Iranian Journal of

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Background: Hypertension and dyslipidemia are common in patients with type 2 diabetes mellitus. The high prevalence of cardiovascular disease in diabetic patients is, in part, related to these two risk factors. This study was performed to determine the prevalence of hypertension and dyslipidemia in newly diagnosed patients with type 2 diabetes mellitus in Isfahan.
Methods : In this cross – sectional study during 2001 – 2003, 310 newly diagnosed type 2 diabetic patients, in Isfahan endocrine and metabolism research center, were studied. Height, weight, blood pressure, Plasma lipid and lipoproteins, and HbA1c were determined for all subjects.
Results: Mean age at presentation was 489.83 years, and mean BMI was 28.44.62 Kg/m2. Hypertension was present in 32.9%, hypercholesterolaemia in 61.3%, hypertriglyceridaemia in 61.6%, high LDL in 77.3%, and low HDL in 67.8% of these patietns. The mean systolic and diastolic blood pressure were 119.0816.59 and 70.0214.02mmHg, respectively. The mean for total cholestrol was 216.1043.65, for triglyceride 207.46105.67, for LDL 124.7331.45, and for HDL 43.119.29 mg/dl.
Conclusion: Hypertension and dyslipidemia are common in newly diagnosed type 2 diabetic patients. This fact demonstrates the importance of early interventions for proper diagnosis and treatment of these two risk factors in diabetic patients.

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Background: Constipation is the most common gastrointestinal complication in diabetic patients. Erythromycin mimics the effects of the gastrointestinal hormone Motilin in gastric contractile activity and insulin secretion. In this study, we compared the effects of Erythromycin and Metoclopramide on glycemic control and constipation in type 2 diabetic patients. Methods: As a clinical trial, thirty-nine type 2 diabetic patients with constipation were divided into two groups. Patients in group 1 (n=24) were treated with erythromycin (400 mg/day before sleep) and participants in the second group (n=15) received metoclopramide (10mg 3 times / day before each meal) for 3 months. FBS, 2hPP BS, HbA1c and the frequency of defecations during a week were measured and compared before and after the intervention. Results: In Erythromycin treated group, 2hPP BS decreased from 199.7 ± 47.0 before treatment to 174.0±46.3 after intervention (P=0.01) and a significant improvement in constipational symptoms was observed in both groups. Conclusion: It seems that Erythromycin not only can improve symptoms of constipation but may have a role in glycemic control in type 2 diabetic patients.

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Background: Retinopathy is one of the microvascular complications of diabetes which is strongly related to the glycemic control and duration of the disease. According to results of other studies, the prevalence of retinopathy has been reported 5-30% in newly diagnosed patients whit type 2 diabetes (T2DM). The aim of this study was to determine the prevalence of idabeteic retinopathy among newly diagnosed T2DM patients in Isfahan, Iran.
Methods: From july 2001 to March 2004, 710 newly diagnosed patients with T2DM were recruited in this study. Patients with duration of diabetes less than 1 year were considered as newly diagnosed ones. Along with physical examination and laboratory measurment for FBS, HbA1c, lipid profile, urea, Creatinin, and 24 houre urin examniation for albumin, retinoscopy was performed by an experienced ophttalmologist.
Results: In this study, 286 men and 424 women were investigated. The mean age of patients at presentation and the mean duration time of diabetes were 48.8 ±9.8 years (range 31-72years) and 8.6±5.4 months respectively. The prevalence of retinopathy was 9 % (9/8% in males and 8.5% in females). Logistic regression analysis revealed that BMI, diastolic blood pressure and 24 hour urine albumin, were independent risk factors for developing retinopathy.
Conclusion: Nevertheless of relatively moderate prevalence of diabetic retinopathy in our study as compared with other studies, it is necessary to perform retinal examination in newly diagnosed T2DM patients in order to prevent the sight-threatening outcomes of diabetic retinopathy.

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Background: Several studies were pointed to oxidized LDL (OX-LDL) as one of the main immunogenic agents which have important roles in primary lesions of atherosclerosis. In this study, via immunization against OX-LDL with two different antigens in an animal model (rabbit) we tried to clear relation between immune system and atherosclerosis. 

Methods: LDL was isolated from healthy human plasma and oxidized with MDA or Cu⁺⁺. Rabbits were divided to three groups and after 2 weeks (under basic diet) immunized with MDA-LDL or Cu-LDL. In control group Phosphate-buffered saline (PBS) was used. Immunization was repeated with these materials again the weeks of 2, 4, 6, and 8 and concentration of OX-LDL antibody was measured in each stage. At the end of 8^th week, rabbits fed normal or high cholesterol regimens. Biochemical factors were measured at the beginning and end of study, also Fatty streaks in aorta and left and right coronary arteries was evaluated.

Results: Immunization with Cu -LDL and MDA-LDL induced adequate antibody formation (IgG) at the end of 8^th weeks. Immunization with MDA-LDL significantly decreased the level of cholesterol, LDL-cholesterol and fasting blood sugar (FBS) (P= 0.04). Also a significant decrease in fatty streak lesions was detected in aorta and right and left coronary arteries as compared with non-immunized high-cholesterol group (P= 0.04). Immunization with Cu -LDL significantly decreased Triglyceride, FBS and cholesterol as compared with non-immunized high cholesterol. No differences were detected in the fatty streak lesions in this group as compared with non-immunized high-cholesterol diet cu⁺²-LDL immunized group, shown significant decrease in CRP as compared with both non-immunized group and high cholesterol diet.

Conclusion: We conclude the protective effects of immune responses on atherosclerosis depend to what kind of antibody, so MDA-LDL and CU-LDL prevent atherosclerosis with different mechanism.

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Objective: The present study describes assessing physical health status of old people in different age groups in Tehran metropolitan area. The outcomes of this study could help to health policy makers to develop of better health policy in gerontology field by determine of priorities of care in different age groups of old people and effect of socio-economic components on elder’s’ physical health. Method: This was a cross sectional study in 2010. The participants were (N=402) aged 60 years old and over which have underrepresented from Shahid Beheshti university. The survey methods were via face- to-face interviews, and just in a few cases as telephone interviews. The instrument to data collection included demographic questionnaire, SF-36 short form and ADL tools. Data analyzed by Stata and SPSS Ver.15 through t-test, one-way ANOVA. Regression models applied as well. Findings: Based on the results 45% of elderly were in (60-69) years old, 36.5% were in (70-79) years old, and 18.5% were 80+ years old. The median age was 71.5±8.9 years. Regarding ADL, 18.2% of elderly were dependent 22.3% were semi dependent, and 59.5% of participants were independent to do activity of daily living. Regarding physical functioning, 29.6% of elderly had severe limitation 32.6% had moderate limitation, and 37.8% had no limitation in their physical function. Components of age, sex, marital status, education, job, income, insurance, housing, and living with whom had significant association with physical health status in old people. Although based on regression model and considering in effect of conflict variables, age and sex had more effect to predict of activity of daily living in old people. Age, sex, to be alone, and financial problems were the most predictors on physical function in aged people. Conclusion: The important components that effect on physical health of elderly related to fragile elderly from aspect of socio economic factors. Based on the results of this study aged elderly and old women were more disable to do Activity of Daily Living (ADL). Regarding physical function age, sex, living with whom, and financial dependency were significant components in relation with physical function. In other words, older people, women, elderly who did not live with their spouse, and elderly who were dependent in financial aspect to others had more difficulty in physical function.

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Background: Discordance (the presence of different categories of T scores in two skeletal sites of a single patient) can affect the physician’s decision to start medication or not. The present study was therefore conducted to assess the prevalence of T-score discordance between spine and femoral neck as well as its risk factors in a group of postmenopausal Iranian women. Methods: The present analytical cross sectional research was conducted based on the results of IROSTEOPs study on 8146 postmenopausal women referred to the bone mineral density (BMD) center of Shariati Hospital affiliated to Tehran University of Medical Sciences between 2000 and 2011. Based on their BMD results, the patients were categorized into three groups: Concordance and Minor and Major discordance. The factors affecting the risk of developing discordance was then studied through uni/and multivariate logistic regression. Results: Discordance between spine and femoral neck was reported in 3741 (45.9%) of the participants. Multivariate logistic regression revealed that older age, higher number of pregnancies and higher body mass index (BMI) are the main risk factors for T-score discordance at the studied sites. The use of hormonal replacement therapy (HRT) on the other hand played a protective role. Conclusion: It could be concluded that performing BMD at two different sites is necessary for the Iranian population, particularly postmenopausal women.

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Background: Diabetic neuropathy leads to skeletal muscle atrophy however atrophy signaling mechanisms are not well documented. The aim of the present study was to investigate Sunday Driver (Syd) gene expression in soleus muscle of Wistar male rats with diabetic neuropathy. Methods: Twelve male Wistar rats were randomly assigned in 3 groups: diabetic trained, diabetic untrained and healthy control. Two weeks after STZ injection (45 mg/Kg), diabetic neuropathy was demonstrated with mechanical allodynia and thermal hyperalgesia tests and after which moderate endurance training protocol was performed for 6 weeks. 48 hours after final training session, the rats were dissected and soleus muscle tissues were removed. Also Sydgene expression was measured with Real time- PCR methods. Results: Soleus muscle weight was decreased in diabetic groups (P=0.001), but compared with diabetic untrained group, was higher in diabetic trained group (P=0.001). Sydgene expression in diabetic untrained group was higher than healthy control group (P=0.001). Also, compared with diabetic untrained group, training significantly decreased Sydgene expression and blood glucose levels in diabetic trained group. (P=0.001 and P=0.0001, respectively). Conclusion: In soleus muscle of diabetic rats, Sydm RNAup-regulation is involved in development of muscle atrophy and training as a non-pharmacotherapy strategy can modulate and get it close to normal levels. So, it is suggested that Syd should be noted as a novel treatment in diabetes disease.

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Background: Health locus of control is an important variable in diabetes. The aims of the present study were to investigate the role of health locus of control in predicting psychosocial adjustment to illness and compare psychosocial adjustment to illness and dimensions of health locus of control among male and female type 2 diabetic patients.

Methods: One hundred and eighteen patients were recruited via convenience sampling method from type 2 diabetic patients who were referred to the Shahid Motahari diabetes clinic in Shiraz. The participants filled Multidimensional Health Locus of Control (MHLC) and Psychosocial Adjustment to Illness Scale (PAIS).

Results: The results indicated that there were significant positive correlations between psychosocial adjustment to illness and internal health locus of control (r= .30,   P &le .001) and God health locus of control (r= .18,   P &le .05). Internal health locus of control (&beta= .28,   P &le .01) significantly predicted psychosocial adjustment to illness. There were significant differences between male and female diabetic patients on the basis of chance health locus of control. Female patients got higher scores on chance health locus of control. Moreover, there were no significant differences between male and female diabetic patients on the basis of psychosocial adjustment to illness.

Conclusion: The findings highlighted that internal health locus of control and God health locus of control play significant role in psychosocial adjustment to illness. Therefore, it is recommended that psychologists and clinicians take the dimensions of health locus of control into considerations in the treatment of psychological problems of diabetic patients.

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Background: Patients with type 2 diabetes mellitus are more prone to depression. Prevalence of depression in the Iranian results of studies is different. Therefore, the present study aims to study the prevalence of depression in Iranian patients with type II diabetes mellitus.

Methods: This study is a systematic review based on PRISMA guideline for systematic reviews and meta-analyses study. Literature searches of, Scopus, MEDLINE, PubMed, Science Direct, Cochrane, EMBASE, Web of Science, Springer, Online Library Wiley, Google Scholar search engine and Iranians database for publications in Persian and English were conducted up to December 2015. Searches were performed by two researchers independently using standard keywords. Reviewers extracted data and assessed methodological quality in duplicate.  Meta-analysis was performed using STATA, version 11.1 to combine data through Random Effects Model.

Results: Sixteen studies and 3,284 subjects with a mean age of 48.6 years were included in the analysis.  The prevalence of depression in Iranian patients with type II diabetes was estimated 54.8% (95% CI: 43.5- 66.1). This range for males and females were calculated 32.2 %( 95% CI: 16.3-48.1) and 60% (95% CI: 46.4-73.7), respectively. The highest prevalence of depression was in the center of Iran (60%) and the lowest rate was in the west of Iran (38%).

Conclusion: Regarding to high prevalence of depression in patients with type II diabetes, Implementation of screening program for psychiatric disorders, especially depression as well as conducted psychiatric consultation routinely for diagnosis and treatment of depression in these patients it seems necessary.

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Background: Inflammation plays an essential role in the insulin resistance process, and chemokines, such as chemerin, seem to play a pivotal role in the pathogenesis of insulin resistance. The aim of this study was to compare the effects of aerobic exercise and caloric restriction on chemerin levels and insulin resistance index in women with type 2 diabetes.
Methods: In a quasi-experimental study, 30 type 2 diabetes women were recruited (Mean age: 49.3±5.4 yr; weight: 78.8±7.3kg). Subjects randomly were divided into three groups: caloric restriction (experimental group 1 or CR), aerobic exercise with caloric restriction (experimental group 2 or EX+CR) and control group. In CR group, subjects follow a diet with 25% caloric restriction for 12 weeks. Subjects in CR+EX group used a training program including aerobic exercise and running on treadmill and diet with 50% caloric restriction of CR group (12.5% caloric restriction+12.5% increase in energy expenditure). Before and after 12 weeks, blood sampling for measurement of chemerin, IL-6, glucose and insulin was carried out. Data were analyzed by paired sample t-test and one way ANOVA at significant level of p<0.05.
Results: Results showed that body mass index (BMI), waist to hip ratio (WHR), insulin resistance index (HOMA-IR) and interleukin6 decreased significantly in experimental groups. chemerin levels were increased significantly in CR (P=0.001) and EX+CR groups (P=0.001). Significant correlation were seen between changes of chemerin with changes of BMI, WHR, HOMA-IR and interleukin6 (P<0.05).
Conclusion: According to the relationship between chemerin and insulin resistance and also, its effectiveness of aerobic exercise and caloric restriction, decreased levels of chemerin may play a special role in reduction of insulin resistance.

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Background: Patient’s adherence to treatment regimen can predict treatment plan and decrease intensity and symptoms of sickness. This study aimed at determining the effect of educational intervention based on AIM (Ability, Information, Motivation) model on improving adherence of patients with type 2 diabetes.
Methods: This semi experimental interventional study was performed on 180 patients with type 2 diabetes as intervention and control groups. The patients selected using simple random sampling. Study instrument was a questionnaire including demographics (14 items) and AIM model questionnaire (10 items about information, 9items about motivation, 6 items for ability). After baseline, educational intervention was performed in intervention group and post test conducted after six months for both groups. Collected data was analyzed with SPSS software version 23using Mann–Whitney U, Wilcoxon and chi-squared tests. The significant level was considered less than 0.05.
Results: There was no significant difference in demographics and AIM model constructs between two groups (p>0.05). After educational intervention, intervention group revealed a significant difference with control group in terms of information (P<0.001), motivation (P<0.001), ability (P<0.001) and level of HbA1C (P<0.001).
Conclusion: study results revealed AIM model based educational intervention has an important role on treatment adherence among type2 diabetic patients.  With increasing patient information and belief regarding disease patient’s motivation will be improved.
 

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Background: Zinc-Alpha 2-Glycoprotein (ZAG) has recently been implicated in the regulation of adipose tissue metabolism due to its negative association with obesity and insulin resistance. The purpose of this study is to investigate the effect of eight weeks HIIT on level of ZAG in plasma and adipose tissue in type 2 diabetic male rats.
Methods: Twenty one male rats were divided into the three groups of sham control (healthy), control (diabetic), and interval training (diabetic with training). The training group received 8 weeks of training sessions each with 5-12 repetitions of high intensity training for 15-30 seconds at the speed of 27-34 meters per second on a treadmill followed by one minute of active rest. Twenty four hours after the training session blood and body fat samples were taken to measure ZAG levels. The data was analyzed using one-way ANOVA and Tukey’s post hock test at the significance level of 0.05 (P<0.05).
Results: There were significant differences between the sham control and the control with respect to ZAG contents in adipose tissue, which was lower in the diabetic control group (P<0.001). Moreover, significant differences in ZAG contents of adipose tissue were also observed between the sham control and the group receiving the training, with the sham control having higher ZAG contents in adipose tissue (P<0.005). The eight-week HIIT significantly increased the amount of secreted ZAG in adipose tissue compared to the control diabetic group (P=0.003). No significant differences were recorded between the groups in ZAG plasma levels.
Conclusion: The HIIT increased ZAG content in the adipose tissue of the male diabetic rats. This can reduce insulin resistance in type 2 diabetes.

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Background: Adiponectin and resin; Adipocytokine relateted with insulin resistance. The purpose of this study was to the Effect of eight-week high intensity interval training and resveratrol intake on Serum Adiponectin and resistin in type 2 diabetic rats.
Methods: During this experiment 32 diabetic rats with High-Dieting Diet Sprague Dowley race with an average weight of 250 ±10 grams and an average age of 10 weeks, were randomly divided into four groups, including the “control group”, the “supplement group”, the “training group” and the “training and supplement group”. For up to 8 weeks, the “practice” groups participated in 5 training sessions weekly; session was 18 minutes under the influence of High-Intensity Interval training with an intensity of 90 to %100 VO2max. moreover, the supplement groups were given 10 milligram daily doses of resveratrol intake solution per kilogram of body weight Gavage was given for 8 weeks and three times a week. The outcome data was analyzed using one-way analysis of variance and significance level of (P≤0.05).
Results: The results showed that eight weeks of exercise and resveratrol consumption increased on serum adiponectin, but did not have a statistically significant effect (P = 0.62). However, serum resistin decreased and significantly affected the training group (P = 0.001). Also, the mean values of fasting glucose, insulin and insulin resistance index decreased significantly in experimental groups (P = 0.001).
Conclusion: It seems high intensity interval training with resveratrol intake can lead to glucose control in type II diabetes by changing its insulin resistance factors.
 
 

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Background: For nearly 100 years, amniotic membranes have been used to treat various types of skin wounds. Amniotic extract is one of the derivatives of amniotic membrane that contains all the properties of amniotic membrane. The aim of this study was to evaluate the safety of the amniotic membrane extract in the treatment of diabetic ulcers.
Methods: This study was an Open labeled clinical trial without control group. A total of 10 patients with Wagner Grade 2 diabetic foot ulcers were selected in both sexes. The extract was used every 48 hours in the first week and every 72 hours from the second week until the end of the wound treatment. Patients were followed up weekly until wound healing.
Results: In this study 80% of patients were men and 20% were women with mean age (56.7 ± 8.7) years. The ulcer duration was 8.9 ± 2.12 weeks. The mean area of ulcers at the time of entry into the wound group ≥ 500 mm², 977.5 ± 201.9 and in the wound group ≤500 mm² was 145.6 ± 36.4. At 4 weeks post treatment, the wound healing rate in the wound group was ≤500mm² ,98.9 ± 2.40 % and in the wound group ≥mm² 500 was 92.1 ± 7.23%. in sixth week of treatment, ulcers were complete closure  in both groups.
Conclusion: The results of this study suggest that the use of amniotic extract can be effective in the healing of diabetes foot ulcer without any side effects.

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Background: The role of Wnts as mediators of pancreatic development has been confirmed, and exercise training may affect this process. Therefore, the present study aimed to investigate the effect of eight weeks of resistance training and moderate-intensity training on plasma Wnt3a, Wnt4, and pancreatic beta-cell count in streptozotocin-induced diabetic rats.
Methods: Twenty-four rats were divided into four groups: healthy control, diabetic control, diabetic + moderate-intensity continuous training, and diabetic + moderate-intensity resistance training. Diabetes was induced by intravenous injection of 110 mg nicotinamide and 40 mg streptozotocin per kg of body weight. The exercise training intervention was performed for eight weeks. Plasma Wnt3a and Wnt4 were measured by the ELISA method, and the number of beta cells was assessed by hematoxylin-eosin.
Results: Data analysis showed that the number of beta cells in the exercise group increased significantly compared to the diabetic control group (P<0.05). Also, a significant change was observed in the plasma levels of Wnt3a and Wnt4 in the exercise group compared to the healthy control group (P<0.05).
Conclusion: It seems that eight weeks of moderate-intensity continuous training and eight weeks of moderate-intensity resistance training probably caused the proliferation and protection of beta cells in response to an increase in Wnt3a and a decrease in Wnt4 in the diabetic rats.

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Background: Searching for health information and gaining knowledge plays an important role in the management of chronic diseases such as diabetes. The aim of this study was to investigate the role of information resources in self-management of diabetes in diabetic patients referred to health centers in Jahrom.
Methods: This study is a descriptive-analytical study that was performed on 393 patients with diabetes in Jahrom city and covered villages in 2018. Data collection tools included a form of personal information, a questionnaire based on the role of information sources in improving the disease of patients with diabetes, and information was collected through it and the results were statistically analyzed by spss24 software.
Results: The highest age range of the participants in this study was 45 to 60 years old (40.7%) and 67.9% of the patient population were women. 68.1% of patients with diabetes had information about their disease after infection. Most of their sources of information included physicians, family and friends, and other patients and the mass media, respectively. The most important reasons for not obtaining information in 31.9% of other patients were difficulty and lack of access to information resources.
Conclusion: The overall result of this study indicated the relatively high and good health literacy of the subjects. Also, the population who did not have knowledge about their disease were very eager to learn that this problem can be solved as much as possible by properly distributing and presenting educational resources and equalizing educational opportunities and equalization in affluent and deprived areas. The results of this research as well as its overall result can be used to improve the health and education system of the country and help improve and enhance the distribution of educational resources through proper training of health personnel and more cooperation of relevant organizations.

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Background: Adrenomodoline (ADM) is a multifunctional peptide involved in a wide range of physiological processes and cardiovascular function. The purpose of the present study was to compare the effect of physical activity on ADM and nitric oxide (NO) levels and insulin resistance in athletes and non-athletes.
Material and
Methods: 12 athletes and 11 non-athletes participated in this quasi-experimental study. Study participants were selected by convenience sampling.  Both groups performed the Bruce protocol. Blood samples were collected before and after the training session to study the variables. Data were analyzed using one-way analysis of covariance, paired t-test, independent t-test and Pearson correlation.
Results: The results showed that after one session of submaximal exercise activity, HOMA-IR index decreased in non-athlete group (P = 0.034) and NO values increased in both athlete and non-athlete groups (P = 0.001, P = 0.002) and this increase was greater in the athlete group. Also, serum ADM levels were increased in the non-athlete group (P = 0.001) after the training session.
Conclusion: The single session of physical activity with increasing ADM and NO levels, can lead to better vasodilation and improved endothelial function as well as improved insulin resistance in inactive individuals. Since in athletes, only NO levels increased after the end of the activity, it seems that PA has a greater effect on improving the endothelial function of inactive people.

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Background: Diabetes leads to numerous side effects in the cardiovascular system and also to improper functioning of the body's antioxidant system. The aim of this study is to investigate the effect of six weeks of high-intensity interval training with coenzyme Q10 supplementation on the values of Nrf2 and NQO1 in heart muscle of elderly diabetic rats.
Methods: In this experimental study, 48 elderly male rats (18 months old) were randomly divided into four groups of intense aerobic exercise with coenzyme Q10 supplementation, intense aerobic exercise group, coenzyme Q10 supplement intake group, and control group. Induction of diabetes was done by injecting a single dose of streptozotocin in the amount of 60 mg/kg intraperitoneally. The program of high intensity interval training was done for six weeks. Coenzyme Q10 supplement group received orally at a dose of 200 mg/kg. Western blot method was used to measure Nrf2 and NQO1 values. The data were analyzed by one-way analysis of variance and Tukey's post hoc test at a significance level of P <0.05.
Results: The results showed taking coenzyme Q10 supplement (P= 0.014), intense intermittent exercise (P= 0.001) and intense intermittent exercise with coenzyme Q10 supplement (P= 0.001) significantly increased Nrf2 values in the hearts of diabetic elderly rats. Also, the use of coenzyme Q10 supplement (P=0.0366), intense intermittent exercise (P= 0.014) and intense intermittent exercise along with coenzyme Q10 supplement use (P= 0.002) significantly increased the amount of NQO1 in the hearts of diabetic aged male rats.
Conclusion: Intermittent intense training along with supplement consumption improves heart function in elderly diabetic patients through increasing endogenous antioxidant enzymes.