive approach. Method: We included originals and reviews related to both topics of gut microbiota and T2DM through searching in Scopus up to 31 December 2019 and then characterized their bibliometric profiles including the number of publications, citations, institutions, journals, countries, and the collaboration network of authors, countries, terms and keywords. Moreover, we performed a descriptive evaluation of the clinical trials based on their intervention type and its influence on gut dysbiosis. Results: We achieved 877 articles (436 originals and 441 reviews) according to our inclusion criteria. The annual publications were constantly increased over time and reached 220 publications in 2019. Out of 436 original articles, 231 animal studies and 174 human studies were found. The majority of human studies were clinical trials (n = 77) investigating the influence of drugs (n = 21), regimens (n = 21), pre/pro/symbiotic (n = 19), surgeries (n = 15), or both drug and regimen (n = 1) on gut dysbiosis. Roux-en-Y gastric bypass and metformin were assessed the most in these trials. Obesity side by side T2DM has been assessed in this area of literature based on term and keyword analyses showing their possible similar pathways mediated by gut microbiota. Conclusion: The exponentially growing documents on gut microbiota and T2DM had been published during the last decade and revealed gut microbiota alteration mediated antidiabetic effect of many interventions. Thus, we suggest other researchers to consider this pathway in efficacy assessment of therapeutic modalities and to find the optimal composition of gut microbiota that guarantees healthy insulin sensitivity. Supplementary Information: The online version contains supplementary material available at 10.1007/s40200-021-00920-1.

The roles of personalized nutrition in obesity and diabetes management: a review.

Background & Aims: Nutrition is one of main environmental factor affecting obesity and its related complications such as diabetes and dyslipidemia. Due to growing prevalence of obesity across the world, it seems that nutritional advice alone is not able to combat this health problem. The present overview aimed to summarize the roles of personalized nutrition (PN) in obesity and diabetes management. Methods: Scopus, PubMed and Google scholar were searched up to February 2021 to find relevant studies with English language in which the roles of PN in obesity and diabetes management were examined. Results: Recent evidence revealed the importance of gene-environment interactions for management of diabetes mellitus and obesity. Moreover, microbiome research showed that personalized diet based on a combination of clinical and microbial features is likely to improve responses to therapeutic interventions. Epigenetics as well as genetic and environmental factors can also contribute to the treatment. In addition, articles showed significant roles of epigenetics and gut microbiome on providing an individualized diet for obese and diabetic patients. Conclusion: PN compare to conventional diet can better improve metabolic status in obese and diabetic patients. Considering genetic differences and microbiome patterns along with environmental factors and their interactions are recommended for obesity and diabetes management. This approach can increase success in promoting health and preventing complications related to diabetes and obesity.

Immunopathology of Type 1 Diabetes and Immunomodulatory Effects of Stem Cells: A Narrative Review of the Literature.

Type 1 Diabetes (T1D) is a complex autoimmune disorder which occurs as a result of an intricate series of pathologic interactions between pancreatic ß-cells and a wide range of components of both the innate and the adaptive immune systems. Stem-cell therapy, a recently-emerged potentially therapeutic option for curative treatment of diabetes, is demonstrated to cause significant alternations to both different immune cells such as macrophages, natural killer (NK) cells, dendritic cells, T cells, and B cells and non-cellular elements, including serum cytokines and different components of the complement system. Although there exists overwhelming evidence indicating that the documented therapeutic effects of stem cells on patients with T1D are primarily due to their potential for immune regulation rather than pancreatic tissue regeneration, to date, the precise underlying mechanisms remain obscure. On the other hand, immune-mediated rejection of stem cells remains one of the main obstacles to regenerative medicine. Moreover, the consequences of efferocytosis of stem-cells by the recipients' lung-resident macrophages have recently emerged as a mechanism responsible for some immune-mediated therapeutic effects of stem-cells. This review focuses on the nature of the interactions amongst different compartments of the immune systems which are involved in the pathogenesis of T1D and provides an explanation as to how stem cell- based interventions can influence immune system and maintain the physiologic equilibrium.

Diabetic Foot scientific activities in Endocrinology and Metabolism Research Institute.

INTRODUCTION: Diabetic Foot (DF) as a common complication of Diabetes should be intensive intervention for prevention, management and rehabilitation. In this regard, Diabetes Research Center of Endocrinology and Metabolism Research Institute (EMRI) of Tehran University of Medical Sciences (TUMS) considered DF as a priority research area to investigate multidimensional aspects of DF care. We are intended to summarize DF research studies affiliated to the EMRI for over the last two decades. METHODS: Three Electronic databases including Web of Science, PubMed, and Scopus were searched until January 2020 to find articles about DF published affiliated to EMRI. The main concepts of search strategies were "diabetes", "Foot". 115 documents retrieved from these databases which screened for inclusion and exclusion criteria. The visualization of the network of co-authorship of authors and co-occurrence of keywords was illustrated and documents were analyzed for content according to the Main areas of DF Research studies. RESULT: 64 related documents including original articles, reviews, letters, notes, and book chapter have included to this study. According to the objectives of the retrieved studies, DF documents and research studies categorized in the two main groups including DF prevention, classification and risk stratification in addition management of DF. CONCLUSION: Despite conducted research and educational activities in DF prevention and management, the following topics would be considered as well: effective offloading treatment, correcting the nutritional status for improving wound healing and novel educational strategies for diabetic foot multi-disciplinary team.

Knowledge discovery in genetics of diabetes in Iran, a roadmap for future researches.

PURPOSE: The pathogenesis of diabetes is considered polygenic as a result of complex interactions between genetic/epigenetic and environmental factors. This review intended to evaluate the scientometric and knowledge gap of diabetes genetics researches conducted in Iran as a case of developing countries, and drawn up a roadmap for future studies. METHODS: We searched Scopus and PubMed databases from January 2015 until December 2019 using the keywords: (diabetes OR diabetic) AND (Iran). All publications were reviewed by two experts and after choosing relevant articles, they were categorized based on the subject, level of evidence, study design, publication year, and type of genetic studies. RESULTS: Of 10,540 records, 428 articles were met the inclusion criteria. Generally, the number of researches about diabetes genetics rose since 2015. Case-control/cross-sectional and animal studies were the common types of study design and based on the subject, the most frequent researches were about genetic factors involved in diabetes development (38%). Briefly, the top seven genes that were evaluated for T2DM were TCF7L2, APOAII, FTO, PON1, ADIPOQ, MTHFR, and PPARG respectively, and also, CTL4 for T1DM. miR-21, miR-155, and miR-375 respectively were the most micro-RNAs that were evaluated. Furthermore, there were six studies about lncRNAs. DISCUSSION AND CONCLUSION: Investigation about the genetic of diabetes is progressed although there are some limitations like non-homogenous data from Iran, heterogeneity of ethnicity, and rationale of studies. Compared to the previous analysis in Iran, still, GWAS and large-scale studies are required to achieve better policies for manage and control of diabetes disease. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40200-021-00838-8.

Assessment of immune-alternations and their correlations with therapeutic outcomes of transplantation of autologous Mesenchymal and Allogenic fetal stem cells in patients with type 1 diabetes: a study protocol.

INTRODUCTION: Stem-cell therapy, which has recently emerged as a potentially therapeutic option for diabetes, is demonstrated to significantly alter both cellular and non-cellular elements of the immune system. In addition, it is demonstrated that allogenic stem-cells, once considered immune-privileged, can be rejected by the host immune system almost similar to any other somatic cell. To date, nonetheless, details of these intricate interactions remain obscure. The current study is designed to illuminate both aforementioned favorable and unfavorable stem cell-mediated immune reactions. Findings of this study may shed some light on how stem cells may exert their therapeutic effect in type 1 diabetes through immune system-mediated mechanisms and illuminate the partially-obscure immune-caused rejection of these cells. METHODS AND ANALYSIS: For the purpose of this study, frozen whole blood samples obtained from patients with type 1 diabetes who received stem cells at the Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences in two different clinical trials will be thawed and analyzed. These clinical trials were carried out using two different sources of stem cells, namely allogenic fetal and autologous mesenchymal cells. The samples we aim to analyze were obtained from the patients before the procedure and regularly after it, one, three, six, 12, and 24 months later. For the purpose of this study, the following parameters will be measured: C-peptide levels, IDAA1c (a surrogate marker of beta cell function which is calculated as HbA1c (%) + [4 × insulin dose (units per kilogram per day)]), frequencies of islet-specific autoreactive CD8+ T cells (CTL), different lymphocyte subsets, thymic function indicators, T cell repertoire diversity (including Treg/Tconv ratios), plasma levels of several pro- and anti-inflammatory cytokines, diabetes autoantibodies, and HLA typing. ETHICS AND DISSEMINATION: The stem cell transplantation clinical trials which provided the primary source of our samples were carried out at the Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences between 2008 and 2012. These series of clinical trials have secured approval of the ethics committee of Tehran University of Medical Sciences (ethical code number: E-0089) and registered on the national clinical trial registry of Islamic Republic of Iran (IRCT) with the identifier codes: IRCT138810271414N8 (for autologous mesenchymal cells) and IRCT201103171414N23 (for allogenic fetal cells). Our findings are to be presented at international scientific events, published in peer-reviewed journals, and disseminated both electronically and in print. Besides, results of the current study will be used for design and implementation of future laboratory investigations and clinical trials at the Endocrinology and Metabolism Research Institute of Tehran University of Medical Sciences.

Association of microRNA gene polymorphisms with Type 2 diabetes mellitus: A systematic review and meta-analysis.

BACKGROUND: Type 2 diabetes mellitus (T2DM) is a metabolic disorder with growing prevalence and increasing economic burden. Based on the role of genetics and epigenetic factors on T2DM, we aimed to carry a systematic review and meta-analysis for all miRNA gene polymorphisms and risk of T2DM. MATERIALS AND METHODS: A computerized literature search was carried out on PubMed, Web of Science, Scopus, Embase, as well as references of relevant review/meta-analysis. Key search terms were "Diabetes Mellitus, Type 2," "MicroRNAs," and "Polymorphism, Single Nucleotide." All types of observational studies from January 1, 1992, to November 30, 2019, were included, without language restriction. Data analysis was performed using R programming language (3.5.2). Level of heterogeneity was obtained by Cochran's Q test (P < 0.05), and subgroup analysis was performed based on ethnicity. RESULTS: Thirty-two polymorphisms from fifteen articles were included. Meta-analysis was carried out based on minor allele frequencies. Seven studies with 2193 cases and 3963 controls were included for rs2910164 polymorphism. In subgroup analysis, there were significant results in Caucasian population in dominant model (odds ratio [OR] =1.12; 95% confidence interval [CI]: 0.83-1.51), homozygote model (OR = 1.78; 95% CI: 1.06-3.00), heterozygote model (OR = 1.77; 95% CI: 1.03-3.05), and recessive model (OR = 1.78; 95% CI: 1.07-2.96). Four studies with 2085 cases and 1933 controls were included for rs895819 polymorphism. Overall, there was no significant result for association with rs895819, but subgroup analysis revealed that minor allele significantly decreased the risk of T2DM in Caucasians by recessive model (OR = 0.34; 95% CI: 0.18-0.66), dominant model (OR = 0.70; 95% CI: 0.52-0.94), homozygote model (OR = 0.32; 95% CI: 0.16-0.62), heterozygote model (OR = 0.37; 95% CI: 0.19-0.74), allelic model (OR = 0.67; 95% CI: 0.52-0.85). CONCLUSION: The minor allele of rs2910164 may increase the risk of T2DM by leading to lower level of miR-146a. In contrast, minor allele of rs895819 may decrease the risk of T2DM by leading to higher level of miR-27a.

Diabetes management during Ramadan amid Covid-19 pandemic.

Management of fasting patients with diabetes during Ramadan has always posed a great challenge on clinicians. This year, Ramadan has coincided with the Covid-19 pandemic which per se can complicate diabetes care. Although patients with diabetes should be generally discouraged from fasting, those who insist to fact during the current Covid-19 pandemic should undergo strict risk assessment and receive thorough education. In patients with type 2 diabetes, administered antidiabetics and their dose should be modified to minimize the risk of hypoglycemia and dehydration. In type 1 diabetic patients, insulin dose and it timing should be precisely calculated based on regular and rigorous blood glucose monitoring. Nonetheless, it would be prudent to generally discourage patients with diabetes form fasting this Ramadan to avoid the risk of life-threatening complications such severe dehydration and ensuing kidney damage.

Design and synthesis of new fused carbazole-imidazole derivatives as anti-diabetic agents: In vitro α-glucosidase inhibition, kinetic, and in silico studies.

Twenty three fused carbazole-imidazoles 6a-w were designed, synthesized, and screened as new α-glucosidase inhibitors. All the synthesized fused carbazole-imidazoles 6a-w were found to be more active than acarbose (IC50 = 750.0 ±â€¯1.5 µM) against yeast α-glucosidase with IC50 values in the range of 74.0 ±â€¯0.7-298.3 ±â€¯0.9 µM. Kinetic study of the most potent compound 6v demonstrated that this compound is a competitive inhibitor for α-glucosidase (Ki value = 75 µM). Furthermore, the in silico studies of the most potent compounds 6v and 6o confirmed that these compounds interacted with the key residues in the active site of α-glucosidase.

Comparison of glomerular filtration rate estimation using Jaffé and enzymatic creatinine assays in diabetic patients.

BACKGROUND: Diabetic kidney disease (DKD) develops an end-stage renal failure and is a major cause of death in diabetic patients. A GFR below 60 ml/min per 1.73 m2 is one of the main markers of DKD. Therefore, the development of an accurate test for diagnosis and monitoring of the mentioned disease would be essential. Here, we examined the impacts of two different kits with different methods for creatinine measurement on the GFR values. METHODS: Blood samples were collected from 80 diabetic patients referring to the clinical laboratory. The levels of serum creatinine were assessed using Jaffé and enzymatic assays by kits from two different manufacturers. Then to assess the eGFR levels, the MDRD equation was used. Further descriptive parameters of both methods and correlation of methods were also calculated. RESULTS: Descriptive analysis of the data demonstrates a slight increase in the serum creatinine measured by Jaffé assay which leads to a substantial decrease in the levels of eGFR compared to the eGFR calculated by the enzymatic assay. Moreover, eGFR over 60 mL/min/1.73 m 2 in enzymatic assay was observed in 27.5% of participants while eGFR of the same participants was below 60 mL/min/1.73 m 2 when it was measured by Jaffé method. Consequently, 27.5% positive discordant cases were reported by Jaffé assay followed by misclassifying them as DKD patients compared with the enzymatic assay. CONCLUSION: While using Jaffé assay, a low level of eGFR is observed which generates more misclassification into the DKD group and demands to an inclusive consideration by physicians in order to diagnose and monitor the DKD patients.

Conceptual map of diabetes education: necessity of establishing iran diabetes academy.

Diabetes Mellitus as a one of common non communicable diseases needs to be managed using multidisciplinary and coordinated approach. Incidentally, Clinical practice guidelines along with Continuing Medical Education (CME) would be essential section in this approach. In this regard Iran Diabetes Academy (IDA) affiliated Endocrinology and Metabolism Research Institute (EMRI) of Tehran University of Medical Sciences (TUMS) was established in 2017. IDA intended to provide and deliver appropriate source of updated information for all health care providers in field of diabetes prevention, management and rehabilitation.

Design and synthesis of novel quinazolinone-1,2,3-triazole hybrids as new anti-diabetic agents: In vitro α-glucosidase inhibition, kinetic, and docking study.

A novel series of quinazolinone-1,2,3-triazole hybrids 10a-p were designed, synthesized, and evaluated for their in vitro α-glucosidase inhibitory activity leading to efficient anti-diabetic agents. All synthesized compounds exhibited good inhibitory activity against yeast α-glucosidase (IC50 values in the range of 181.0-474.5 µM) even much more potent than standard drug acarbose (IC50 = 750.0). Among them, quinazolinone-1,2,3-triazoles possessing 4-bromobenzyl moiety connected to 1,2,3-triazole ring (10g and 10p) demonstrated the most potent inhibitory activity towards α-glucosidase. Compound 10g inhibited α-glucosidase in a competitive manner with Ki value of 117 µM. Furthermore, the binding modes of the most potent compounds 10g and 10p in the α-glucosidase active site was studied through in silico docking studies. Also, lack of cytotoxicity of compounds 10g and 10p was confirmed via MTT assay.

Biology-Oriented Drug Synthesis (BIODS) Approach towards Synthesis of Ciprofloxacin-Dithiocarbamate Hybrids and Their Antibacterial Potential both in Vitro and in Silico.

A novel series of ciprofloxacin-dithiocarbamate hybrids 7a - 7l were designed, synthesized, and evaluated against Gram-positive and Gram-negative bacteria. A significant part of the title compounds showed considerable antibacterial activity against Gram-positive species. The most potent compound against Gram-positive bacteria was 2-chloro derivative 7h and the most potent derivative against Gram-negative bacteria was 3-chloro compound 7i. In vitro antibacterial evaluation of compound 7h against clinically isolated bacteria methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA) showed that this compound acted better than ciprofloxacin against the latter bacteria. Docking study of compound 7h in the active site of S. aureus DNA gyrase revealed that this ciprofloxacin-dithiocarbamate derivative interacted with the main components of the active site of the enzyme.

Resveratrol supplementation decreases blood glucose without changing the circulating CD14+CD16+ monocytes and inflammatory cytokines in patients with type 2 diabetes: a randomized, double-blind, placebo-controlled study.

Chronic low-grade inflammation is the hallmark of type 2 diabetes (T2D). Although in vitro and animal studies have shown that resveratrol exerts anti-inflammatory effects, clinical trials addressing these effects in patients with T2D are limited. Therefore, in the present study, we hypothesized that supplementation of resveratrol might improve inflammatory markers in patients with T2D in a randomized, double-blind, placebo-controlled clinical trial. A total of 45 T2D patients were supplemented with either of 800 mg/d resveratrol or placebo capsules for 8 weeks. Percentage of CD14+CD16+ monocytes, plasma levels of inflammatory cytokines (tumor necrosis factor α, interleukin [IL] 1ß, IL-6, and monocyte chemoattractant protein-1), the expression levels of genes involved in the inflammatory responses (toll-like receptor 2, toll-like receptor 4, and nuclear factor κB), lipopolysaccharide-stimulated cytokine (tumor necrosis factor α, IL-1ß, and IL-6) secretion from peripheral blood mononuclear cells, and metabolic and anthropometric parameters were assessed at both the baseline level and the end of the study. Compared with the placebo group, we could not detect any significant difference in the percentage of CD14+CD16+ monocytes, lipopolysaccharide-induced cytokine secretion, plasma levels of inflammatory cytokines, and the expression of inflammatory genes in resveratrol group. Moreover, we did not find any significant change in the metabolic and anthropometric parameters except for a significant reduction in fasting blood glucose and blood pressure. In conclusion, 8-week supplementation of resveratrol reduces blood glucose level in patients with T2D without improving their inflammatory markers.

Decreased Serum Level of miR-155 is Associated with Obesity and its Related Metabolic Traits.

BACKGROUND: Type 2 diabetes is the most common metabolic disease, affecting many of the adult population all around the world. In recent years much attention has been paid to the role of circulating miRNAs as novel biomarkers for various diseases. The aim of this study was to investigate the expression level of miR-155 in serum samples of diabetic and healthy subjects. METHODS: 42 healthy and 45 type 2 diabetic subjects participated in the study. Serum miR-155 level of the subjects was measured using real-time PCR. The levels of IL-6 and TNF-α were quantified using ELISA. RESULTS: There was no significant difference in the level of miR-155 between the diabetic and non-diabetic groups. The level of miR-155 in non-diabetic obese group was significantly lower than the non-diabetic lean subjects. Correlation analyses in non-diabetic group revealed a significant negative correlation between the amount of miR155 and body mass index and cholesterol levels after the elimination of the confounding factors. In diabetic group, a negative correlation was found between miR-155 and insulin, HOMA-IR, and waist circumference levels. Furthermore, no significant relationship between miR-155 and inflammatory cytokines (TNF-α and IL-6) was observed in both diabetic and healthy groups. CONCLUSIONS: A reduced level of miR-155 might associate with obesity and its related metabolic traits such as hyperinsulinemia and dyslipidemia.

Association Between the Polymorphism of Glu298Asp in Exon 7 of the eNOS Gene With Foot Ulcer and Oxidative Stress in Adult Patients With Type 2 Diabetes.

OBJECTIVES: Diabetic foot ulcer (DFU) is a common and major manifestation in patients with diabetes. Oxidative stress (OS) plays an important role in diabetic complications, such as DFU. Nitric oxide deficiency contributes to the impairment of diabetic wound healing. The aim of this study was to examine the association between the eNOS Glu298Asp polymorphism and DFU and oxidative stress in patients with type 2 diabetes mellitus in an Iranian population. METHODS: In this case-control study, 123 patients with type 2 diabetes and DFU and 134 patients without DFU were recruited. The genotypes of eNOS Glu298Asp polymorphism in exon 7 were determined by the polymerase chain reaction-restriction fragment length polymorphism analysis. We measured the levels of thiobarbituric reactive substances and ferric-reducing ability of plasma as the potential markers of OS. RESULTS: There were significant differences in genotype frequencies of eNOS Glu298Asp polymorphism between case and control groups (GG+TG vs. TT; p=0.002; OR=0.22, 95% CI 0.83 to 0.62). Also, the frequency of the T allele in cases was less common than in controls (p=0.004). There was no significant difference in levels of OS parameters and various genotypes (p>0.05). CONCLUSIONS: These results imply that the T allele might be protective against DFU.

Diabetes in Iran: Prospective Analysis from First Nationwide Diabetes Report of National Program for Prevention and Control of Diabetes (NPPCD-2016).

We estimated proportions of different types of diabetes, comorbidities, treatment (the use of oral glucose-lowering agents and insulin), control (hyperglycemia, dyslipidemia and hypertension) and chronic microvascular and macrovascular complications among people with diabetes presenting to the tertiary-care academic diabetes outpatient clinics in Iran. This study is the prospective analysis of data (n = 30,202) from the registry of university-affiliated adult outpatient diabetes clinics in the country during 2015-2016. The proportions of type 1 diabetes, types 2 diabetes, and other types of diabetes were 11.4%, 85.5%, and 1.3%, respectively. The frequencies of drug-naivety, use of oral agents, insulin monotherapy and insulin combination therapy were 2.9%, 60.5%, 11.5%, and 25.1%, respectively. Around 13.2%, 11.9% and 43.3% of patients with diabetes had controlled hyperglycemia, hyperlipidemia and hypertension, respectively. The proportions of retinopathy, nephropathy, peripheral neuropathy, diabetic foot, and ischemic heart disease were 21.9%, 17.6%, 28.0%, 6.2%, and 23.9%, respectively. Despite the wide availability of medications and insulin coverage in Iran, the estimated national control of hyperglycemia, hyperlipidemia and hypertension (especially for young men and old women) remains subpar. The present study further suggests that the frequencies of chronic vascular complications among patients with diabetes are relatively high in Iran.