Razi Journal of Medical Sciences

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Background & Aims: Type 2 diabetes is a chronic and progressive, chronic metabolic disease in the world and hyperglycemia, is the main characteristic of this disease. Overweight and obesity are effective factors in the development of type 2 diabetes, which are closely related to hypertension and other cardiovascular risk factors. In these patients, due to hyperglycemia and inflammation, causing pathological injuries in cardiovascular system such as vascular macro and micro vascular disease, arterial stiffness, hypertension, Diabetic cardiovascular autonomic neuropathy and changes in cardiac function such as tachycardia at rest, and decreased functional capacity such as cardio respiratory endurance. Poor management of diabetes increases the risk of cardiovascular factors disease and increases morbidity and mortality in patients with type 2 diabetes. The need to use effective methods to glycemic control and cardiovascular risk factors as one of the effective factors in Shows the disabilities associated with type 2 diabetes. Therefore, the use of effective methods in glycemic control and cardiovascular risk factors as one of the effective factors in disabilities associated with type 2 diabetes is essential. Nursing is one of the ways of intervention in the field of communication technologies such as the telephone and messaging software, which as a telenursing, can lead to better communication between type 2 diabetes patients and medical team to get the knowledge and health services. Scientific research has also shown that a sedentary lifestyle is associated with type 2 diabetes and obesity, and exercise training has been introduced as one of the main parts of treatment for type 2 diabetes. Due to the fact that no specific research has been done to compare the effect of regular aerobic training and telenursing intervention on anthropometric and cardiometabolic indices in patients with type 2 diabetes, the present study aimed to compare the effect of telenursing and aerobic training on glycemic control. Blood pressure, body composition, resting heart rate and cardiorespiratory endurance (vo2max) were assessed in patients with type 2 diabetes.
Methods: In a semi-experimental study, 60 patients with type 2 diabetes were selected through targeted sampling and randomly divided into 3 groups (n = 20): 1) aerobic training group, 2) telenursing group and 3) control group. After baseline measurements (pretest), intervention study was conducted for eight weeks and 48 hours after the end of treatment variables were measured again (posttest). The exercise program consisted of eight weeks of aerobic training, three sessions per week consist of 30 to 50 minutes running exercises by intensity of 50-70% of the subjects' heart rate reserve in each session. In the telenursing group, Educational Intervention Based on treatment of diabetes, including diet, exercise training, how to use the drug and how to use a glucometer and barometer and glycemic and blood pressure monitoring, were provided to patients through a software. During the study, the control group received no intervention other than their routine management. Body weight, body fat percentage, fasting blood glucose, Hemoglobin A₁C (HbA₁C), systolic and diastolic blood pressure, resting heart rate and maximum oxygen consumption (VO₂max) were measured before and after intervention. For statistical analysis, dependent t-test was used to examine within-group changes and one-way analysis of variance and Tukey's post hoc test were used to examine between-group changes. The data were analyzed using SPSS software version and P < 0.050 was considered as statistically significant level.
Results: After eight weeks aerobic training intervention, a significant decrease was observed in levels of body weight (P = 0.023), body fat percentage (P < 0.001), fasting blood sugar (P = 0.003), HbA₁C (P = 0.009), systolic blood pressure (P < 0.001), diastolic blood pressure (P = 0.039) and resting heart rate (= 0.004) P) and a significant increase in VO2max (P <0.001). Also in the telenursing intervention group, was observed a significant decrease in levels of body weight (P = 0.048), fasting blood sugar (P < 0.001), HbA₁C (P = 0.012), systolic blood pressure (P = 0.007), and diastolic blood pressure (P = 0.045). But in the control group, no significant difference was observed in any of the variables (p <0.05). In the study of between group changes, the results showed that in the both of aerobic training and telenursing groups, there was a significant decrease in fasting blood sugar (P < 0.001) and HbA₁C (P <0.001; P = 0.005, respectively) compared to the control group was observed. There was a significant decrease in body fat percentage and resting heart rate and a significant increase in VO2max in the aerobic training group compared to the telenursing and control groups (P <0.001). Significant decrease was observed in systolic blood pressure levels in the aerobic taining group (P <0.001) and telenursing group (P = 0.018) compared to the control group, Also reduction of systolic blood pressure in the aerobic training was significantly greater compared to the telenursing group (P <0.001).But no significant difference was observed in changes in weight (P = 0.083) and diastolic blood pressure (P = 0.617) between groups.
Conclusion: According to the findings of the present study, it can be said that both intervention methods of aerobic training and telenursing are effective intervention methods on glycemic control and cardiovascular risk factors in patients with type 2 diabetes. In the study of two intervention methods on glycemic control (fasting blood sugar and HbA₁C), there was no significant difference was observed between the two intervention methods of aerobic training and telenursing, and both interventions were effective for glycemic control. Comparing the two methods of intervention on body composition, only aerobic training could reduce body fat percentage and improve body composition in type 2 diabetes patients. In the study of changes in blood pressure, two intervention methods reduced systolic blood pressure without significant change in diastolic blood pressure and the reduction of systolic blood pressure in the aerobic training group was significantly greater than the telenursing group. Comparing the effect of interventions on resting heart rate and VO2max as two variables related to cardiorespiratory function, the results were similar to changes in body fat percentage in the aerobic training group and a significant increase in VO2max and a significant decrease in resting heart rate were observed in type 2 diabetes patients. In general, although both methods of intervention have an effective role in the management of type 2 diabetes, especially glycemic control in these people, However, due to the results and greater effectiveness of aerobic training on body composition and cardiovascular function (systolic blood pressure, resting heart rate and VO₂max), More care to exercise training as an important port of the treatment of type 2 diabetes is essential.
 

Keywords: Type 2 diabetes, Exercise training, Telenursing, Cardiovascular risk factors

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