Iranian Journal of Diabetes and Obesity
Volume:10 Issue: 4, Winter 2018

Traditional health care systems were not capable to face successfully with chronic diseases including diabetes mellitus. In this regard, the Chronic Care Model or CCM was created to promote quality of care. The aim of this study was to examine whether establishment of chronic care model, with focus on diabetic patients, has led to clinically significant outcomes in Iran. The samples were confirmed type 2 diabetes patients who had been attending to 20 CCM-based clinics in Tehran for at least one year. Repeated measurements of the same variable (including demographic, anthropometric and biochemical variables) on the same individual in 5 serial time points were used. Totally, 7190 patients (4793 females and 2397 males) with the mean age of 56 years old fulfilled inclusion criteria and entered the study. HbA1c (P-value: 0.001), fasting blood sugar (P-value: 0.001), systolic and diastolic blood pressures (P-value: 0.001), low density lipoprotein (P-value: 0.001), total cholesterol (P-value: 0.001), triglyceride (P-value: 0.001), and body mass index (P-value: 0.001) have significantly decreased during 4 measurement intervals. Implementation of CCM frame in primary health care clinics as the first model-based participatory care has been relatively successful in the field of diabetes management in Iran. Our findings support the idea that multifaceted interventions provided through a collaborative team work could relieve various health risk factors in diabetics.

Remote Ischemic Preconditioning (RIPC) as the transient ischemia and reperfusion of the arm is a promising method for protecting different tissue from future ischemia. These effects might be mediated through vascular and endothelial growth factor (VEGF) pathway. We investigated the influence of RIPC on diabetic macular edema (DME) as a chronic ischemic condition in patients who were candidate to receive anti-VEGF therapy. In this Single blinded, randomized controlled trial, 40 eligible type 2 diabetes mellitus (T2DM) patients with macular edema who were candidate to receive anti-VEGF therapy randomized into intervention (CP) and sham controlling (SP). The CP received RIPC in three consecutive days before anti-VEGF injection. Data of optical cochrane tomography (OPC) before and 10 days after procedure were compared as outcomes. Central foveal volume and visual acuity mean difference before and after intra-vitral anti-VEGF injection in both groups was significant. There were no significant mean differences in central macular thickness in case groups. Comparing the mean between two groups did not show a significant difference in visual acuity, central foveal volume (P-value: 0.69) and central macular thickness (P-value: 0.62). There were no significant differences in the desired changes pattern of DME between two groups (P-value: 1.00). This pilot study did not show any additive positive effect of RIPC on retinal outcomes especially visual acuity in T2DM patients with DME who were received anti-VEGF treatment.

Physical exercise is a well-established therapeutic method in type 2 diabetes treatment. The purpose of this study was to investigate the effects of eight weeks combined and High Intensity Interval Training on serum apelin levels and pancreatic β-cell function in overweight women with type 2 diabetes mellitus. Fifty-two overweight female patients with type 2 diabetes (aged 45-60 years old, BMI> 30) with HbA1c>6.5% participated in the study voluntarily. The participants were assigned to High Intensity Interval Training (HIIT) group (n= 17), combined training group (n= 17), and control group (n= 18) according to their HbA1c levels. The exercises included 12 weeks of combined training and HIIT. Levels of HbA1c and fasting glucose and insulin were measured. There was a significant decrease in the fasting blood glucose in the HIIT groups (P-value: 0.001). Serum insulin levels showed significant increases in the HIIT (P-value: 0.001) and combined training groups (P-value: 0.001). Changes in apelin level were not significantly different within HIIT and combined training groups (P-value: 0.13 and 0.09, respectively). The data showed significant differences in pancreatic β-cells function in HIIT (P < 0.001) and combined training groups (P= 0.003). Furthermore, the ANCOVA test showed that there were no significant differences in fasting blood glucose concentrations (F= 1.853, P-value: 0.171), apelin (F= 0.511, P-value: 0.12). However, significant differences were observed between groups in insulin (F= 3.622, P-value: 0.036), and β-cell function (F= 4.243, P-value: 0.003). Physical exercise is an effective training method to improve glycemic control in woman with type 2 diabetes.

The aim of this study was to investigate the effect of endurance activity on XBP-1 protein content in sciatica tissue of diabetic male Wistar rats. The experimental design was a post-test design with control group. In this study, 32 male Wistar 10 weeks old rats with the mean weight of 253.16 (±10.16) grams were randomly divided into four groups: healthy control, healthy exercise, diabetic control and diabetic training group. An intraperitoneal injection of STZ (45 mg / kg) solution was used to induce diabetes after 12 hours fasting, 48 hours after STZ injection, the moderate-intensity endurance protocol was performed for 6 weeks. Twenty-four hours after the last training session, the mice were exposed and their sciatic nerve was extracted. The amount of XBP-1 protein was measured by ELISA method. For statistical analysis, SPSS software and two-way ANOVA with repeated measure and independent T-test were used. Data analysis showed that endurance activity had an effect on the amount of XBP-1 protein and reduced the protein content, so that the difference was significant in the diabetic training group compared to the diabetic control group (P-value: 0.007). These findings indicated that moderate aerobic exercise has a significant effect on the amount of XBP-1 protein in healthy and diabetic rats.

Diabetes is chronic and debilitating disease that affects all aspects of a person's life. The purpose of this study was to compare the effectiveness of compassion focused (CFT)-acceptance commitment (ACT) combined therapy with cognitive-behavioral therapy (CBT), on interpersonal forgiveness in women with type II diabetes. This was of quasi- experimental study on three groups (CFT-ACT combined therapy, a cognitive-behavioral and a control group) and three stages (pre-test, post- test and follow up). Among diabetic women population, 47 patients were selected purposefully and randomly assigned to three groups. Tow experimental groups (CFT- ACT & CBT) received 120 minutes’ sessions of CFT- ACT and CB for10 weeks. The control group did not receive any treatment .Data were analyzed by repeated measures analysis of variance using SPSS-24 software. The results showed that the scores of experimental group participants in the post test of CFT-ACT and CBT improved significantly compared to the control group in all three components of forgiveness, including reconnection and  revenge  control, resentment control and  realistic understanding (P-value: 0/000). The experimental group of the combined therapeutic model was more effective than the CBT group in the two components of resentment control and realistic understanding. Based on the findings, the combination therapy of CFT- ACT and CBT can be used to promote reconnection and revenge control, resentment control and realistic understanding in diabetic patients.

Exercise as a non-pharmacological treatment plays an important role in regulating and reducing the inflammatory cytokine associated with beta cell function. Genetics is one of the most important and effective factors in the incidence of diabetes, in most cases. The present study aims to explain the effect of 12 weeks aerobic training on FOXO1 expression in pancreatic tissue, insulin and blood glucose levels in male wistar rats with type 2 diabetes mellitus. In this study, 16 male wistar rats were divided into diabetic control and diabetic training groups. The two groups were diabetic with nicotine amide and streptozotocin injections and the training group did aerobic exercises for treadmill for 12 weeks.   The results of the study showed a significant increase in FOXO1 expression after 12 weeks of aerobic training (P-value: 0.027), which resulted in a significant decrease in blood glucose concentration (P-value: 0.0001). The induction of type 2 diabetes leads to a reduction in the expression of FOXO1 gene in the tissues of the pancreas in experimental rats, which is associated with a decrease in serum levels of insulin and an increase in blood glucose levels. On the other hand, 12 weeks of aerobic training of 5 sessions per week leads to a significant increase in the expression of FOXO1 gene, with decreasing glucose and increased serum insulin in the pancreatic tissue of diabetic rats.

This study examined the effect of high intensity interval training (HIIT) on HNF-4α gene expression, glucose and insulin in liver tissue of type 2 diabetic male Wistar rats. In this study, 20 male Wistar rats weighing 220 (±20) grams were selected. After type 2 diabetes (T2D) induction, the samples were divided into two groups of HIIT and control. The training program was 12 weeks and 5 times a week. Fasting glucose, serum insulin and HNF-4α gene expression in the liver tissue were measured in both groups after the last exercise session by using independent T-test. The results showed that HIIT decreased significantly the fasting glucose (P-value: 0.001) and increased serum insulin (P-value: 0.001). Also, the expression of HNF-4α after HIIT significantly decreased in comparison to the control group (P-value: 0.003). Based on the findings, HIIT resulted in a significant decrease in fasting glucose and a significant increase in insulin that is likely to reduce the liver HNF-4α gene expression of T2D male Wistar rats by increasing serum insulin.

Fat mass and obesity associated gene (FTO) was identified as a candidate gene contributing to obesity, insulin resistance and type 2 diabetes mellitus (T2DM). This study aimed to determine the effect of resistance training on FTO expression in subcutaneous fat tissue, insulin resistance and glucose in T2DM rats. For this purpose, sixteen obese males wistar rats with T2DM were randomly divided into exercise (n= 8) and control (n= 8) groups. Exercise group were completed six weeks resistance training included climbed on a stepladder (5 days per week) and control group did not participate in exercise intervention. Relative expression of FTO expression in subcutaneous fat tissue, fasting glucose and insulin resistance were measured 48 hours after last exercise session of two groups. Independent t-test used to compare data. In comparison with control group, resistance training induced significant decrease in fasting glucose (P-value: 0.001) and insulin resistance (P-value: 0.001). But FTO expression in subcutaneous fat tissue did not change by resistance training (P-value: 0.318). Resistance training did not influence FTO expression in fat tissue of T2DM rats. Improved insulin resistance and glucose can be attributed to the change in other genetic or hormonal factors by resistance training.

The purpose of this study was to measure the changes of the SUN1 protein levels on soleus muscle in diabetic male wistar rats. Twenty male Wistar rats with 10 weeks old and weighing 200-250 grams were selected. After two weeks, the rats were divided into two groups (diabetic group and healthy group). After 12 hours fasting, diabetes was induced by intraperitoneally injection of streptozotocin (STZ). At the end of sixth week, the soleus muscle was removed and kept at a temperature of -80 degrees to evaluate the difference of SUN1 protein between two groups. there was not significant difference in SUN1 protein levels between diabetic and control groups (P-value: 0.525). Although in most of laminopathies, the SUN1 protein that located in the inner nuclear membrane changed, but it seems the proteins in the inner membrane, are not affected by diabetes.