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Abstract: This study was performed to compare the clinical value of fructosamine and glycosylated hemoglobin for the evaluation of NIDDM. In this study, 100 cases of NIDDM (50 males, 50 females) and 100 control subjects (60 male, 40 female) were selected. Venous blood samples were collected at fasting status to measure fasting blood glucose (FBG), glycosylated hemoglobin, albumin and fructosamine. Significant correlation between FBS with serum levels of glycosylated hemoglobin (r=0.64, P<0.001) and fructosamine (r=0.34, P<0.001) was observed in patients versus control group (r=0.3, P<0.001, and r=0.5, P<0.001, respectively). There was also significant correlation between serum levels of glycosylated hemoglobin and fructosamine (r=0.99, P<0.001). The results of this study demonstrated that fructosamine measurement is an appropriate parameter for evaluation of NIDDM control.

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Abstract: To determine the association of serum apolipoprotein (apo) A-I and apo B concentrations, and paraoxonase (PON) high-density lipoprotein (HDL) associated enzyme activity with angiographically determined coronary artery disease (CAD) in Iranian diabetic and nondiabetic CAD patients and nondiabetic control subjects, 251 subjects aged 30-70 years, who underwent their first coronary angiography were matched and randomly assigned into three groups: CAD+DM+, CAD+DM-, and CAD-DM- (control). Stenosis of >= 50% in 1 or more coronary arteries was classified as CAD+. CAD- was defined as a maximum stenosis of 10% in any coronary artery. Fasting serum concentrations of cholesterol (TC), triglycerides (TGs), LDL-C, HDL-C, apo A-I, apo B, and PON activity were determined. Apolipoprotein concentrations were measured in a fasting serum sample by immunoturbidometric assay and paraoxonase/arylesterase activities by spectrophotometric assay of p-nitrophenol/phenol production following addition of paraoxon/phenylacetate. Information concerning nonlipid risk factors were collected by questionnaires. No significant difference was observed in HDL-C, LDL-C, apo A-I, and PON/arylesterase activity between the study groups. The values of TC (213 ± 38 vs 196 ± 45, p<0.05), TGs (209 ± 187 vs 151 ± 113, p<0.005), apo B (99 ± 22 vs 96 ± 24, p<0.0001), TC/HDL-C (4.8 ± 1.5 vs 4.0 ± 1.3, p<0.001), and LDL-C/HDL-C (2.9 ± 1.1 vs 2.4±1.1, p<0.05) were higher and apo A-I / apo B (1.7 ± 0.4 vs 2.0 ± 0.6, p<0.01) was lower in CAD+DM+ patients than in control subjects. In CAD+DM- group, only the level of apo B (96 ± 24 vs 85 ± 18, p<0.01), and the ratio of apo A-I/apo B (1.8 ± 0.4 vs 2.0 ± 0.6, p<0.01), were significantly higher than those of control group. On multiple logistic regression analysis, the best markers for discrimination between CAD+ groups and CAD- control subjects were the ratio of apo A-I/apo B in diabetic and apo B in nondiabetic patients. The results suggest that in Iranian diabetic and nondiabetic patients with CAD the concentration of apolipoproteins are better markers than traditional lipid parameters in discriminating between CAD+ and CAD- subjects. Lack of significant difference in PON activity between CAD+ patients and CAD- controls supports the concept of interethnic variability in PON polymorphism and unimodal distribution of its activity in non-Europid populations observed in other studies.

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Abstract: Finding a simple clinical method for early and cost-effective diagnosis of osteomyelitis in diabetic patients is of great importance due to high prevalence of diabetic foot infection and the devastating outcome of osteomyelitis. Bone involvement in diabetic foot infection is due to local spread not hematogenous spread. Therefore, bone exposure predisposes bone to osteomyelitis. In this study, diabetic foot ulcers were examined by sterile probe (D/E) to detect exposed bone in the depth of the ulcer and the results were compared with the results of other clinical and paraclinical methods. This study was performed on 35 cases admitted in Imam Khomeini Hospital with a total of 37 pedal ulcers in 1998. Among 37 evaluated ulcers, 17 were positive on probing and 20 were negative on probing. Among 17 positive ulcers, 13 had osteomyelitis. Among 20 ulcers with negative probing, only 5 ulcers had osteomyelitis. The sensitivity, specificity and positive predictive value of bone touch by probing were %78.9, %76.4 and %75, respectively. So, there is strong association between bone touch by probing in the depth of diabetic foot ulcers with the presence of osteomyelitis.

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Abstract: Tehran Lipid and Glucose Study is a study to determine the risk factors for atherosclerosis among Tehran urban population and develop population-based measures to change the lifestyle of the population and prevent incidence of diabetes mellitus and dyslipidemia. 17000 men and women between 3 and 69 years of age are randomly sampled from Tehran urban district 13 for assessment of conventional (i.e. smoking, diabetes and hypertension) and emerging (i.e. glucose intolerance, obesity, physical activity and diet) cardiovascular risk factors. In the baseline examination a general questionnaire on persons’ health condition and risk factors is filled up and a brief physical examination is done. Cardiovascular disease is assessed by using a 12-lead electrocardiogram and London School of Hygiene Cardiovascular (Rose) Questionnaire. The relationship between the conventional and emerging risk factors and vascular disease and markers of end-organ damage will be evaluated in the urban residents of Tehran. In the second phase of the study, healthy individuals will be followed up in a 10-year-long cohort to determine the trend of changes in lipid and glucose status and development of vascular complications. Selected people undergo interventions with modifications in their lifestyle to assess the efficacy of certain measures in preventing the development of diabetes mellitus and dyslipidemia.

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Abstract: Phyical activity is considered to be effective in prevention and modification of diabetes melitus. The aim of this study was to evaluate physical activity in women with NIDDM who reffered to Endocrine and Metabolism Research Center. In an analytic-descriptive study ,135 women with NIDDM chosen by simple sampling method were evaluated using the World Health Organization (WHO) questtionnaire. Total physical activity, household physical activity, job related physical activity, physical activity in leisure time and walking in minute per week were measured. These data were compared with physical activity in American women. P<0.05 was considered statisticaly significant. The mean and standard diviation for age, BMI and weight was 49.6±10.23 years, 28.8±4.97kg/m2 and 69.36±12.55 kg respectively. The results showed that 90% of samples were inactive in leisure time. The minute spared for physical activty in leisure time and job related per week, was significantly lower than American women. The household physical activity in minutes per week was higher than American women, although 99.3% of household activity was light and very light. We conclude that minutes spared for physical activity which is useful for control of weight, lowering adiposity and increasing fittness was very low in our participants. The findings from this study suggest that improvement in physical activity behavior in women particularly in leisure time is essential.

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Abstract: Diabetic patients need to monitor blood glucose level (BGL) for diagnosis, treatment and follow up of their disease. Typically a blood sample for analysis is obtained via intravenous or a finger stick or other such invasive procedures. Often, this blood collecting causes physical and mental stress to the patient. For this reason, it is desirable to use other biologic liquids such as saliva to detect the blood glucose level. This article studies correlation coefficient between blood glucose level and salive glucose level (SGL) in healthy men. This is a descriptive, cross sectional study. 130 Blood and 130 saliva samples were obtained from 10 healthy men in 13 times in 5 days. Each day samples were taken in 3 times, fasting, postprandial and evening. Samples were analyzed with glucose oxidase method. Value of blood glucose level ranged from 58mg/dl to 118 mg/dl. Mean of fasting blood glucose level was 84.9±3.13mg/dl. Value of salive glucose level ranged from 0.322mg/dl to 4.941 mg/dl. Mean of saliva glucose level was 1.22±0.81mg/dl. Correlation coefficient between BGC and SGL from the 5 days of measurement was 0.23. Correlation coefficient for each day was 0.38 (first day), 0.21 (second day), 0.01 (third day) 0.37 (fourth day). Correlation coefficient for each person was 0.31 (case A). (case B), 0.07 (case C), 0.07 (case D), 0.45 (case E), 0.10 (case F), -0.05 (case E), 0.32 (case H), 0.87 (case I), 0.87 (case J). Unfortunately considering the values of correlation coefficients and the limited range of SGL we cannot use saliva for detecting BGL.

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Abstract: Glycated hemoglobin (HbA1C) is known as an indicator of diabetes metabolic control and glycation of proteins. There are some evidences about the role of vitamin C on inhibition of hemoglobin glycation. So, in this study, we evaluated the effect of vitamin C on glycated hemoglobin (HbA1C) level in type 2 diabetic patients. A clinical trial study was conducted on 18 type 2 diabetic patients (14 women, 4 men). We used 1000 mg supplement of vitamin C (4250 mg) per day for 6 weeks. BMI, 3-day food records, fasting plasma glucose and glycated hemoglobin were measured before and after using vitamin C supplements. The results were analyzed by paired t-test and P<0.05 was considered significant. Glycated hemoglobin was significantly decreased at the end of the study (P<0.015). Fasting plasma sugar increased slightly but it was not statistically significant. Our results show that vitamin C, which has structural similarities with glucose, can reduce the glycosylation of hemoglobin in type 2 diabetic patients through competition with glucose. This effect can be used to control the pathogenic mechanism of protein glycation in diabetes, after more detailed studies.

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Abstract: Zinc deficiency could be a cause of growth retardation in children with insulin dependent diabetes. In this study 20 diabetic children (11-15 years old) who were under 5th percentile of weight and height for their age were enrolled. None of this group of patients had the signs of sexual maturity. Not any underlying disease such as urinary tract infection or hypothyroidism was detected. The patients were randomly divided into two groups of 10 patients. 10 patients were treated with daily zinc sulfate equal to 25mg. Height, weight, blood sugar and HbA1C were measured at the onset of study, three and six months after treatment with zinc. The other 10 patients were followed as the control group. Mean blood sugar and HaA1C at the onset of study, followed by three and six months later are as follows: (150±30mg/dL, 6.7±3.4%), (140±28 mg/dL, 7±2.3%) and (158±25mg/dL and 6.4±3.8%). According to SDS* formula the velocity of increase of weight and height was significantly more in the treated group compared with the control group (P<0.001). Oral zinc therapy is recommended in growth retarded diabetic children to accelerate the growth velocity.

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Abstract: In our study, in addition to determination of frequency of appearance of aggravation of diabetes in our patients, we considered suggesting some risk factors which can predict the appearance of aggravation of diabetes in order to control the diabetes in its early stages. Recorders of 127 patients who had been transplanted in Sina hospital during years 1376-78, were studied. Patients were divided into 2 general groups before transplantation: diabetic and non-diabetic. The frequency of appearance or aggravation of diabetes in each group was determined and in each case, its distribution according to age, sex, blood levels of cyclosporine, Cholesterol, TG, Cr, duration of dialysis, acute rejection and source of transplanted kidney was detetmined. Graft survial after one year was also determined. Before transplatation, 7 patients had diabetes. In non-diabetic group, 14 patinet (11.7%) had got diabetes. By increasing age, duration of dialysis, blood levels of cyclosporine, cholesterol, creatinine and also female sex, the percentage of appearance of diabetes was higher. In diabetic group, all the patients (100%) had aggravation of diabetes. All these diabetic patients and also those who had post transplantation diabetes, had functioning graft after one year and no acute rejection was seen. The source was living doner in former patients. Relative frequency of post transplantation diabetes appearance and aggravation was 11.7% and 100% respectively. It is probable that variables such as blood levels of cyclosporine, cholesterol, creatinine, duration of dialysis, sex and age can be used as predictors of appearance or aggravation of diabetes in transplanted patients. If it becomes true, early diagnosis and treatment of diabetes will be held in order to give and end to the effects of diabetes in transplanted patients.

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Abstract: Diabetic osteopenia is a recognized but neglected complication of diabetes mellitus. Most studies have reported low BMD values in type 1, but the BMD results in type 2 is often conflicting. Considering the high prevalence of diabetes type 2 and the importance of osteopenia in postmenopausal women together with its socioeconomic and health burdens, we designed a controlled study of BMD in postmenopausal diabetic women. Proximal femoral and lumbar BMD findings in the subjects were compared to the healthy postmenopausal controls. BMD results from 65 postmenopausal women, aged 45-65 years old, with diabetes type 2 were compared with 65 age matched controls. BMD at proximal femur (neck, ward, trochanter) and lumbar spine (L2-L4) was performed using DEXA. Subjects were categorized as “diabetic – non osteopenic” (or high BMD) and “diabetic osteopenic – osteoporotic” (or low BMD) based on whether their femoral neck T-score were above or below –1, respectively. Serum levels of FBS, 2hpp glucose, HbA1C, Ca, Ph, alkaline phosphatase, urinary Ca and Na were also assessed between two subgroups. Mean BMD value of ward area in diabetic women was 0.644±0.165 g/cm2 vs. 0.705±0.138 g/cm2 in controls (P<0.03). Trochanteric mean BMD in cases was 0.658±0.21g/cm2 vs. 0.737±0.99 in controls (P=0.01). But at femoral neck and lumbar spine no significant difference was seen between two groups. The osteoporotic subgroup of diabetic patients showed higher levels of HbA1C, alkaline phosphase and 24h urinary Ca and Na, but lower levels of serum Ca and Ph, however, the differences did not reach statistical significance. Estrogen consumption was more common in high BMD patients (P=0.05). There was no significant difference between the case and control groups in respect of absent vertebral fractures in the course of recent five years. Age and span of time following menopause, appear to be major risk factors for osteopenia in diabetic patients. Despite higher body mass index in diabetes and considering the protective role of obesity on bone mass, there seems to be a significant decrease in ward and trochanteric BMD values in diabetic patients, indicating that factors other than obesity could affect their BMDs.

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Abstract: Diabetic nephropathy is the most common cause of ESRD. Proteinuria has an important role in rapid progression to ESRD. Pentoxifylline (PTX) is a drug with TNF-α suppression effect and hence reduction of proteinuria and slowing of progression of diabetic nephropathy. To evaluate this hypothesis of PTX effect in comparison with captopril, we studied 40 type 2 diabetics with macroproteinuria (> 300 mg/day), who had no contraindication for PTX and didn’t take PTX or ACEI for the past year. We didn’t change the profile of diabetes or HTN drugs of our patients. We planned a cross over study in two 2-month periods of PTX or captoril therapy spaced with a one-month washout period. At beginning and the end of each treatment period we measured blood pressure, FBS, creatinine and 24-hour urine collection for volume, creatinine and protein. PTX reduced proteinuria by 0.44±0.63g/day in comparison with 0.1±0.22g/day with captoprial (P = 0.008). In conclusion PTX is superior than captopril in reducing proteinuria in type 2 diabetic patients.

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Abstract: The risk of developing vascular diseases in diabetic patients is significantly increased. Its etiology may involve oxidative damage by free radicals, and protection against such damage can be offered by antioxidant systems. To study the antioxidant status and oxidative stress in patients with type II diabetes mellitus. (n=30) and controls (n=28), we measured total antioxidant capacity by ferric reducing ability of plasma (FRAP) assay, malondialdehyde (MDA) as a final product of lipid peroxidation by HPLC method, carbonyl groups, thiol groups, vitamin E and C in plasma samples. In addition, we analyzed biochemical parameters such as blood glucose, HBA1c, cholesterol, triglycerids, HDL-C, LDL-C, bilirubin and uric acid. A significant increase in MDA concentration was found in diabetic patients compared to controls (P<0.005). There was also a significant drop in plasma thiol groups (P<0.05), while no significant difference was observed in total antioxidant capacity, carbonyl groups, vitamin E and C between two groups. Plasma vitamin E/cholestrol ratio was significantly lower in diabetic patients than controls. In conclusion, we have shown that there is enhanced oxidative stress in patients with type II diabetes, an important factor in the pathogenesis of diabetic complications.

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Abstract: Eleven NIDDM patients (7 women and 4 men, aged 51.2±7.6 year, BMI:29±3.6 kg/m2, duration of diabetes: 9±6.9 years) were selected in a cross-over clinical trial to assess the effects of fortification of bread with wheat bran on blood glucose and lipids. The patients consumed isocaloric dites for 10 weeks and took no drugs. Six patients consumed fortified bread for 4 weeks (period I), followed by a two-week washout period and then crossed over to ordinary bread for another 4 weeks (period II) and the next five patients had the reverse periods. Fasitng serum glucose levels at the end of period I were 20.2% and 21.45% less than the baseline value and end of period II, respectively these differences were significant (P<0.005). At the end of period I, serum glucose 1, 2 and 3 hours after breakfast tolerance test (BTT) were 18.17, 11.54 and 13.57% less than the baseline values, respectively (P<0.005). Serum glucose 1, 2 and 3 hours after BTT at the end of period I were 19.19, 25.52 and 24.3% less than those at the end of period II, respectively, and the differences were significant (P<0.05). Fasting total cholesterol at the end of period I was significantly less than the baseline value (P<0.05). Fasting LDL-C at the end of period I was significantly decreased as compared to that at the end of period II (P<0.005). The differences between serum triglycerides, HDL-C and VLDL-C at the end of period I and at the end of period II were not significant. It can be concluded that bread fortified with wheat bran may cause a reduction in fasting serum glucose, serum cholesterol and LDL-C.

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Introduction: Many studies have been conducted to compare WHO and ADA criteria for detection of new diabetic patients. This study aims to compare these two criteria in a community-based epidemiological survey in an urban population of the Tehran, Iran. Materials and methods: We studied 3870 men and 5359 women aged 20 years and over, participating in Tehran Lipid and Glucose Study (TLGS). Those with known diabetes were excluded. Blood samples were taken after 12-14 hours’ overnight fast and 2 hours after taking 75gr of glucose orally. Prevalence of showed tolerance categories and the level of agreement (κ statistic) were obtained using WHO and ADA criteria. Results: Using WHO criteria,6.0% (0.95% CI:5.5-6.5) had type-2 diabetes and 13.0% (12.3-13.7) had IGT (Impaired glucose tolerance). Using ADA, 3.3% (2.9-3.7) had type-2 diabetes and 4.8% (4.4-5.2) had IFG (Impaired fasting glucose)(p<0.05 and <0.001) for diabetes and IGT respectively. 7355 (84%) should concordant results with both criteria. Among 7105 normal subjects by WHO, 153 (2.2%) had IFG or diabetes by ADA, whereas among 8068 normal subjects according to ADA, 1116 (13.8%) had IGT or diabetes by WHO. The level of agreement (κ statistic) between two criteria was 35% (p<0.001). Sensitivity and specificity of ADA criteria were 45.5 and 99.8%, respectively, taking WHO as the gold standard. Conclusion: Our data shows low agreement between WHO and ADA diagnostic criteria for detection of diabetes. Patients with unknown diabetic IGT are detected more frequently using WHO criteria.

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Introduction: This study was designed to investigate the relationship between food habits and fasting blood glucose and glycosylated hemoglobine in petients with type 2 diabetes. Materials and methods: In a descriptive analytic study, type 2 diabetic patients over 30 years old, referred to Endocrine and Metabolism Research Center, were studied. Using the Passim and Bennett questionnaire, 34 different sorts of foods were divided into 3 groups: Foods eaten over 3 times a week, 1-3 times a week, and less than 1 time a week. Glycosylated hemoglobin (HbA1c) and fasting blood sugar (FBS) were measured. Results: The results were analysed using factor analysis, multiple regression and t-student methods in SPSS package and p<0.05 was statistically significant. There were 86 participants in this study (31 males and 55 females). The results showed that raw vegetables and fresh fruits were conversely related with HbA1c and raw vegetables with FBS. Also, veal and lamb meat, potato, lard and sucrose were related with FBS. Conculsion: We conclude that fruits and vegetables are useful for the control of diabetes and the prevention of diabetic complications. Also, it seems that the use of red meat, potato, lard and sucrose for diabetic patients needs to be limited.

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Introduction: Formation of end-glycation products is one of the major causes of chronic diabetes complications. Although there is some evidence that vitamin C inhibits protein and hemoglobin glycosylation in healthy individuals, its effect on diabetic patients is still being debated. The aim of this clinical trial was to examine the pharmacologic effect of vitamin C on hemoglobin A1c (HbA1c) and fasting blood sugar (FBS plasma levels) in diabetic patients. Materials and Methods: For this purpose 53 (8 male, 45 female) type 2 diabetic patients who had FBS <250 mg/dL were selected for the study. The age range was 37-70 years with a mean of 52.8±10 years. Patients were given 1g vitamin C per day for 3 months. Changes in body weight, FBS, and HbA1c level were compared before and after therapy. FBS was measured by the enzymatic glucose oxidase method (normal range: 75-110 mg/dL) and HbA1c was assayed according to WHO calorimetric method with a normal range of 2.5-4 μmol/g Hb%. Results: The mean FBS level was 185±43.9 mg/dL at the beginning and 176.5± 48.7 mg/dL at the end of study. The mean FBS level changes during study was -8.9±40.2 mg/dL, which was not significant (p>0.05). The mean HbA1c level at the beginning was 4.9± 0.9, at the end 4.7±1, with a mean change of range -0.2±0.9 μmol/gHb%, which was not significant (p>0.05). Also mean body weight changes were not significant during study (p>0.05). The decrease in level of HbA1c from 1 to 15%, shown in 49% of patients was related significantly to decreased weight (p<0.001) and in the 26% with most decreased HbA1c levels (10-15%), it was related also to decreased FBS (p<0.05). Conclusion: According to these results, decreased HbA1c level was due to weight loss and better glucose control rather than vitamin C effects. Therefore vitamin C consumption for prevention of type 2 diabetes complications by inhibition of protein glycosylation is not recommended.

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Introduction: Gestational diabetes mellitus (GDM) is a disorder of carbohydrate metabolism, first diagnosed during pregnancy. This study aims to determine the prevalence of GDM in young pregnant women. Materials and Methods: Two thousand one hundred pregnant women referred to five university hospital clinics, 1043 under 25 years old. Previously known diabetic patients were excluded from the study. Universal screening was performed with a 50 gram 1-hour glucose challenge test (GCT). Those with plasma glucose levels ≥ 130 mg/dL underwent a 100 gram 3-hour glucose tolerance test to diagnose GDM according to Carpenter and Coustan criteria. Family and obstetric histories were taken followed by a complete physical examination. Results: Among the 1209 young pregnant women (mean age±SD 20.97± 2.1, years), 27 (2.23%) were detected to have GDM (mean age ±SD 21.11±1.85 years). Of the GDM patients, 14.81% were obese, 22.22% had glycosuria. Among GDM patients, 16 (59.25%) did not have any recognized risk factors. Conclusion: High prevalence of gestational diabetes mellitus in young Iranian pregnant women may suggest revision of the appropriateness of criteria for GDM screening.

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Introduction: Physical diseases and human psychological structure are closely interlinked and their effects on each other have been the subject of discussion for scientists for many years. In psychiatric classification, diabetes mellitus is categorized in psychosomatic diseases and the effect of behavior patterns and mental stresses on development of the diseases are dicussed in the above-mentaned category. The aim of this research was to study the relationship between type A behavior pattern and type 1 and 2 diabetes. Materials and methods: The sample consisted of 150 people, 50 were type 1 diabetics, 50 type 2 and 50 formed our control group. The Jenkins questionnaire was used to determine type A & B behaviors. Results: In statistical analysis type A behavior pattern was seen more in type 1 diabetics (74%) which in comparison with the control group and type 2 diabetetics (54%) was significant (p<0.05). Conclusion: These findings demonstrate the role of behavior patterns and psychologic factors on the clinical course of diabetes and stress the importance of psychologic intervention in the management of diabetics.

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Introduction: Psychological and sexual problems are more prevalent among diabetic women, and diabetes, as a chronic disease threatens mental health itself. Considering the fact that both factors can affect family relationship, and that family relations are the cornerstones of an ideal community relationship, this study was conducted to assess and compare the family relationship of diabetic and non-diabetic women. Materials and methods: Data were collected from 198 and 81 non-diabetic and diabetic 25-50 year old married women, respectively, who were randomly selected and administered the Stevens Relationship Questionnaire (SRQ), previously validated for Iran by one of the researchers. This 72-item questionnaire measures Assertive Conflict Resolution (ACR), Intimate Communication (Int), Romantic Attitudes and Behaviors (Rom), Equality (Eq), Independence (Ind), and Liberated Role Beliefs (Lib). The total score of this questionnaire is between +144 and – 144. Results: Mean ages of the women with and without diabetes were 36.4 ± 11.2 and 33.8 ± 7.8 years, respectively. Mean overall SRQ scores in non-diabetic and diabetic individuals were –3.37±22 and –1.15± 20, respectively, without any significant statistical difference. Romantic family relationship scores (Rom) in diabetic women and non-diabetic women were +2.92 ± 7.2 and +5/13 ± 9.1, respectively, (p<0.05), and Intimacy in family relationship scores (Int) were lower in diabetic women than in the non-diabetics (-1.92 ± 5.1 vs. –0.93 ± 4.4, p<0.05). On the other hand, Independence (Ind) in diabetic women was more than the non-diabetics (-4.58 ± 4.8 vs. –6.74 ± 7.4, p<0.05). Conclusion: No significant difference was found in overall SRQ scores between diabetic and non-diabetic women, although none of the diabetic and non-diabetic women SRQ scores were suitable.

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Introduction: Diabetes is an important public health problem resulting in substantial morbidity and mortality and naturally, significant medical costs. This study was performed to determine the direct and indirect medical costs attributable to type 2 diabetes and calculate total and per capita expenditures of type 2 diabetic patients in Isfahan- Iran in 1998. Materials and methods: Consistent with prior cost-of- illness studies, direct medical expenditures were estimated after calculating the cost imposed by diabetes-related chronic complications and general medical conditions in people with type 2 diabetes and multiplying the results by their corresponding disease- related etiologic fraction. Indirect costs were estimated after calculating the value of productivity lost due to work loss, restricted activity and bed days, disability and premature death. Results: Direct medical expenditures and indirect costs attrtibutable to type 2 diabetes in 22349 patients in Isfahan (1998) totalled about 8.998 and 167 billion rials respectively, resulting in total economic costs of about 176.4 billion rials or 7893868.3 rials per capita. Taking into account the 1.2 million type 2 diabetic patients living in Iran, the total expenditures attributable to type 2 diabetes were estimated to be 6472.6 billion rials in the Islamic Republic of Iran in 1998. Conclusions: The economic burden of type 2 diabetes mellitus in the Islamic Republic of Iran is enormous. It is necessary to pay more attention to medical interventions that can delay the onset and slow the progression of diabetes and its complications in order to improve the patient’s quality of life and mitigate the burden of associated expenses.