Razi Journal of Medical Sciences

fa اثر تمرینات ورزشی بر میزان ایریزین سرمی و شاخص‌های گلایسمی در بیماران مبتلا به دیابت نوع دو: یک مطالعه مرورنظام‌مند و فراتحلیل The Impacts of Exercise Training on Serum Irisin Levels and Glycemic Indices in Type 2 Diabetes Patients, a Systematic Review and Meta-Analysis فیزیولوژی ورزش Exercise Physiology مروري review article <div style="text-align: justify;">زمینه و هدف: دیابت نوع دو (TD2M) یک بیماری متابولیکی است که بر اثر تولید ناکافی انسولین توسط سلول‌های بتا پانکراس و یا بر اثر عدم پاسخ مناسب به انسولین توسط سلول‌های بدن به وجود می‌آید. تمرینات ورزشی ممکن است یک مداخله مؤثر برای بهبود شاخصهای گلایسمی از طریق ترشح ایریزین از بافت عضلانی باشد. هدف مطالعه حاضر، بررسی اثر انواع تمرینات ورزشی بر میزان ایریزین سرمی و شاخصهای گلایسمی خون در بیماران T2DM است. روش کار: جستجوی نظام مند مقالات انگلیسی و فارسی از پایگاه‌های اطلاعاتیPubMed ، Scopus،Web of Science ، SID و Magiran تا آگوست سال 2023 انجام شد. فراتحلیل برای بررسی اثر انواع تمرینات ورزشی بر میزان ایریزین سرمی و شاخص های گلایسمی خون (گلوکز ناشتا، انسولین ناشتا، شاخص مقاومت به انسولین (HOMA-IR)، هموگلوبین گلیکوزیله (HbA1c) در بیماران T2DM در مقایسه با گروه کنترل (بدون انجام تمرینات ورزشی) انجام شد. تفاوت میانگین و فاصله اطمینان 95% (CI) با استفاده از مدل اثر تصادفی محاسبه شد. ناهمگونی با استفاده از آزمون I2 و سوگیری انتشار با تحلیل بصری فونل پلات و آزمون Egger بررسی شدند. یافته‌ها: در مجموع 8 مطالعه شامل 14 مداخله ورزشی و 315 آزمودنی مبتلا به T2DM فراتحلیل شدند. نتایج نشان داد که تمرینات ورزشی سبب افزایش معنادار ایریزین سرمی ]03/0P= ،(96/0 الی 04/0) 5/0= [SMDو کاهش معنادار قند خون ناشتا ]001/0P= ،(29/6- الی 01/0-) mg/dL 76/20-= [WMD، انسولین ناشتا ]01/0P= ،(11/0- الی 83/0-) μU/mL 47/0-= [WMD، HOMA-IR ]001/0P= ،(28/0- الی 82/0-) 55/0-= [WMD و HbA1C ]001/0P= ،(01/1- الی 82/1-) mmol/mol 41/1-= [WMDنسبت به گروه کنترل در بیماران T2DM شد. نتیجه‌گیری: نتایج مطالعه حاضر نشان داد که تمرین ورزشی یک روش بهینه و مناسب برای افزایش ایریزین سرمی و بهبود شاخصهای گلایسمی از جمله کاهش قند خون ناشتا، انسولین ناشتا، HOMA-IR و HbA1c در  بیماران T2DM محسوب می‌شود. </div> <div style="text-align: justify;">Background & Aims: Type 2 diabetes (T2DM) is a chronic disease of global significance characterized by hyperglycemia. Several risk factors influence T2DM, but obesity has a direct effect on insulin resistance and is of particular importance, with type 2 diabetes increasing linearly with increasing body mass index. Despite the efforts made to manage T2DM, there is a growing need to find better approaches to more effectively control T2DM. Exercise training can increase the expression of FNDC5 in skeletal muscle, which is converted into irisin after exercise and structural changes and is released in the bloodstream ،which can cause the conversion of white fat cells into beige fat cells and increasing the expression of the UCP1 gene, which leads to the induction of thermogenesis and increased energy consumption. It also reduces oxidative stress and reduces pro-inflammatory conditions. Therefore, it can help reduce blood lipids and hyperglycemia in patients with T2DM and slow down the progression of the disease. Studies report that circulating irisin levels are lower in diabetic patients compared to healthy control subjects. In diabetic patients. That serum irisin levels were significantly lower in these patients. Exercise training is associated with a significant decrease in HbA1C, so that reduces the risk of complications related to diabetes acceptably. All types of exercise increase the level of irisin in the blood circulation in T2DM, and high-intensity exercise increases irisin levels. Along with drug therapy and a healthy diet, it can help to increase the secretion of irisin and, as a result, increase energy consumption. Despite the conducted research, we still need more research in this area due to the newness of the topic of irisin and its relationship with exercise. Also, despite the significant relationship between irisin and glycemic indices in diabetic patients, in meta-analyses, the serum levels of irisin and index are still high. This issue raises questions about the type and extent of the relationship between irisin and glycemic indices in diabetes to help these people. Methods: A systematic search of English and Persian articles published in PubMed, Scopus, Web of Science, SID, and Magiran databases was conducted until August 2023. Meta-analysis to investigate the effect of various types of exercise on serum irisin levels and blood glycemic indices (fasting glucose, fasting insulin, insulin resistance index (HOMA-IR), glycosylated hemoglobin (HbA1c)) in T2DM patients compared to the control group (without exercise training) were done. The Mean difference and a 95% confidence interval (CI) were calculated using a random effect model. Heterogeneity was evaluated using the I2 test, and Risk of bias was evaluated by visual analysis of the funnel plot and Egger's test. Results: Based on the search in scientific databases until August 2023, 1655 articles were found. After removing duplicate articles (462 articles), and after reviewing the titles and abstracts of the articles, 79 articles were finally selected for full text evaluation, and after reviewing the full text of the articles, 71 articles were excluded from the present study. 26 studies were excluded from the existing study due to lack of control group, 9 studies due to lack of pre-test data and 36 studies due to lack of type 2 diabetes and finally 8 studies were included in the meta-analysis. The results showed that exercise significantly increased serum irisin [SMD=0.5, P=0.03] and sports training caused a significant decrease in fasting blood sugar [WMD=-20.76 mg/dl, P=0.001], Fasting insulin [WMD=-0.47μU/mL, P=0.01], HOMA-IR [WMD=-0.55 mmHg, P=0.001], HbA1C [WMD=-1.41 mmol/mol, (P=0.001)] compared to the control group in T2DM patients. Conclusion: The purpose of the present meta-analysis is to compare the effect of various types of exercise compared to the control group on irisin and glycemic indices including (fasting glucose, insulin, insulin resistance and glycosylated hemoglobin). It was conducted in T2DM patients. The results of 8 studies with 315 subjects indicated that exercise training caused a significant increase in serum irisin level, a significant decrease in fasting blood sugar, fasting insulin, HOMA-IR, and HbA1C, compared to the control group. T2DM patients. Investigating the effects of exercise on serum irisin and blood glycemic indices in diabetic people is small and the general evidence obtained shows that the effect of various sports exercises on serum irisin levels exercise causes a significant increase in the level of serum irisin compared to the control group. Compared to hypertrophy in non-diabetic people it is inconsistent, which can be due to the decrease in serum irisin in diabetic people and the decrease in muscle volume of these patients, which can have a greater potential to increase muscle volume due to exercises and despite the positive relationship between muscle volume and irisin levels it causes a more significant increase in irisin serum levels in these people. Also, by examining the intensity of exercise, it was found that high-intensity exercise has a greater effect on serum irisin levels than moderate-intensity exercise in diabetic people. The intensity and duration of exercise training has a positive relationship with the increase in serum irisin regardless of energy consumption. Considering this issue, in one of the combined intervention studies including two combined groups, Resistance-Aerobic and Aerobic-Resistance, it was investigated that no significant difference was observed in the amount of serum irisin in these two groups, and it seems that in combined exercises, the training sequence has no effect on the concentration of serum irisin. Comparison of the effect of aerobic, resistance and combined exercise on irisin level has resulted in inconsistent results that different measurement kits and sampling conditions and the wide variety of exercise and metabolic conditions of patients such as duration and rate of disease progression can be effective. Exercise training can play an important role in treating and preventing the development of diabetes in diabetic and prediabetic people. In all the studies that reported HbA1C in the present study, a significant decrease with a high effect size was observed. In aerobic exercises which is probably the result of the reduction of fat tissue, and in resistance training.it is due to the increase in muscle volume and possibly FNDC5. It can be concluded that exercise training is a very effective intervention in controlling the side effects of diabetes and improving metabolic function and glucose removal from the blood. The results of the present study showed that exercise training is an optimal and suitable method for increasing the serum irisin level and improving glycemic indices, including reducing fasting blood sugar, fasting insulin, HOMA-IR, and HbA1C in type 2 diabetes patients compared to the control group. to be the combination of this type of exercise with drug therapy and a controlled diet creates a clear perspective for the control and treatment of T2DM.</div> تمرین ورزشی, دیابت نوع دو, ایریزین, مقاومت به انسولین Exercise training, Type 2 diabetes, Irisin, Insulin resistance 1 17 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7894-2&slc_lang=fa&sid=1 Fatemeh Kazeminasab فاطمه کاظمی نسب fkazeminasab@kashanu.ac.ir 3900319475328460087125 3900319475328460087125 Yes Assistant Professor, Department of Physical Education and Sport Sciences, Faculty of Humanities, University of Kashan, Kashan, Iran استادیار، گروه علوم ورزشی، دانشکده علوم انسانی، دانشگاه کاشان، کاشان، ایران Ahmad Reza Moien احمد رضا معین 3900319475328460087126 0009-0005-1433-0558 No Master of Exercise Physiology, Department of Physical Education and Sport Sciences, Faculty of Humanities, University of Kashan, Kashan, Iran کارشناسی ارشد فیزیولوژی ورزشی، دانشکده علوم انسانی، دانشگاه کاشان، کاشان، ایران Mohammad Javad Pourvaghar محمد جواد پوروقار 3900319475328460087127 3900319475328460087127 No Department of Physical Education and Sport Sciences, Faculty of Humanities, University of Kashan, Kashan, Iran دانشیار، گروه علوم ورزشی، دانشکده علوم انسانی، دانشگاه کاشان، کاشان، ایران