Razi Journal of Medical Sciences

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  Background : Diabetes mellitus is a common metabolic disease. Its association with low level of testosterone has already been shown in many studies. Considering the role of testosterone hormone in impotency, fatigue, and bone mass deficiency this study aimed to investigate the association between serum total testosterone, free testosterone index (FTI), and sex hormone-binding globulin (SHBG) with type 2 diabetic patients and other factors.

  Methods : A cross-sectional, analytic study was conducted on 38 non-diabetic and 36 diabetic men aged 40-60 years old with Body Mass Index (BMI) 18-40 (kg/m²). Fasting serum total testosterone, SHBG, FBS (Fasting Blood Sugar), HbA_1C, and other hormone tests were measured at the department of endocrinology, Firouzgar Hospital. The association between serum testosterone level, SHBG, FTI with FBS, HbA_1C, BMI, and other factors were separately measured. For quantitative parametric variables, independent sample T test was used. For non-parametric variables, Mann- Whitney test was used. Pearson’s correlation was performed to assess the correlation between quantitative variables.

  Results : The mean age of participants was 47.7±5.7 years. Serum total testosterone, FTI, and SHBG had no difference between case and control groups. No significant association was found between good glycemic control (HbA_1C<7) and serum testosterone level. However, there was a negative correlation between BMI and age with testosterone level. Mean testosterone level of smokers was significantly lower than non-smokers (p=0.008).FSH (Fasting Stimulating Hormone) in diabetic group was significantly lower (p=0.04).

  Conclusion : Our study has shown that there was no relation between serum testosterone level with type 2 diabetes and glycemic control in men.

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  Background: Mindfulness is a mind-body medicine technique which is used in stress reduction and promotion in many patients quality of life, with chronic diabetes. The purpose of this study was evaluating the effectiveness of mindfulness based on stress reduction on glycemic control of patients with diabetes.

  Methods : in the case-control experimental research60 diabetic patients (30 control group, 30 experimental groups) in Shahriyar city were invited to participate in this study. Mindfulness presents in 8 weekly sessions. Glycolysis hemoglobin as indicator of glycemic control was assessed, before and after this intervention. T-test for dependant groups and independent groups and one-way ANOVA was used for data analysis.

  Results: Results indicate a significant difference between pre test and post test of experimental group.

  Conclusions: So it is concluded that mindfulness has significant effects on glycemic control.

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Background: Type 2 diabetes is one of the chronic metabolic diseases that because of the high incidence and burden of this disease it was introduced as one of the public health problems (1). Complications of diabetes are related to problem in controlling the glycemic level in type 2 diabetic patients which leads to increased mortality and morbidity in these patients (5,6). Quality of lifestyle is one of the main principles of diabetes treatment (7). The results of longitudinal research indicate that exercise is one of the effective therapeutic interventions to treat, prevent and reduce the complications of metabolic diseases (8). One of the methods of aerobic training is Body pump. Although this sport does not have much history, but it has quickly been able to gain a lot of popularity in the must countries of the world, however, not much study has been done about it in Iran. Body pump is a program to improve physical fitness that includes about 60 minutes of training in the classroom with training weights based on predetermined tracks in which various sports movements are preformed with the rhythm of the music (9). In general, Body pump training class is a typical resistance training program with a large number of repetitions that is include low and medium intensities with focuses on endurance (10). On the other hand, one of the items that is in compliance with exercise is intensity, which is impact on the adaptation and obtained from exercise in healthy people and patients (12). It could be considered that the intensity of exercise can be one of the factors affecting metabolic adaptations in diabetic patients. So far a specific study on the role of intensity in Body pump exercises was confirmed as one of the new styles of rhythmic exercises in controlling blood sugar in patients, therefore, the aim of this study is to compare the effect of eight weeks of exercise with two different intensities on controlling the glycemic level in obese women with type 2 diabetes.
Methods: In the present quasi-experimental study, 30 women with type 2 diabetes from Ahvaz Diabetes Clinic were selected by random sampling method and randomly divided into 3 groups of 10, including two groups. Intervention Body pump exercises were divided into moderate and high intensities and controls. The training program was performed for 24 sessions for eight weeks and in each session on a daily basis (3 day a weeks), and each training session including 60-90 minutes of Body pump exercise which performed at 9-10 am. In the first group exercise was performed with 55-60 percent of maximum reserved heart rate (moderate intensity training) and in the second group training with 75-80 percent of maximum reserved heart rate (high intensity training). Fasting blood sampling was performed in two stage of pre-test (24 hours before the start of research interventions) and post-test (48 hours after the last training session) and fasting blood sugar levels, fasting insulin, insulin resistance and HbA1c were measured. The statistical analysis of information obtained from the subjects, dependent t-test was used to examine intragroup changes and statistical test of analysis of covariance and LSD post hoc test were used to examine intergroup changes. Statistical analysis was performed with SPSS software version 25 and was considered at a significate level (p≥0.05).
Results: The subgroup analysis showed the significant decrease in the level of fast blood sugar, fast insulin, resistance to insulin and HbA1c in both  groups with medium intensities exercise (p=004; p=0.029; p=0.20; and p<0.001, respectively) and high intensities exercise (p=0.020; p<0.001; p=006; and p<0.001, respectively). No significant difference was observed in the control group with no exercise (p>0.05). To evaluate the effect of the intensity of the training on the variables of the study, significant difference was observed between changing in fast blood sugar (p=0.591), fast insulin (p=0.847), resistance to insulin (p=0.989) between both medium and high intensities training. However, HbA1c changes were significant and it was higher in the high intensities training group in comparison with medium intensities group (p=0.019).
Conclusion: According to the results, both intensities in Body pump training led to decrease in fast blood sugar, fast insulin, homeostatic model assessment of insulin resistance (HOMA-IR) and HbA1c in type 2 diabetic women. Based on previous results, medium (24, 23, 8) and high intensities training (25) led to control glycemic level in type 2 diabetic patients. To analysis the effect of the intensity of the training on variables, it was shown that there is no significant differences between the changes in the level of fast blood sugar, fast insulin and resistance to insulin in both Body pump with medium intensity and high intensity groups. However, changes in HbA1c as a blood sugar average index in Body pump with high intensity group showed a significant difference in comparison with medium intensity group. This results showed the positive effects of training as a variable in control of hypoglycemic level in type 2 diabetic women. According to this result in clinical condition, controlling the blood sugar level and HbA1c level can prevent the complication and mortality and morbidity in type 2 diabetic patients and the Body pump training had a great effect on health promotion and decreasing the diabetic complication. High concentration of HbA1c is related to diabetic neuropathy, diabetic retinopathy and nephropathy in long time (28). In the present study 6.3 % HbA1c and 23.3 % resistance to insulin were decreased in Body pump with medium intensity group. Also, in Body pump with high intensity group, 12.4 % HbA1c and 24.7 % insulin resistance were decreased. It was reported that 1 % decrease in HbA1c is related to 14 % decrease in acute myocardial infraction and 21 % decrease in mortality (29). Based on twice more intensity in high intensity Body pump training group in comparison with medium group, it could be concluded that Body pump training with high intensity is more appropriate for reducing the microvascular and macrovascular complications. It is also recommended for diabetic type 2 patients that have no problems in practicing to do high intensity training.

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Background & Aims: One of the main complications of type 2 diabetes is cardiovascular complications, which greatly increases mortality and reduces the quality of life of these patients. Complications of type 2 diabetes, which are known as cardiovascular risk factors, include dyslipidemia (1, 3) and high blood pressure, which are common diseases in type 2 diabetes (1, 4). Another complication of type 2 diabetes is liver complications (5). Which is associated with cardiovascular risk factors (5, 8) in type 2 diabetes. Despite extensive research to identify the pathological causes of type 2 diabetes, no definitive treatment for type 2 diabetes has been found so far, and the annual death rate from type 2 diabetes and liver disorders due to diabetes due to cardiovascular events is increasing (5). Indicating the need for further research to reduce cardiovascular risk factors in these patients. Exercise is one of the main pillars in the treatment of type 2 diabetes (13), but these patients may be limited in performing continuous aerobic exercise due to overweight and low level of physical fitness (14); For this reason, interval training is recommended for these patients because resting between exercise intervals reduces the cardiac stress caused, leading to metabolic recovery and rebuilding energy systems, allowing for more exercise in one session (18); Therefore, the aim of this study was to investigate the effect of interval aerobic training on cardiovascular risk factors including cardiovascular and hepatic complications in men with type 2 diabetes.
Methods: In the present quasi-experimental study, 20 men with type 2 diabetes were randomly selected from volunteer patients aged 35 to 50 years, sedentary lifestyle (no physical activity in the last six months), no insulin injection, no acute cardiovascular disease, no respiratory disease, and no musculoskeletal disease. Then, they were randomly divided into two groups of aerobic interval training and control. Exercise training intervention in the present study included 12 weeks of aerobic interval training, three sessions per week and each exercise session included 1)10-15 minutes of warm-up, 2) the main exercise program (10-40 minutes aerobic interval training with 5 minute intervals and a rest-to-activity ratio of 1: 1), 3) and 10 minutes of coolingdown. 24 hours before the intervention and 48 hours after the last training session, the research variables were measured in fasting. Paired sample t-test and independent t-tests were used to examine changes within and between groups. All statistical analysis operations were performed at the significant level of P 05 0.05 by SPSS software version 22.
Results: The results showed that after the training period there was founded a significant decrease in the levels of HbA1c (P <0.001), triglyceride (P = 0.038), low-density lipoprotein (P = 0.008), alanine aminotransferase (P <0.001), aspartate aminotransferase (P <0.001), systolic blood pressure (P = 0.06) and body fat percentage (P = 0.003) and significant increase in high-density lipoprotein (P = 0.002) And maximum oxygen consumption (P <0.001) was observed compared to the control group, but there was no a significant difference in changes in total cholesterol (P = 0.159), diastolic blood pressure (P = 0.211) and body weight (0.061). = P) between training and control groups.
Conclusion: Regarding the chronic effect of regular exercise on glycemic control in diabetic patients, it can be said that aerobic interval exercise has increased glycemic control in patients with type 2 diabetes by increasing cell sensitivity with insulin-dependent molecular pathways and insulin-independent pathways (19). Also, after the training period, was observed a significant decrease in body fat percentage. The ratio of fat to muscle mass plays an important role in insulin resistance and metabolic disorders (21); therefore, the decrease in HbA1c caused by exercise can be justified in relation to the reduction of body fat percentage. Also, after the training period, a significant improvement in lipid profile was observed in the form of a decrease in triglycerides and LDL and a significant increase in HDL levels. The improvement in lipid profile in the present study may be due to the reduction of insulin resistance and glycemic control in adaptation to periodic aerobic exercise (16). Also, a significant decrease in serum aminotransferases was observed in the exercise group compared to the control group; it can be said that improving insulin resistance in the liver has reduced the accumulation of triglycerides in hepatocytes, which has resulted in reduced hepatic steatosis and improved liver function in patients. It is reported that body composition and HbA1c levels were associated with NAFLD. Also, after the training period, a significant increase in VO2max was observed compared to the control group. Cardiorespiratory fitness, measured by maximal oxygen consumption (VO2max), is related to functional capacity and human function and has been shown to be a strong predictor of disease mortality (27). One of the complications of diabetes is decreased functional ability in patients during exercise, the optimal delivery and use of oxygen means the interaction of various physiological functions, such as pulmonary ventilation, gas exchange, cardiac output, muscle blood distribution, aerobic capacity and energy production in skeletal muscle, as well as perception of fatigue (14). It can be said that exercise improves the function of the cardiorespiratory system by increasing the absorption and delivery of oxygen to the active muscles. Also in the present study, a significant decrease in systolic blood pressure was observed compared to the control group. Due to the fact that exercise training can affect vascular function and thus the response to vascular flow, it can increase blood flow to active muscles during exercise and provide the need for muscle oxygen by increasing blood flow, as well as increasing flow. The blood expels the metabolites produced and thus reduces the accumulation of these metabolites in the muscles (4, 28). On the other hand, by reducing insulin resistance in muscle cells, glucose uptake increases and as a result, glycogen stores in muscle cells increase, which can be useful in performing long-term exercise. Improving insulin signaling also leads to better glucose uptake during exercise (27, 29), resulting in better performance in long-term aerobic activity.

 

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Background & Aims: Diabetes is a metabolic disease characterized by chronic hyperglycemia and impaired metabolism of carbohydrates, lipids and proteins. This disease is caused by defects in insulin secretion, insulin function, or both (1, 2). This chronic disease can have serious short-term and long-term consequences that affect the health and quality of life (QOL) of patients (3). Type 2 diabetes accounts for approximately 90% of all cases of diabetes and is associated with a variety of immutable and modifiable risk factors (4). QOL refers to a person's individual perception of physical, emotional, and social status (5, 6). Patients with type 2 diabetes have a lot of stress to treat and their QOL is lower than healthy people (7, 8). Also, for chronic diabetics, complete cure cannot be achieved and clinical interventions can provide a good estimate of disease control, but the ultimate goal of diabetes care is to prevent the patient's QOL from worsening (3). It is important to understand the predictors and identify risk factors for QOL, and these factors may be targeted for prevention (5). Since the improvement of QOL is one of the important goals of treatment of diabetic patients (3, 10) and studies have shown that diabetes can have negative effects on physical function, development of complications, mental and psychological and personal, family and social relationships (15, 16); Therefore, understanding the factors related to QOL is of particular importance in the treatment programs of these patients (5). Cardiorespiratory endurance is one of the health-related physical fitness factors (2). Cardiorespiratory endurance is defined as the ability of the circulatory and respiratory systems to supply oxygen during physical activity and is usually defined as the maximum oxygen consumption (VO₂max) during submaximal or maximal tests. The main determinants of VO₂max are cardiovascular function, cardiac output, pulmonary diffusion capacity, oxygen carrying capacity, liver function, and other environmental constraints such as muscle diffusion capacity, mitochondrial enzymes, and capillary density, all of which are examples of determinants. Are VO₂max (2, 21). VO₂max is associated with functional capacity and human function and has been shown to be a strong and independent predictor of mortality from all specific causes and diseases (22). Physical activity and the resulting cardiorespiratory fitness are associated with several health benefits, including reduced risk of diabetes, cardiovascular complications, and mortality (23). In view of the above, cardiorespiratory fitness is a variable related to mortality prediction and as a health-related variable in diabetic patients (23); Therefore, cardiorespiratory fitness can be considered in determining the strategies of primary and secondary prevention programs of cardiovascular diseases in patients with type 2 diabetes; Considering the importance of factors related to the prediction and identification of risk factors for QOL (5); It is necessary to measure the relationship between cardiorespiratory fitness as a health-related physical fitness variable with QOL in patients with type 2 diabetes. In view of the above, the aim of this study was to investigate the relationship between QOL and cardiorespiratory endurance in patients with type 2 diabetes.
Methods: In this cross-sectional correlational study, 150 patients with type 2 diabetes mellitus were randomly selected from patients that had referred to health centers in Zabol city, which included 75 women and 75 men. QOL, demographic characteristics and history of diabetes in patients were measured using a questionnaire. Blood variables were measured on an empty stomach. Cardiorespiratory fitness was also measured using the Tecumseh step test. Pearson correlation coefficient was used for statistical analysis.
Results: There was a positive and significant relationship between cardiorespiratory endurance and QOL in patients with type 2 diabetes. There was also a significant negative relationship between cardiorespiratory endurance with glycemic control, age and history of type 2 diabetes.
Conclusion: In the study of the relationship between cardiorespiratory endurance and QOL, the results showed that there was a positive and significant relationship between cardiorespiratory endurance and QOL in patients with type 2 diabetes. In a study of patients with type 2 diabetes, Leite et al. (2009) reported that a decrease in VO₂max is associated with impaired insulin sensitivity, and that the most common abnormality in the population is at risk for insulin resistance and type 2 diabetes, and a decrease in VO₂max is one. Is an important risk factor for disease progression (28). Low resting heart rate and VO₂max are associated with a reduction in cardiovascular events (29). Cardiorespiratory disorders are more common in diabetic patients and may partly explain the morbidity and mortality in these patients. There are several potential causes for dysfunction in diabetics: hyperglycemia, insulin resistance, endothelial dysfunction, inflammation, microvascular dysfunction, myocardial dysfunction, and skeletal muscle changes. These changes are somewhat reversible, and improvement in each of these components may increase functional capacity in diabetic patients (30). Interventional studies indicate an increase in VO2max in adaptation to exercise in patients with type 2 diabetes (2, 31, 32). It can be said that with increasing cardio-respiratory endurance, the level of health increases and with increasing health, patient satisfaction with treatment and satisfaction with QOL improve (27). Also, The results of the present study showed that there was a significant negative relationship between aerobic fitness and HbA1c levels in patients with type 2 diabetes. Jekal et al. (2010) in a study that examined aerobic fitness and HbA1c levels, stated that people with higher cardiorespiratory fitness had better weight and lower HbA1c levels than people with lower endurance (25), which It was consistent with the results of the present study. Abushamat et al. (2020) also stated in their research that diabetes leads to decreased cardiorespiratory function, which is associated with poor glycemic control and its complications (35). Physical activity is effective in controlling blood glucose in diabetics; because it increases insulin sensitivity and glucose tolerance and decreases the level of hyperglycemia in these patients (36). Adaptations in insulin signaling as well as insulin receptors can lead to better blood glucose uptake by muscles. Increasing the number of GLUT4 carriers and increasing muscle mass, which plays a major role in blood glucose uptake, increases the body's response to insulin (38). The results of the present study also showed that there was a significant negative relationship between aerobic fitness and history of diabetes in patients with type 2 diabetes. Hadipoor et al. (2014) also introduced the years of diabetes as one of the factors affecting the physical dimension and QOL of these patients (45). Due to the fact that type 2 diabetes is associated with aging (46) and also the complications of diabetes, including cardiovascular complications with a history of diabetes and poor glycemic control are increased (47); with an increased history of diabetes, it reduces cardiorespiratory endurance in these people. On the other hand, due to having an active lifestyle and higher level of physical fitness, in addition to controlling blood sugar, the potential benefits of physical activity on reducing the complications of diabetes can be enjoyed (44, 50), which can improve QOL in patients with Type 2 diabetes is effective (50, 51). Overall, the results of our study showed that cardiorespiratory fitness was associated with improved QOL in patients with type 2 diabetes, which was negatively associated with age, duration of diabetes, and HbA1c levels.
 

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Background & Aims: Diabetes is a chronic metabolic disease that is spreading rapidly around the world (1). Diabetic neuropathy is a common complication of diabetes, with progressive destruction of the sensory and motor nerves of the lower extremities in these patients. Peripheral nerve problems in these patients also lead to functional deficits and muscle mobility (5, 6). In general, it is agreed that metabolic and vascular disorders caused by diabetes lead to peripheral neuropathy and nerve damage in these patients (8). Based on the hypotheses that cause diabetic neuropathy, it can be said that the use of exercise can be effective in improving diabetic neuropathy by improving vascular function (13, 14) and controlling blood sugar (13-15). The present study was to determine the effect of a period of functional training on blood sugar control and nerve conduction velocity in patients with diabetic neuropathic disorders. Diabetic neuropathy is a common complication of diabetes, with progressive destruction of the sensory and motor nerves of the lower extremities in these patients. Peripheral nerve problems in these patients also lead to functional deficits and muscle mobility (5, 6). In general, it is agreed that metabolic and vascular disorders caused by diabetes lead to peripheral neuropathy and nerve damage in these patients (8). Based on the hypotheses that cause diabetic neuropathy, it can be said that the use of exercise can be effective on diabetic neuropathy by improving vascular function (13, 14) and controlling blood sugar (13-15). The present study was to determine the effect of a period of functional training on blood sugar control and nerve conduction velocity in patients with type 2 diabetes.
Methods: In the present quasi-experimental study, 12 patients with type 2 diabetes living in Karaj (45-65 years old) were selected as the research sample and randomly divided into 2 groups of 6 exercise and control intervention. The training protocol in the present study was a researcher-made protocol that adjusted the volume and intensity of training based on exercise recommendations for patients with type 2 diabetes. The training program was performed for 8 weeks and 3 sessions per week. These exercises were designed as exercises at home. The exercises were designed to improve general endurance, endurance, strength, muscle flexibility and balance and with the approach of improving the function of the neuromuscular system and were designed as a station (20). In order to study blood variables 48 hours before and 48 hours after the intervention, fasting blood sampling was performed and electromyography devices were used to evaluate the nerve conduction velocity (21). Dependent t-test and independent t-test were used for statistical analysis; Statistical analysis was measured using SPSS software version 26 and the significance level was P <0.05.
Results: According to the results of paired sample t-test  after the training period, a significant decrease where founded in fasting blood sugar (P = 0.046), fasting insulin (P = 0.033) and insulin resistance (P = 0.028) and a significant increase There was founded in median sensory nerve conduction velocity (P = 0.037) and a median motor nerve conduction velocity (P = 0.001) in the exercise group compared to baseline values, but no significant difference was observed in the measured variables in the control group ( P < 0.05). In comparison between the changes, the results of independent t-test showed that there were significant differences in fasting blood sugar (P = 0.007), fasting insulin (P = 0.019), insulin resistance (P = 0.005), Median sensory nerve conduction velocity (P = 0.005) and median motor nerve conduction velocity (P <0.001) compared to the control group.
Conclusion: The results of the present study showed that after the training period, a significant decrease in levels of fasting blood sugar, fasting insulin and insulin resistance was observed compared to the control group without exercise. Due to the pathology of type 2 diabetes and insulin resistance in insulin-sensitive tissues such as muscle tissue and adipose tissue, blood glucose levels increase in these people, and due to increased hyperglycemia, diabetic patients develop complications of diabetes, including neuropathy (7). Even a session of physical activity has been reported to stimulate glucose uptake by upregulating GLUT4 levels in sarcoma. This effect is independent of the effect of insulin and glucose uptake continues for several hours after the end of physical activity. Physical activity also increases insulin sensitivity in skeletal muscle; this effect lasts for several hours after the end of physical activity and is clearly dependent on insulin and insulin function in target tissues (22). Regarding the chronic effect of regular exercise on blood sugar control in patients with diabetes, it can be said that regular exercise helps control blood sugar and thus reduces hyperglycemia in these people due to increased cell sensitivity to insulin-dependent molecular pathways. Which improve insulin signaling (ACC and MAPKs PI3-kinase) as well as insulin-independent pathways (Akt and mTOR AMP-kinase), control glycemia in patients with type 2 diabetes and prevent the complications of diabetes (1, 13, 23). In investigating the effect of exercise on nerve conduction velocity, the results of our study showed that after the training period, a significant increase in sensory and motor nerve conduction velocity was observed compared to the pretest and control group; The results of our study showed the effect of almost twice the effect of exercise on increasing the conduction velocity of the median motor nerve compared to the conduction velocity of the median sensory nerve. The conduction of a shock in the human nerve depends on the electrochemical activity of single nerve fibers within the nerve (26). In their study, Galliro et al. (2021) reported that the rate of nerve conduction decreases in diabetic neuropathy, especially in the sensory fields in the lower extremities (18). It has been shown that metabolic abnormalities seen in impaired glucose tolerance may lead to changes in neural conduction (27). Given that diabetic neuropathy is associated with poor glycemic control, and in our study, increased nerve rate was negatively associated with insulin resistance, an increase in nerve conduction velocity can be justified; Research on laboratory animals has shown that exercise improves nerve function through adaptations in the presynaptic and postsynaptic sections (29). It has also been reported that impaired neural conduction in diabetic patients with mild to moderate peripheral neuropathy may be improved by drug doses of antioxidant supplements such as vitamin E (30). Although in the present study, factors related to free radicals, inflammatory factors or total antioxidant levels were not measured and were one of the limitations of the present study, but according to previous research results that show antioxidant and anti-inflammatory effects of exercise in diabetes (31), it can be said that exercise, like antioxidant vitamins, can improve nerve function. Overall, the results of the present study showed the positive effects of functional exercises on metabolic indicators and also increased nerve conduction velocity, which indicates the positive effects of functional exercises on preventing the complications of diabetic neuropathy.
 

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