Iranian Journal of Diabetes and Obesity

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Objective: Oxidative stress is involved in the pathophysiology of diabetes and cardiovascular complications of metabolic syndrome. The main objective of this study was to evaluate total antioxidant status by diphenylpicrylhydrazyl (DPPH)-scavenging activity in patients developed metabolic syndrome (MetS). Materials and Methods: Forty-four patients with MetS diagnosed on the basis of adult treatment panel (ATPIII) criteria along with 46 age- and gender-matched healthy controls were studied. A blood sample was taken after a 12-hour fasting period, and blood glucose, lipid profile, and DPPH were determined. Results: A significant decrease (p=0.03) in DPPH-scavenging activity levels in the study group was observed compared to the control group. Among the components of metabolic syndrome, hyperglycaemia, hypertriglyceridaemia and hypertension were negatively correlated with DPPH-scavenging activity levels. Conclusions: The findings of the present study suggest the oxidative stress in patients with MetS which further increases the cardiovascular risk and diabetes mellitus in these patients. We posited that studying of the oxidative status is crucial in order to prevent type 2 diabetes development and cardiovascular disease and its complications because it is installed long before the disease actually appears.

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Abstract Diabetes mellitus is one of the major metabolic disorders. Diabetes is recognized for severe complications including diabetic nephropathy, neuropathy and retinopathy. Long-lasting effect of hyperglycemia results in increased oxidative stress. Oxidative stress results from an imbalance between radical-generating and radical scavenging systems. Increased oxidative stress has been shown to be increased in both insulin-dependent (IDDM), and noninsulin-dependent (NIDDM) diabetes mellitus and it could cause initial β cell damage in type I diabetes, or impaired insulin production, release or function in type II diabetes. Therefore, people with diabetes may also have greater antioxidant requirements because of increased production of free radicals in hyperglycemia. In this article, oxidative stress, free radicals, antioxidants and various mechanisms of reactive oxygen species (ROS) formation such as polyol pathway, protein oxidation, advanced glycation endproducts and lipid peroxidation in diabetic patients will be surveyed.

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Objective: Diabetes is a chronic disease that causes severe side effects in patients. According to the previous studies, the incidence of depression and anxiety is higher among patients with diabetes type 2. The present study was conducted with the aim of examining the effectiveness of mindfulness-based stress reduction program and conscious yoga on depression, anxiety and stress in patients with diabetes type 2. Materials and Methods: The study was quasi-experimental with pre-test, post-test, control group and a 2-month follow-up. 24 patients among patients with diabetes who referred to Imam Hossein hospital were selected in an available way and were randomly assigned into experimental (n1=12) and control groups (n2=12). The level of quality of life was measured using Quality of Life Questionnaire (SF-36) in pre-test. Then, participants of the experimental group received group mindfulness-based stress reduction program and conscious yoga for 8 sessions. After completing the interventions, patients' quality of life level was measured again and data were analyzed using multivariate repeated measurement model. Results: Findings showed there is a significant difference between experimental and control groups in terms of the quality of life level and mindfulness-based stress reduction program significantly increases the quality of life in the participants of the experimental group. Conclusion: The result of this study suggests that mindfulness-based stress reduction program can be an appropriate therapeutic method for improving quality of life in patients with diabetes type 2.

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Objective: The use of non-enzymatic antioxidants in food supplements and proper exercise can have a positive effect on decreasing oxidative stress by free radical hunting. The purpose of this study was to investigate the effect of aerobic training and L-carnitine supplementation on some of the oxidative stress factors in the liver of diabetic rats.
Materials and Methods: In this experimental study, 45 male wistar rats (200-300 gr) were randomly divided into six groups: 1) sham group, 2) healthy control group 3) diabetic control group, 4) diabetic group receiving L-carnitine, 5) diabetic group of aerobic training, 6) diabetic group of aerobic training and receiving L-carnitine. The aerobic exercise protocol included six weeks, five sessions per week on the treadmill. After intervention, malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GPX) levels were determined in liver tissue.
Results: Six weeks of aerobic exercise had a significant effect on MDA factor in hepatic tissue in diabetic rats (P-value: 0.024). However, supplementation (P-value: 0.868) and combined intervention of aerobic exercise and supplementation of L-carnitine (P-value: 0.465) did not have the significant effect on MDA factor. Also, 6 weeks of aerobic training, supplementation of L-carnitine, and combined intervention had no significant effect on SOD and GPX factors of hepatic tissue in diabetic rats (P-value> 0.05).
Conclusion: L-carnitine supplementation with regular exercise can have beneficial effects on hepatic antioxidant defense system in rats with type 2 diabetes.

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Objective: Physical exercise has different effects on oxidative stress. Oxidative stress influences TLR4 and NFkB gene expression. The purpose of this study was to investigate the effect of aerobic training and vitamin D on gene expression of TLR4 and NFkB in lung tissue of obese rats exposed to oxygenated water.
Materials and Methods: In an experimental study, 30 obese male wistar rats were randomly divided into five groups: control, oxygenated water, oxygenated water + vitamin D, oxygenated water + aerobic training, and oxygenated water + aerobic training + vitamin D. All the rats were injected intraperitoneally with oxygenated water. Vitamin D was performed by intraperitoneal injection of 0.5 μg daily for eight weeks. The aerobic training protocol included 8 weeks, 5 sessions per week running on treadmill. TLR4 and NFkB gene expression of lung tissue were investigated using real time & PCR. Two-way ANOVA and Bonferroni post hoc test were used to analysis the data. The significant level was set at P-value< 0.05.
Results: Aerobic training significantly reduced TLR4 expression compared with other groups (P-value: 0.046) but did not significantly affect the expression of NFkB gene (P-value: 0.261). Vitamin D alone and aerobic training and vitamin D interaction did not significantly alter the gene expression of TLR4 (P-value: 0.072 and P-value: 0.695, respectively) and NFkB (P-value: 0.243 and P-value:< 0.195, respectively).
Conclusion: It seems that performing aerobic training is likely to be beneficial in reducing oxidative stress and inflammation compared to inactivity.

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Objective: Oxidative stress plays an important role in the onset and progression of diabetic nephropathy. So antioxidant agents may be one of the key treatment strategies for prevention of diabetic nephropathy progression .The aim of this study was to determine the effect of selenium (Se) on micro-albuminuria in type 2 diabetic (T2DM) patients.
Materials and Methods: This study was a clinical study on 60 T2DM patients with micro-albuminuria who were referred to Yazd diabetic research center from March 2016 till April 2017. Patients were randomized in to two groups: Se (200 microgram Se daily) and control. The control group did not receive placebo. The intervention duration was 12 weeks. Micro-albuminuria, fasting blood sugar (FBS), cholesterol, triglycerides, HDL-C, LDL-C, urea, creatinine, HbA1c, plasma Se concentration were measured at the baseline and after 12 weeks. 
Results: Micro-albuminuria decreased after 12 weeks in both studied groups but it was not statistically significant. Cholesterol and LDL levels improved statistically in both studied groups at the end of study (P-value: 0.034, 0.023 respectively). Plasma Se level increased in intervention group (P-value< 0.001). There were clinically improvement in other studied variables after 12 weeks in two studied groups but not statistically significant
Conclusion: Our study demonstrated that Se supplementation for 12 weeks among patients with micro-albuminuria had no beneficial effects on micro albuminuria.

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Objective: Diabetes is a common chronic disorder in which there is a high risk of physical complications and psychological problems such as hypoglycemia and inability to express emotions. Psychological interventions can be effective in this regard. The aim of this study was to investigate the effectiveness of mindfulness-based stress reduction (MBSR) training on emotional expressiveness and fear of hypoglycemia (FOH) in patients with type 2 diabetes visiting Yazd Diabetes Center.
Materials and Methods: This study was a quasi-experimental study with a pretest and posttest design. The statistical population was all patients with type 2 diabetes visiting Yazd Diabetes Center in 2020. Forty men and women were selected using purposeful sampling and were randomly allocated to case and control groups. The case group received 8 sessions of MBSR training, 2 hours each and the control group received no interventions. Emotional Expressiveness Questionnaire (EEQ) and the Hypoglycemia Fear Survey (HFS) were used to collect data.
Results: Results of ANCOVA showed that MBSR training significantly increases emotional expressiveness and its components (P-value< 0.0001) and decreases the fear of hypoglycemia (P-value< 0.0001) in patients with type 2 diabetes (P-value< 0.035).
Conclusion: Based on the results of the study, MBSR training could improve emotional expressiveness, prevent hypoglycemia and reduce the fear of it.

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Objective: Yoga has also been implemented in healthcare institutions to manage disease-sequelae, including pain, anxiety, depression, fatigue, and insomnia. In this study, we aimed to evaluate the effect of Yoga-based mindfulness training on anxiety and depression in adolescents with type 1 diabetes (T1D) at clinics of the Shiraz University of Medical Science.
Materials and Methods: This study was conducted via a quasi-experimental method pretest-posttest design on 10-17 years old subjects with T1D, Shiraz, Iran, in 2019-2020. Twenty patients were randomized to the education group (n=10) and the control group (n=10). Data collection tools included the depression, anxiety, and stress scale (DASS-21). The group training intervention was done for the experimental group (ten weeks, 45 minutes every week) without training for the control group. Three months after the training, two groups filled questionnaires. Data were analyzed by multivariate analysis of covariance (MANCOVA) using SPSS- 22 software.
Results: The findings revealed a significant reduction in the mean anxiety level of patients in the intervention group before and after intervention (P< 0.05). Furthermore, following group training, there was a significant change in the mean of depression and stress among the patients in the intervention group (P< 0.05).
Conclusion: Yoga-based mindfulness training was found to improve depression and anxiety in T1DM adolescents. As a consequence, including training sessions in the appropriate care plans would be advantageous.
 

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Objective: This study investigated the mediating role of self-compassion in the relationship of perceived stress with physiological well-being and self-care behaviors among patients suffering from type II diabetes mellitus (T2DM).
Materials and Methods: In this descriptive, cross-sectional study, 369 patients with T2DM were selected through purposive and consecutive sampling from the cities of Rasht and Rezvanshahr (Northern Iran) in 2020-21. The participants completed the perceived stress scale (PSS-4), summary of diabetes self-care activities (SDSCA) questionnaire, Ryff's scale of psychological well-being (RSPWB), and self-compassion scale (SCS-SF). The data were processed through structural equation modeling (SEM) in AMOS-24. Bootstrapping was carried out in MACRO to analyze the mediating relationships.
Results: The perceived stress had a negative and significant correlation with self-compassion (r= -0.456), psychological well-being (r= -0.699), and self-care behaviors (r= -0.671) (For all cases P< 0.01). In addition, self-compassion had a positive and significant relationship with psychological well-being (r= 0.760) and self-care behaviors (r= 0.657) (P< 0.01). The modified structural model had the desired fitting with the collected data (CFI= 0.955, RMSEA= 0.079, χ²/df= 2.842). Following the bootstrapping analysis, self-compassion significantly mediates the relationship between perceived stress, psychological well-being (P< 0.0001), and self-care behaviors (P< 0.0001).
Conclusion: Self-compassion can serve as a shield against and reduce the destructive effects of stress on the psychological well-being and self-care behaviors of diabetic patients. The beneficial effects of self-compassion can be used in diabetic psychotherapy protocols to improve psychological well-being and self-care behaviors.
 

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Objective: This study aimed to investigate the effectiveness of cognitive behavioral stress management (CBSM) on health-related quality of life (HRQOL), self-efficacy of diabetes management, and adherence to treatment of patients with type 2 diabetes.
Materials and Methods: The present study was a semi-experimental study with a control group. The research samples included 30 patients with type 2 diabetes. Data collection tools in this study included the Boyer & Earp quality of life (QOL) scale for patients with diabetes (D-39), the diabetes management self-efficacy scale (DMSES), and treatment adherence questionnaire in patients with chronic diseases. The CBSM therapy was performed in 8 sessions for the experimental group. To analyze the data, a univariate analysis of covariance was used with SPSS-23 software.
Results: The results showed that the CBSM had a significant effect on the overall health-based QOL (F=8.620; P=0.007), diabetes management self-ffficacy (F=12.021; P=0.002), and treatment adherence (F=83.253; P=0.0001). In addition, the CBSM has a significant effect on diabetes control (F=8.932; P=0.007), anxiety and worry (F=5.023; P=0.035), and sexual functioning (F=7.611; P=0.011), diet (F=10.041; P=0.004), therapeutic regimen (F=24.250; P=0.0001), making effort for treatment (F=22.987; P=0.0001), intention to take the treatment (F=108.001; P=0.0001), adaptability (F=28.704; P=0.0001), and integrating illness into life (F=38.263; P=0.0001).
Conclusion: The CBSM intervention can be used to improve health-based QOL, diabetes management self-efficacy, and treatment adherence in type 2 diabetes patients.
 

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Objective: Diabetes is a chronic metabolic disorder that can be exacerbated by stress, poor compliance and self-care practices. This study investigated the effects of self-care training combined with stress management on treatment adherence in type 2 diabetes mellitus (T2DM) people.
Materials and Methods: This is a randomized clinical trial with repeated measures. The study sample included 30 T2DM who were purposively selected among the eligible members of the Kerman Diabetes Association. The participants were randomized to the experimental group (stress management based on cognitive-behavioral therapy and self-care training) (n=15) and the control group (no intervention) (n=15). Both groups completed the Medanlo Treatment Adherence Questionnaire at the pretest, posttest, and follow-up time points. Data were analyzed statistically using ANOVA.
Results: The post-test and follow-up mean scores of treatment adherence significantly increased in the experimental group compared with the control group (P< 0.001). In addition, the results demonstrated that treatment adherence improved in follow-up (P< 0.001).
Conclusion: According to the study results, psychological training should be integrated with self-care training to achieve long lasting treatment adherence in T2DM people.