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Background and purpose : Chromium deficiency leads to impaired glucose and lipid metabolism. Chromium supplementation in type II diabetic patients improves glucose and lipid profiles. Organic chromium, such as found in brewer’s yeast, is much better absorbed than inorganic chromium. In this study, the effect of chromium supplementation in the form of brewer’s yeast on glucose and lipid profile of diabetic patients were evaluated.
Materials and methods : In a clinical trial study (before and after) forty (32 women and 8 men) dyslipidemic diabetic patients without liver and cardiovascular diseases, 40-68 years old and BMI ³ 28 were randomly selected. Each patient received brewer’s yeast tablets containing 14.4 microgram chromium per day for 4 and 8 weeks. Fasting blood glucose, total cholesterol, HDL-C, LDLC and triglycerides were measured at the beginning and the end of 4 and 8 weeks after consumption of brewer’s yeast. A 24 hr dietary recall before and 4 and 8 weeks after consumption of brewer’s yeast were analyzed using Nutrition III software. Data were compared using paired t-test and x2-test as appropriate.
Results : There were no statistical significant changes in body weight, BMI, energy and macronutrient intake before and after brewer’s yeast tablet. Mean total cholesterol (p<0.05) and fasting blood sugar levels (p<0.04) were significantly decreased after 8 weeks consumption of brewer’s yeast tablets. Mean LDLC and triglyceride level were significantly (p<0.001) decreased after 4 and 8 weeks consumption of brewer’s yeast tablets. Mean HDLC level was significantly (p<0.001) increased after 4 and 8 weeks consumption of brewer’s yeast tablets. An negative relationship was found between total cholesterol, LDLC, HDLC and TG of primary concentration and percentage of changes during study for each parameters.
Conclusion : Improved glucose and lipid profile was noted in patients following 4 and 8 weeks consumption of brewer’s yeast tablets containing 14.4 microgram chromium per day. Also low chromium levels in diabetic patients,prevents diabetic patient from cardiovascular disease.

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Background and purpose: The newly updated American Diabetes Association guidelines based on evidence-based medical practice have proposed screening of the patients for neuropathy at the time of diagnosis with type II diabetes mellitus. However, the complex and extensive clinical manifestation of diabetic peripheral neuropathy and lack of objective evaluation indexes makes this screening rather troublesome. The goal of this study was screening of sensory peripheral neuropathy in type II diabetic patients in Ahvaz, Iran. Materials and methods: Our study population consisted of 150 patients treated for diabetes mellitus in the Clinic of Diabetes at the Ahvaz Jundishapur University of Medical Sciences. Non-randomized sampling method was used to select the participants. All patients were tested for sensory neuropathy using two different modalities of testing: 8 and 10 gram Semmes-Weinstein Monofilaments Examinations. In next phase nerve conduction velocity was examined. Then, sensitivity and specificity of 8 and 10 gram Semmes-Weinstein Monofilaments were analyzed. Results: Gram Semmes-Weinstein Monofilament had a sensitivity ranging from 30.8% to 64.1% at sites 1-10 while its specificity ranged from 64% to 89.2%. The sensitivity and specificity of 8 gram Semmes-Weinstein Monofilament were 28.2 to 64.1% and 62.2% to 88.3%, respectively. Conclusion: Semmes-Weinstein Monofilament is believed to be the best choice for clinical screening that has a good predictive ability for the risk of ulceration and amputation among people with diabetes.

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Background and purpose: Diabetes mellitus due to impaired insulin secretion, leads to short term and long term complications. Some of these complications are diabetic nephropathy and renal failure. The prevalence of diabetic nephropathy is 20-30% in Iran and 20% of type II diabetes and 75% of type I diabetes are affected in 20 years. Microalbuminuria has utmost importance as a marker of renal dysfunction in predicting the course and treatment of disease. The aim of this study was to evaluate microalbuminuria and diabetic nephropathy and their related risk factors in type II diabetic patients referred to endocrine clinics in Sari. Materials and methods: In this study, 914 patients with type II diabetes mellitus who referred to endocrine clinics in Sari from 2003 to 2009 were investigated on the 24-hour urine samples, fasting blood glucose, glucose 2 hours after a meal, glucose 4 pm and HbA1c. Data were entered into SPSS17 statistical software and statistical analysis was performed. Data were extracted from patient records. Results: The prevalence of microalbuminuria was 45% in this study. There was a significant correlation statistically between microalbuminuria and variables body mass index (P= 0.02), systolic blood pressure (P= 0.05), total cholesterol (P= 0.05), metformin (P= 0.033). Thus, the body mass index, systolic blood pressure and total cholesterol were higher in patients with microalbuminria. And the consumption of Metformin was lower in them. Conclusion: Microalbuminuria is a major problem in our patients and according to study findings, attention to control of blood pressure, reducing of serum cholesterol and weight in these patients is essential.

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Background and purpose: One of the important concepts in diabetic mellitus as a chronic disease is quality of life that it has extensive effects on social and individual performance.Due to the short-term and long- term effects and expensive costs of these diseases,the present study was carried out to determine the quality of life of these patients and finally was presented a structural model. Material and Methods: This study was performed on250patients with type IIdiabetes in Yazd.it was used from the questionnaire of standard quality of life(QOLID)as the data collection tool that contains a total of34questions and8domains Role Limitation Due to Physical Health,Physical Endurance,General Healt,Treatment Satisfaction,Symptom Bothe,Financial Worries,Emotional/Mental Health,Diet Satisfaction . Data were analyzed by using from spss(16) and amos(21)softwares. Results: in this study درصد 42 of the patients were male and درصد 58 were female.Betweenquality of lifeandage groupsEducation,income and smoking,there was significant relationship(P<0.05).According to the study, domains general health and physical endurance had the lowest mean.according to the result, diabetes in the domains on quality of life of diseases had the most influence.in structural model,Direct effect of endurance physically on general health,role limitation,mental healthand treatment satisfaction,was(0.69, 0.57, -0.29,0.19)respectively.Direct effect of general health and role limitations on Treatment Satisfaction was(0.30,-0.13) respectively.All of the direct effects were significanted at the level of 0.05.Indirect effect physical endurance on treatment satisfaction was0.28that it was significanted at the level of0.05. Conclusion: Diabetes is a chronic disease that severely effects on the patient's quality of life.Every attempt in predicting structural models of quality of life play a meaningful role in the solution of patient's problems.

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Background and purpose: The most important underlying cause of death in diabetic patients is the lack of self-care. One way to assess self-care skills in diabetic patients is the measurement of glycated hemoglobin (HbA1c). Different training programs are implemented to improve self-care behavior, however, the role of nurses in such trainings and counseling is neglected. The aim of this study was to compare the effect of group education versus group counseling for self-care on HbA1c in patients with diabetes type II. Materials and methods: In a clinical trial, 112 patients with type II diabetes mellitus attending Mashhad Parsian Diabetes Clinic in 2014 who were selected by convenience sampling. They were randomly allocated into three groups, counseling (n= 37), education (n = 37) and control (n= 38). Group counseling and group education were held for five sessions (1.5 hours each) every three days, in groups consisting of 8 to 10 patients. HbA1c test was performed before and two months after the intervention. Data was analyzed in SPSS V. 11.5 applying Paired sample T Test and ANOVA. Results: The groups did not show any significant differences in HbA1c levels before the intervention (P=0.133). But after the intervention, the HbA1c levels decreased significantly in patients who had group counseling (8.3±0.9) and group education (8.5±1.1) compared to the control group (9.1±1.4) (P=0.016). Conclusion: This study showed that group education and group counseling improved self-care behaviors in patients with diabetes, therefore, they could be highly beneficial when integrated into an educational program.

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Background and purpose: Diabetes is a chronic disease which requires lifelong use of drugs. These drugs have high costs, therefore, there is a need to find economic, efficient, simple, and local solutions. This study aimed to investigate the effect of oral supplementation of cinnamon on glucose and glycosylated hemoglobin (HbA1c) levels in patients with type II diabetes.
Materials and methods: This clinical trial was conducted in 136 patients with type II diabetes in Birjand, Iran 2015. They were randomly assigned into intervention or placebo groups (n=68 per group). Subjects in the intervention group received 500 mg of cinnamon three times a day after breakfast, lunch, and dinner for 90 days (1500 mg daily). While the other group were advised to take the placebo in the same manner. Fasting blood sugar and HbA1c levels were measured before and after the study.
Results: In this study, the levels of HbA1c reduced significantly in intervention group after the treatment (P≤0.05). Daily intake of 1500 mg of cinnamon for 90 days was found to be effective in reducing glycosylated hemoglobin levels, but it did not have a significant effect on reducing fasting blood sugar in 90 days (P≥0.05).
Conclusion: Daily dose of 1500 mg of cinnamon for 90 days significantly reduced the HbA1C levels in type II diabetic patients and also had a moderate effect on fasting blood sugar concentrations. Therefore, it is recommended alongside conventional medication used in treatment of type II diabetes mellitus.
(Clinical Trials Registry Number: IRCT2016100230098N1)
 
 

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Background and purpose: Today, cognitive-behavioral group therapy is empirically supported in treatment of emotional disorders and in some ​​chronic diseases such as diabetes. The aim of the present research was to study the effect of cognitive-behavioral group therapy on glycosylated hemoglobin (HbA₁c), self-efficacy, depression, illness perception, and quality of life in patients with type II diabetes.
Materials and methods: In this clinical trial, 43 patients were found eligible, of whom 30 were selected using simple random sampling and were divided into two groups: experimental and control. HbA1c was measured in all participants and they completed the Beck Depression Inventory (BDI), Self-efficacy in diabetic patients (DMSES), Illness Perception Questionnaire (IPQ), and Diabetes D-39. The experimental group attended 10 training sessions based on cognitive-behavioral therapy (Beck approach), for 1.5 hours, twice a week. The scales were completed again, after the intervention and a month later. The HbA1c was also measured again.
Results: The mean age of participants was 46.5±7.21 years. At first, both groups were heterogeneous in dependent variables. Cognitive behavioral group therapy decraesed depression (P=0.049) and increased illness perception (P=0.005) in patients with type II diabetes, but HbA1c, self efficacy, and quality of life did not change significantly.
Conclusion: In this study, cognitive-behavioral group therapy was found to have positive effects on reducing depression and increasing the illness perception in diabetic patients. Hence, it is suggested along with current treatments in type II diabetes.
 

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Background and purpose: The boundary between bipolar disorder and borderline personality disorder has always been a matter of debate. Despite the importance of this issue, only a few studies have directly compared these two groups. The main purpose of this study was to compare the cognitive profile of patients with bipolar disorder and borderline personality disorder in terms of attentional bias.
Materials and methods: In this causal-comparative study, attentional bias was compared between 52 patients with bipolar II disorder and 50 patients with borderline personality disorder attending cognitive disorder and psychological clinics in Babol, Iran. Also, 50 healthy individuals were studied as control group. Dot-probe task was done and Young Mania Rating Scale was completed. Data were then analyzed using independent T-test.
Results: The mean age and sex (F and M) of patients with bipolar II and borderline disorders and healthy controls were 25±1.73 (52% and 48%), 27.33±2.87 (61% and 39%), and 26.47±2.34 (50% and 50%), respectively. Mean scores for attentional bias in control group and patients with bipolar II and borderline disorders were 11.36±6.57 (P=0.0012), 19.67±6.85 (P=0.0025), and 16.26±5.85 (P=0.003), respectively.  
Conclusion: In current study, both patient groups had poor performance in attentional bias tasks compared with control group. Patients with bipolar disorder showed more deficits in attention bias than patients with borderline personality disorder and healthy individuals. According to the differences in attention bias found in this study, cognitive studies may help to clarify the boundaries between bipolar disorder and borderline personality disorder.

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Schmidt syndrome is a polyendocrinopathy characterized by multiple organ failures. Patients with two or more of the following characteristics are diagnosed with this syndrome: Graves' disease, adrenal insufficiency, autoimmune thyroiditis, and type I diabetes. The present case report concerns a Schmidt syndrome patient (polyglandular autoimmune syndrome type II). The patient is a 42-year-old woman with type I diabetes and complaints of imbalance, weakness and lethargy, weight loss, darkened skin, blood pressure drop, hypoglycemia, and hyperkalemia who visited the Hospital frequently and was discharged every time after intravenous potassium chloride and dextrose injections and orders to reduce insulin consumption at home. Her blood cortisol level was measured in her last visit with suspicion of adrenal insufficiency, which was revealed to be low (less than 0.5 μg/dL). A high ACTH, low aldosterone, and normal renin were also reported, indicating secondary adrenal insufficiency. Furthermore, T4 and TSH tests were performed, reporting a TSH lower than 0.2 in the initial TSH test, which was revealed to be normal after the test was repeated. Subclinical hyperthyroidism was indicated, given the high TRAb figure. The patient underwent treatment with fludrocortisone and prednisolone, which improved her condition. This report accentuates that diabetic patients with reduced insulin requirements must be checked for adrenal insufficiency immediately to prevent potential complications.