Volume 27 -                   RJMS 2020, 27 - : 15-25 | Back to browse issues page

Research code: 121856
Ethics code: IR.SSRI.REC.1398.008
Clinical trials code: IRCT20161218031451N2

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Mohajer Iravani O, Abdi A, Abbassi Daloi A. Effects of aerobic exercise training with Momordica charantia L. on DPP-4, IGFBP1 and HbA1C in men with type 2 diabetes. RJMS 2020; 27 :15-25
URL: http://rjms.iums.ac.ir/article-1-6455-en.html
Azad University , a.abdi58@gmail.com
Abstract:   (1110 Views)
Background & Aims: The International Diabetes Federation (IDF) estimates that approximately 425 million adults aged 20-79 in the world will have diabetes in 2017, and is projected to increase to 629 million by 2045 (2). Dipeptidyl peptidase-4 (DPP-4) is an important cytokine that plays a role in metabolic syndrome and T2DM (3). DPP-4 was initially thought to be linked to immune and inflammatory processes, but the role of DPP-4 endocrine has recently received more attention because DPP-4 reduces pancreatic insulin secretion by reducing GLP1 action (4). Insulin-like growth factor-binding protein (IGFBP1) is an IGF-dependent protein that is mainly produced in the liver and kidneys and affects metabolism through IGF-dependent and independent mechanisms (8). Studies have shown that exercise affects cytokine levels (6) in diabetics. Because multifactorial diabetes mellitus requires a multifactorial therapeutic approach, future treatment strategies suggest a combination of different treatment modalities. Momordica charantia is one of the plants that has been widely used to control T2DM (11). In one study it was shown that the extract extracted from bitter cucumber had a hypoglycemic effect on healthy and diabetic rabbits (12). Given the growing prevalence of diabetes as well as the consequences of this disease, as well as the high cost of treatment, it seems reasonable to use a cheap and affordable solution.On the other hand, by looking at the effect of bitter cucumber as well as exercise activities on diabetes control, this study was conducted to investigate the simultaneous effect of aerobic exercise with bitter cucumber consumption on some glycemic control indices in diabetic patients.
Methods: In this study, 36 men with type 2 diabetes were selected from Tehran and were randomly divided into four groups (Control, Momordica charantia, Training and Momordica charantia+Training). The training groups participated in a progressive aerobic training for eight weeks, three sessions a week (40% to 70% of the reserved heart rate and for 15 to 45 min) (16). The groups of Momordica charantia and Momordica charantia+Training were consumed2000 mg of Momordica charantia for eight weeks (Twice a day before breakfast and dinner) (17). Two days before and after the protocol, blood samples were taken in fasting state. Paired t-test and one-way analysis of variance were used for statistical analysis.
Results: The results of the present study showed that there was a significant difference in the rate of DPP-4 changes between the control groups with momordica (p= 0.006), Training (p= 0.001) and Training+momordica (p= 0.001), and also between the Training+momordica group with momordica (p= 0.010) and Training (p= 0.045). The results also showed that there was a significant difference in the rate of IGFBP1 changes between the control groups with Training+momordica (p= 0.003), Training (p= 0.006) and Training+momordica (p= 0.001), as well as between Training+momordica and momordica (p= 0.036) and Training (p= 0.019). Another result of the present study was a significant difference in the rate of HbA1C changes between control groups with momordica (p= 0.001), Training (p= 0.001) and Training + momordica (p= 0.000), as well as between Training + momordica groups with momordica (p= 0.010) and Training (p= 0.011). Finally, the results showed that there was a significant difference in the rate of changes in insulin resistance between the control groups with Training (p= 0.033) and Training + momordica (p= 0.020).
Conclusion:  The results of the present study showed a significant decrease in DPP-4 levels in the Training group in T2DM men. In this study, a decrease in DPP-4 was associated with an improvement in insulin sensitivity, indicating the role of DPP-4 in regulating glucose metabolism. In this regard, Malin et al. (2013) showed that aerobic exercise significantly reduces DPP-4 and improves insulin sensitivity in adults with metabolic syndrome (6). Decreased DPP-4 levels are responsible for improving insulin sensitivity due to exercise (6). The association between increased insulin sensitivity and decreased DPP-4 suggests that exercise reduces the effect of DPP-4 on skeletal muscle glucose uptake. Thus, the improvement in insulin sensitivity is due to the reduced effect of DPP-4 on skeletal muscle insulin signaling (20). In the present study, the decrease in HOMA-IR with aerobic exercise was in line with the decrease in DPP-4. With this result, it can be argued that a decrease in DPP-4 may alter insulin sensitivity after exercise. This result is consistent with previous findings that reported DPP-4 is associated with the pathogenesis of nonalcoholic fatty liver disease (13). Since increased aerobic fitness is associated with decreased cytokines associated with inflammation and metabolic syndrome (22), it seems logical that low levels of DPP-4 are associated with a reduced risk of metabolic syndrome. In this study, a decrease in DPP-4 was associated with a decrease in IGFBP1. Exercise as a non-pharmacological method seems to improve insulin sensitivity and reduce cardiovascular risk (9). Researchers have suggested that lowering IGFBP1 is a compensatory mechanism for improving insulin resistance (23). Insulin appears to be the most important regulator of IGFBP1 expression and suppresses IGFBP1 secretion in the liver (25). In this study, insulin levels increased in the experimental groups, and this change may be responsible for the decrease in IGFBP1 levels in the experimental groups. Another result of the present study was a significant decrease in HbA1C levels following aerobic exercise. The reduction in HbA1C is of great clinical significance because a 1% reduction in this index reduces the risk of death from diabetes by 21% (28). Another result of the present study was a significant decrease in the levels of DPP-4, IGFBP1 and HbA1C in the Momordica charantia group in men with T2DM. Also, glucose and insulin levels decreased and increased, respectively. Momordica charantia with compounds such as charantin and Momordicoside activates GLP-1 and simultaneously inhibits DPP-4 (29). Inhibition of DPP-4 improves glucose tolerance in diabetics (30). Another study showed that Momordica charantia significantly reduced HbA1C compared with the placebo group (11). The hypoglycemic effects of Momordica charantia are due to the presence of phytochemical compounds in this plant (32). In the present study, aerobic exercise significantly reduced DPP-4, IGFBP1, HbA1C and insulin resistance in type 2 diabetic patients, and Momordica charantia also had anti-diabetic effects. In the present study, the simultaneous effect of aerobic exercise with Momordica charantia was more than each alone. Therefore, it is recommended to pay attention to the combination of the two to control glycemic index in type 2 diabetic patients.
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Type of Study: Research | Subject: Exercise Physiology

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