Iranian Journal of Diabetes and Obesity

en Beyond HbA1c: Artificial Intelligence and Gut Microbiome Metabolites for Predicting Diabetic Complications تخصصي Special پژوهشي Research Dear Editor, I am writing to draw attention to the remarkable advances in integrating artificial intelligence (AI) and gut microbiome metabolomics for predicting diabetic complications. Despite achieving recommended HbA1c targets, many patients continue to develop diabetic microvascular complications (1). 154 155 http://ijdo.ssu.ac.ir/browse.php?a_code=A-10-30-483&slc_lang=en&sid=1 Elaheh Ghanbari 0000-0006-2518-2877 Yes Student Research Committee, Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.

en Hematological and Inflammatory Cytokine Profiles in Subjects with Type 2 Diabetes Mellitus in Port Harcourt, Nigeria تخصصي Special پژوهشي Research Objective: Type 2 diabetes mellitus (T2DM) is associated with chronic hyperglycemia and systemic inflammation, which contribute to hematological alterations and vascular complications. This study evaluated hematological indices, interleukin-1β (IL-1β), and tumor necrosis factor-α (TNF-α) in individuals with T2DM in Port Harcourt, Nigeria, and examined their relationship with glycated hemoglobin (HbA1c). Materials and Methods: This case-control study involved 70 T2DM patients (HbA1c≥ 6.5%) and 70 age- and sex-matched healthy controls. Fasting blood glucose (FBG) was measured enzymatically, HbA1c by fluorescence immunoassay, complete blood count using an automated hematology analyzer, and cytokines by ELISA. Statistical analysis was performed using GraphPad Prism version 8.0.2, with effect sizes reported and P≤ 0.05 considered significant. Results: T2DM subjects had significantly higher FBG, HbA1c, WBC, neutrophil percentage, and IL-1β, and significantly lower RBC, lymphocyte percentage, PLT, and PCT (adjusted P< 0.05). IL-1β was more than three-fold higher in diabetics, with a very large effect size. FBG increased significantly with longer disease duration (P= 0.008). HbA1c correlated positively with FBG (P< 0.001) WBC (P= 0.044), MPV (P= 0.006), and PDW (P= 0.015), and negatively with MCV (P= 0.019) and Mixed WBC population (P= 0.001). Conclusion: This study simultaneously assessed complete blood count parameters alongside IL-1β and TNF-α in the same cohort. The findings demonstrate that T2DM in this population is characterized by clinically meaningful hematological and inflammatory alterations linked to poor glycemic control. Integrating routine complete blood count and selected inflammatory markers into diabetes monitoring may enhance early risk stratification, particularly in resource-limited settings. . Diabetes, Blood cell count, Interleukin-1beta, Inflammation 156 167 http://ijdo.ssu.ac.ir/browse.php?a_code=A-10-30-484&slc_lang=en&sid=1 Christopher Aloy Simeon 0000-0005-8647-6409 Yes Department of Hematology and Blood Transfusion Science, Faculty of Medical Laboratory Science, Rivers State University, Port Harcourt, Nigeria. Serekara Gideon Christian 0000-0003-2169-8906 No Department of Hematology and Blood Transfusion Science, Faculty of Medical Laboratory Science, Rivers State University, Port Harcourt, Nigeria. Stella Urekweru Ken-Ezihuo 0000-0001-5129-9063 No Department of Hematology and Blood Transfusion Science, Faculty of Medical Laboratory Science, Rivers State University, Port Harcourt, Nigeria.

en Assessment of the Effect of Diabetes Education and Knowledge on Management Outcomes تخصصي Special پژوهشي Research Objective: Diabetes education is a key component of type 2 diabetes mellitus (T2DM) management. However, evidence from Nigeria on the effectiveness of diabetes education remains limited. This study evaluated the impact of a structured education program on diabetes knowledge, glycemic control, and some metabolic parameters among adults with T2DM. Materials and Methods: This single-group interventional study consecutively recruited T2DM adults attending a tertiary diabetes clinic. The intervention was initially planned with a three months follow-up but was terminated at four weeks due to substantial loss to follow-up. Participants received three structured diabetes self-management education and support (DSMES) sessions at baseline (week 0), week 2 and week 4. Diabetes knowledge was assessed at baseline and at four weeks using the Michigan Brief Diabetes Knowledge Test. Sociodemographic and clinical data were obtained from structured proformas and medical records. Data were <a name="_Hlk218232511">analyzed using descriptive and inferential statistics at P< 0.05</a>. Results: A total of 118 participants were enrolled (mean age 58.25± 14.26 years; 63.3% female). At baseline, only 36% achieved good diabetes knowledge (≥ 65%); this increased significantly to 85% after the education program (P= 0.01). Significant improvements were also observed in fasting blood glucose (P= 0.01) and blood pressure (P= 0.04). Independent predictors of good diabetes knowledge included shorter disease duration (< 10 years), regular exercise, and better short-term glycemic control. Conclusion: Structured diabetes education significantly improved diabetes knowledge and short-term clinical outcomes. Incorporating structured education into routine diabetes care may help reduce the burden of T2DM in Nigeria.   Blood glucose, Diabetes mellitus, Health education, Health knowledge, Treatment outcome 168 179 http://ijdo.ssu.ac.ir/browse.php?a_code=A-10-30-485&slc_lang=en&sid=1 Ayotunde O. Ale 0000-0003-1779-7311 Yes Department of Medicine, Olabisi Onabanjo University, Sagamu Campus, Ogun State, Nigeria. Odusan Olatunde 0000-0002-3308-5501 No Physiotherapy Department, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. Taiwo O. Afe 0000-0003-2757-367X No Department of Medicine, Olabisi Onabanjo University, Sagamu Campus, Ogun State, Nigeria. Olufemi O. Oyewole 0000-0003-2432-247X No Physiotherapy Department, Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State, Nigeria. Jane C. Bakare 0009-0002-3254-3782 No Department of Medicine, Alimosho General Hospital and Eko University of Medicine and Health Sciences, Lagos, Nigeria. Oluwabukola O. Ale 0009-0008-6372-2939 No College of Medicine and Health Sciences, Afe Babalola University, Ekiti State, Nigeria.

en Structural Relationships between Anxiety and Diabetes Self Management in Adolescents with Type 1 Diabetes: The Mediating Role of Perceived Stress تخصصي Special پژوهشي Research Objective: Adolescents with type 1 diabetes often face psychological challenges that may interfere with effective disease management. This study aimed to examine the structural links between anxiety and diabetes self-management, with perceived stress tested as a potential mediator. Materials and Methods: This descriptive correlational study was conducted among adolescents with type 1 diabetes attending diabetes treatment centers in Tehran, Iran, in 2024. A convenience sample of 310 participants completed the Diabetes Self-Management Questionnaire, the Perceived Stress Scale, and the Beck Anxiety Inventory. Path analysis was conducted using AMOS version 24. The adequacy of the proposed model was evaluated through standard goodness-of-fit indices, and the mediating effect of perceived stress was tested using bootstrap confidence intervals. Results: The structural model showed an acceptable fit to the observed data. Anxiety had a significant positive effect on perceived stress, β= .33, t= 4.61,P< 0.001, and a significant negative effect on diabetes self-management, β= −0.28, t= −3.90, P< 0.001. Perceived stress was also negatively associated with diabetes self-management, β= −0.46, t= −6.20, P< 0.001. Bootstrap analysis confirmed the significant indirect effect of anxiety on diabetes self-management via perceived stress, 95% CI [-0.28, -0.11]. The final model explained 48% of the variance in diabetes self-management. Conclusion: Anxiety appears to compromise diabetes self-management among adolescents with type 1 diabetes, partly through heightened perceived stress. Integrating anxiety- and stress-focused psychological interventions into routine diabetes care may improve self-management outcomes in this vulnerable population. Anxiety, Perceived stress, Diabetes self management, Type 1 diabetes, Adolescents 180 189 http://ijdo.ssu.ac.ir/browse.php?a_code=A-10-30-486&slc_lang=en&sid=1 Fatemeh Amirzadeh 0009-0009-4160-463X No Department of Health Psychology, Go.C., Islamic Azad University, Gorgan, Iran. Mohsen Jalali 0000-0002-1835-0776 Yes Assistant Prof of clinical psychology, Faculty of Humanities and Social sciences, Golestan University, Gorgan, Iran. Elnaz Pourahmadi 0009-0007-1538-718X No Department of Psychology, BG.C.,Islamic Azad University, Bandar Gaz, Iran. Seyedeh Leila Azizi 0000-0003-4576-6141 No Department of Nursing, Go.C., Islamic Azad University, Gorgan, Iran.

en Effect of Resistance and Interval Training on Serum Melatonin and Expression of Its Receptors (MTNR1A and MTNR1B) in the Pancreas Tissue of Diabetic Rats تخصصي Special پژوهشي Research Objective: This study aimed to examine the association between depression and quality of life in patients with diabetes at risk of diabulimia, with a particular focus on the mediating role of illness perception. Materials and Methods: This descriptive-correlational study was conducted among patients with diabetes attending specialized diabetes clinics in Shiraz, Iran, between July and October 2025. Using convenience sampling, 161 eligible participants were recruited. Data were collected using the Beck Depression Inventory-II (BDI-II), the Brief Illness Perception Questionnaire (B-IPQ), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Data were analyzed using SPSS version 27 and SmartPLS version 4. Structural equation modeling was applied to test the hypothesized direct and indirect relationships among depression, illness perception, and quality of life. Results: The findings showed that depression had a significant negative direct effect on illness perception (P< 0.001) and quality of life (P< 0.001). Illness perception had a significant positive effect on quality of life (P< 0.001). In addition, the indirect effect of depression on quality of life through illness perception was significant (P< 0.001), indicating the mediating role of illness perception. Conclusion: Depression was associated with poorer quality of life among patients with diabetes at risk of diabulimia, both directly and indirectly through illness perception. These findings highlight the importance of psychological interventions that address depressive symptoms and illness-related perceptions to improve quality of life in this population.   Depression, Illness perception, Quality of life, Diabulimia 190 199 http://ijdo.ssu.ac.ir/browse.php?a_code=A-10-30-487&slc_lang=en&sid=1 Sara Jahandarpour 0000-0002-2274-142X No PhD candidate, Department of Psychology, Azad university, Bushehr, Iran. Moolod Keykhosravani 0000-0002-0388-4265 Yes Assistant professor, Department of Psychology, Azad university, Bushehr, Iran. Ali Pouladi Rishehri 0000-0001-8314-7099 No Associate professor, Department of Psychology, Payam Noor university, Tehran, Iran. Vahid Rafiee Dehbidi 0000-0002-2752-5566 No Assistant Professor of Sports Management, Department of Sports Sciences, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran.

en The Effect of Exercise Training Combined with Nanocurcumin Supplementation on Metabolic and Liver Function Markers in Post-Bariatric Surgery Patients: A Randomized Controlled Trial تخصصي Special پژوهشي Research Objective: Obesity is a chronic inflammatory condition associated with metabolic disorders such as cardiovascular disease, diabetes, and non-alcoholic fatty liver disease. This study aimed to investigate the additive effects of nanocurcumin supplementation combined with exercise training on metabolic and liver function markers in patients after bariatric surgery. Materials and Methods: In this randomized, single-blind, placebo-controlled trial, 60 patients (35-45 years) with a history of bariatric surgery were assigned to two groups: exercise + nanocurcumin or exercise + placebo (n= 30 each). Both groups performed combined aerobic-resistance training (3 sessions/week) for 6 weeks. The intervention group received 40 mg nanocurcumin twice daily. Blood samples were collected before and after the intervention. Data were analyzed using MANCOVA (P≤ 0.05). Results: A significant multivariate effect of group was observed (Wilks’ Lambda, P< 0.001). Compared with placebo, the intervention group showed significant reductions in LDL, triglycerides (P= 0.001), body fat percentage (P= 0.004), ALT (P= .017), AST (P= .004), and ferritin (P= 0.002) along with increases in HDL (P= 0.023) and albumin (P= 0.017). Conclusion: Nanocurcumin supplementation combined with exercise training may improve lipid profile, liver enzyme levels, and inflammation-related markers in patients after bariatric surgery. However, due to identical exercise protocols in both groups, the findings reflect the additive effect of nanocurcumin rather than its independent effect.   Bariatric surgery, Metabolic syndrome, Exercise training, Nanocurcumin, Liver enzymes 200 207 http://ijdo.ssu.ac.ir/browse.php?a_code=A-10-30-488&slc_lang=en&sid=1 Mohammad Reza Goshtasbi 0009-0007-5539-8166 No MSc of Exercise Physiology, Department of Physical Education and Sport Sciences, ET.C. , Islamic Azad University, Tehran, Iran. Masoumeh Hosseini 0000-0001-8457-1924 Yes Associate Prof., Department of Physical Education and Sport Sciences, ET.C. , Islamic Azad University, Tehran, Iran. Shahab Shahabi Shahmiri 0000-0002-8415-2567 No Assistant Prof., Department of General Surgery, Rasoul Akram Hospital. Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran. Shahin Riyahi Malayeri 0000-0001-6989-4821 No Associate Prof., Department of Physical Education and Sport Sciences, ET.C. , Islamic Azad University, Tehran, Iran.

en Effects of Eight Weeks of Swimming Training on Fetuin-A, FGF21 Levels, and Oxidative Stress in Liver Tissue of Mice with Type 2 Diabetes تخصصي Special پژوهشي Research Objective: The aim of the present study was to investigate the effect of eight weeks of swimming training on Fetuin-A, FGF21, and oxidative stress levels in the liver tissue of type 2 diabetic mice. Materials and Methods: A total of 32 male BALB/c mice were randomly assigned to four groups: healthy control (HC), healthy training (HT), diabetic control (DC) and diabetic training (DT). Type 2 diabetes was induced using a high fat diet combined with streptozotocin. Swimming sessions were conducted five days/week over eight weeks with progressive intensity. Liver samples were harvested 48 hours after the final session. Fetuin-A and FGF21 gene expression were measured via real-time PCR, and ROS levels were quantified using a fluorescence assay. One-way ANOVA with Tukey's post hoc test was used for comparisons (P≤ 0.05). Results: Diabetes induction significantly increased Fetuin-A, FGF21, and ROS levels in the DC group compared to the HC group (P< 0.001). The adaptation resulting from eight weeks of swimming training in the diabetic exercise group probably decreased Fetuin-A and ROS and increased FGF21 (P< 0.001). In the HT group, decreased Fetuin-A and increased FGF21 were also observed compared to the HC group (P< 0.001). Conclusion: Swimming training modulates key hepatokines(decreasing Fetuin-A and increasing FGF21) and reduces oxidative stress, thereby creating a more favorable metabolic environment in the liver of diabetic mice. These findings in the studied group suggest that swimming training could probably be considered as a non-pharmacological strategy.   Type 2 diabetes, Swimming training, Fetuin-A, FGF21, Oxidative stress, Liver 208 218 http://ijdo.ssu.ac.ir/browse.php?a_code=A-10-30-489&slc_lang=en&sid=1 Mozhgan Zare 0009-0009-3726-7538 No M.Sc. in Exercise Physiology, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran Sirous Farsi 0000-0002-5339-4205 No Department of Sports Physiology, Laristan Branch, Islamic Azad University, Laristan, Iran. Ali Shaker 0009-0009-5023-1521 Yes Department of Exercise Physiology, Shiraz Branch, Islamic Azad University, Shiraz, Iran.

en Evaluation of Cardiac Events in Diabetic Patients with Inadequate Exercise Test and Normal Myocardial Perfusion Scan Compared to the Control Group تخصصي Special پژوهشي Research Objective: Ischemic heart disease is one of the most important complications of diabetes mellitus. This study aimed to compare the incidence of cardiovascular events in diabetic patients with inadequate exercise testing and normal myocardial perfusion scans with those who had adequate exercise testing and normal scans. Materials and Methods: This retrospective study was conducted at Shahid Sadoughi Hospital in Yazd, Iran. Medical records of patients referred to the nuclear medicine department were reviewed. Patients were divided into two groups: those with inadequate exercise tests but normal myocardial perfusion scans and those with adequate exercise tests and normal scans. Patients’ contact information was obtained from their medical records, and follow-up was performed by telephone to determine the occurrence of cardiovascular events, including cardiovascular-related death, coronary angiography, percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG), myocardial infarction, and hospitalization due to cardiovascular disease. Data were analyzed using SPSS version 20, and statistical analyses were performed using the independent t-test and Chi-square test. Results: A total of 210 patients were included in the study, of whom 86 (41%) were male. Dyslipidemia was present in 120 patients (57.1%), hypertension in 89 (42.4%), and smoking in 48 (22.9%). Hypertension and smoking were significantly more common in the study group than in the control group. Cardiovascular events occurred in 18 patients (17.1%) in the study group and 10 patients (9.5%) in the control group; however, this difference was not statistically significant (P= 0.10). Although the risk of cardiovascular events in the study group was 1.35 times higher than in the control group, this difference was not statistically significant (P= 0.60). Conclusion: Although the incidence of cardiovascular events was higher among diabetic patients with inadequate exercise testing and normal myocardial perfusion scans, the difference compared with patients with adequate exercise testing and normal scans was not statistically significant.   Cardiovascular events, Diabetes, Mortality, Ischemic heart disease, Myocardial perfusion scan 219 226 http://ijdo.ssu.ac.ir/browse.php?a_code=A-10-30-490&slc_lang=en&sid=1 Amir Mohammad Heydari No Faculty of Medicine Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Elahe Ahmadi No Faculty of Medicine Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Seyed Kazem Razavi 0000-0002-7365-6399 No Associate Professor of Nuclear Medicine, Shahid Sadoughi University of Medical Sciences, Yazd. Iran. Mohammad Ali Jolodari No Faculty of Medicine Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Nasim Namiranian 0000-0002-5133-6204 No Associate Professor of Nuclear Medicine, Shahid Sadoughi University of Medical Sciences, Yazd. Iran. Zeinab Sahebi 0009-0001-7009-8387 Yes Diabetes Research Center, Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

en Epigenetics in Diabetes Management: A Comprehensive Review of Diagnostic and Preventive Strategies تخصصي Special پژوهشي Research As diabetes mellitus evolves into a global health crisis, conventional diagnostic and therapeutic paradigms are no longer sufficient and necessitate innovative treatment approaches that extend beyond traditional pharmacotherapy. Recent advances in epigenetics have uncovered heritable and reversible changes in gene regulation that contribute to the pathogenesis of diabetes. This review provides a comprehensive analysis of various epigenetic mechanisms, including DNA methylation, histone modifications, and the role of non-coding RNAs in diabetes development, and evaluates their integration into a precision medicine framework for early diagnosis, risk stratification, and biomarker-guided therapeutic interventions. Furthermore, we discuss personalized management strategies that leverage epigenetic understanding to optimize therapeutic and preventive outcomes. Finally, we consider the upcoming obstacles and prospective scope of personalized medicine in the field of diabetes management. Incorporating epigenetic profiling into diagnostic and therapeutic workflows enables higher-resolution risk assessment, precision targeting of interventions, and improved pharmacodynamic outcomes. Epigenetically informed strategies, including HDAC inhibitors, DNMT modulators, and microbiota-driven interventions, hold promise for enhancing therapeutic efficacy, optimizing drug selection, and personalizing lifestyle interventions. While translational challenges remain, this review highlights that the integration of epigenetic data with genomics, metabolomics, and microbiomics facilitates next-generation personalized diabetes care and has the potential to reshape both clinical practice and public health strategies in the fight against diabetes.   Diabetes mellitus, Epigenomics, Precision medicine, Multiomics 227 238 http://ijdo.ssu.ac.ir/browse.php?a_code=A-10-30-491&slc_lang=en&sid=1 Alireza Abbasi-Bafetrat 0009-0004-0285-4613 Yes Clinical Research Development Unit, Hajar Hospital, Shahrekord University of Medical Sciences, Shahrekord, Iran. Mohammad Abbasi-Bafetrat 0009-0006-7169-7396 No Department of Education, Faculty of Biology, Farhangian University, Shahrekord, Iran.

en The Role of Irisin in Type 2 Diabetes: Mechanisms and Therapeutic Implications تخصصي Special پژوهشي Research Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by decreased insulin sensitivity, impaired glucose homeostasis, and progressive pancreatic β-cell dysfunction. In addition to insulin and glucagon-like peptide-1 (GLP-1), the secretion of other hormones has emerged as a vital regulator of metabolic health, with potential implications for the prevention and treatment of T2DM. One of the hormones in question is irisin. It is a myokine substantially secreted by skeletal muscle during exercise. The aim of this study is to determine the roles of irisin in T2DM, along with its associated mechanisms and therapeutic implications. Irisin levels are declined in T2DM. Irisin enhances insulin secretion and sensitivity in T2DM, which is associated with improved glycemic indices. Medications such as sitagliptin, metformin, and simvastatin stimulate the release of irisin.   T2DM, Irisin, Insulin, Glycemic 239 246 http://ijdo.ssu.ac.ir/browse.php?a_code=A-10-30-492&slc_lang=en&sid=1 Ali Nosrati Andevari 0000-0002-8699-4688 Yes Department of Clinical Biochemistry, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran.