Iranian Journal of

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Background: Although dietary guidelines recommend increased intake of grain products to prevent chronic diseases, epidemiologic data regarding whole-grain intake associated with metabolic syndrome is sparse. This study was undertaken to evaluate the relationship between whole-grain intake, metabolic syndrome and metabolic risk factors in Tehran adults population.
Methods: In this cross-sectional study, 827 subjects aged 18-74 were randomly selected from participants of the Tehran Lipid and Glucose Study. Usual dietary intake was assessed using a semi-quantitative food frequency questionnaire and two 24-hour dietary recalls. BMI, FBS, blood pressure, hypertriglyceridemia, hypercholesterolemia, high LDL, low LDL, metabolic syndrome (according to ATP III guidelines) and hypertension (based on JNC VI) were assessed subjects were categorized on quartile cut-points of whole and refined grain intake.
Results: Mean (±SD) consumptions of whole- and refined grains were 93±29 and 201±57 g/d, respectively. Compared with subjects in the lower quartile category, those in the upper category of whole-grain intake had lower prevalence of metabolic risks. Conversely, those in the higher category of refined grain intake had higher prevalence of metabolic risk factors, except for diabetes. After controlling for confounders, a significant decreasing trend was observed for the risk of having hypertriglyceridemia [odds ratios among quartiles: 1.00,0.89, 0.74, 0.61, respectively], hypertension and metabolic syndrome. Higher consumption of refined grains were associated with higher risk of having hypercholestrolemia [1.00, 1.07, 1.19, 1.23), hypertriglyceridemia [1.00, 1.17, 1.49, 2.01), hypertension and metabolic syndrome.
Conclusion: Whole grain intake is inversely and refined grain intake is positively associated with the risk of developing metabolic syndrome. Recommendations to increase whole-grain intake may reduce the risk of developing metabolic syndrome.

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Background: The risk of cardiovascular diseases increase in diabetic patients. So, it is important for patients to achieve the optimal lipid levels. Nutrition including consumption of anthocyanins plays a primary role in reducing the risk of heart disease and hypertension. In this study, we assessed the effect of concentrated sour cherry juice (SCJ) consumption as a rich source of anthocyanins on lipid profile and blood pressure of type II diabetic patients.
Methods: In this quasi-experimental study 16 type II diabetic women with fasting blood sugar ≥110 mg/dl and LDL-C ≥100 mg/dl were recruited and consumed 40 g/day of SCJ for 6 weeks. Measurements of weight, lipid profile and blood pressure were done in baseline and after completion of the study. A 2-day food records was completed by patients so. The Wilcoxon test was used for statistical analysis. Results: Mean (± SD) age, weight, total cholesterol, LDL-C, systolic and diastolic blood pressure were 53.6±8.8 years, 72.8±14.9 kg, 213.9±27/0 mg/dl, 118.4±14.7 mg/dl, 129.1±15.7 mmHg and 81.7±8.1 mmHg respectively in the beginning of the study. After consumption of SCJ, a significant decrease (P<0.05) in weight, total cholesterol, LDL-C, systolic and diastolic blood pressure was seen. Changes in serum triglyceride and HDL-C concentrations were not significant statistically.
Conclusion: It is concluded that SCJ consumption may modify cardiovascular disease risk factors in diabetic type 2 patients.

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Background: Cardiovascular disease including hypertension are complications of long-standing diabetes. A few Studies had shown the positive effects of L-carnitine on hypertension. In this study, the possible effects of L-carnitne on nitric oxide (NO) levels and angiotensin-converting enzyme (ACE) activity in serum as well as systolic blood pressure (SBP) in diabetic and normal rats were studied.

Methods: In this study forty rats were used in four groups including non-treated control (C), L-carnitne treated control (CT), diabetic (D) and L-carnitne treated diabetic (DT). Diabetes was induced in rats by injection of stereptozotosin. Both of C & D groups had a free access to food and water and CT & DT groups were received daily dose of L-carnation in drinking water. At the end of 12 weeks SBP, serum NO and ACE activity were measured.

Results: Systolic blood pressure was significantly decreased in DT group compared to D group. Serum ACE activity was also significantly decreased in DT group compared to D group and the serum NO levels were significantly increased in DT & CT groups compared to D & C groups respectively.

Conclusion: Finally it could be concluded that L-carnitine may reduce SBP in diabetic rats via elevation of serum NO levels and reduction of serum ACE activity.

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Background: Milk and fermented milk products have been known as foods with possible hypocholesterolemic effects. In this study we compared the effects of milk replacement with regular and probiotic yogurt in normocholesterolemic (N) and hypercholesterolemic (H) subjects.

Methods: Twenty eight subjects with total serum cholesterol 160-280 mg/dl were included. They did not consume yogurt for 2 weeks after that 300 g/day of milk was added to their diet. Then, blood lipids were measured and they were randomly allocated to 2 groups to receive either 300g/day of ordinary yogurt or probiotic yogurt for 6 weeks as a substitution for milk. Blood lipid tests were repeated at the end of the study. Subjects in both groups were divided into these two subgroups according to their baseline blood cholesterol level: subgroup N (cholesterol<220mg/dl) and H (cholesterol≥220mg/dl). Blood lipid changes were compared between these subgroups in each experimental group.

Results: Total cholesterol and LDL-C levels reduced in the H as compared to N subgroup after regular yogurt consumption instead of milk and the reduction of LDL-C was significant (P=0.033). The effect of milk replacement with probiotic yogurt on total cholesterol and LDL-C reduction in H compared to N subgroup was higher than regular yogurt consumption (P=0.028 and P=0.014 for total cholesterol and LDL-C respectively).

Conclusion: The higher the baseline blood cholesterol level, the more beneficial effects of milk replacement with yogurt, especially probiotic yogurt. So, it is suggested for hypercholesterolemic individuals to consume more yogurt as the source of dairy products in their diet.

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Background: Food insecurity refers to the inability to afford enough food for an active, healthy life. The metabolic syndrome, otherwise known as syndrome X or the insulin resistance syndrome, is a collection of cardiovascular risk factors including hypertriglyceridemia, lowered HDL-cholesterol, glucose intolerance, abdominal obesity and hypertension. Recent studies indicate widespread prevalence of food insecurity and metabolic syndrome in various regions of Iran. No studies have been conducted so far to investigate the relationship between food insecurity and the metabolic syndrome in Iran. This study was conducted to investigate the relationship between food insecurity and metabolic syndrome in women. Methods: In this study, 130 women 30 to 60 years old with metabolic syndrome as cases and 130 women without metabolic syndrome as controls referred to clinics affiliated to Shiraz University of Medical Sciences were selected. The USDA household food security questionnaire was used to assess food insecurity status. The metabolic syndrome was defined according to the criteria of the Adult Treatment Pane l II (ATP III). Results: The prevalence of food insecurity was 69.2% in cases and 45.4% in controls (P< 0.001). After multiple logistic regression and removal of potential confounders, food insecurity was significantly associated with metabolic syndrome (OR3.2&CI 95%: 1.9-5.6)(P<0.05). Conclusion: Given that food insecurity is an important risk factors for metabolic syndrome, Planners should reduce food insecurity in society, especially women through measures to improve the economic situation and dietary patterns of households.

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Background: There are growing concern globally regarding fast food consumption and its related cardiometabolic outcomes. In this study we investigated whether fast food consumption could affect the occurrence of metabolic syndrome after 3-years of follow-up in adults or not. Methods: This longitudinal study was conducted in the framework of Tehran Lipid and Glucose Study on 1476 adults, aged 19-70 years old. The usual intakes of participants were measured using a validated semi-quantitative food frequency questionnaire at baseline. Biochemical and anthropometric measurements were assessed at baseline (2006-2008) and 3 years later (2009-2011). Multiple logistic regression models were used to estimate the incidence of the MetS in each quartile of fast food consumption. Results: The mean age of participants was 37.8±12.3 years old, and the mean BMI was 26.0±4.5 kg/m2 at baseline. Participants in the highest quartile of fast food consumption were significantly younger (33.7 vs. 43.4 years, P <0.01). Higher consumption of fast food was accompanied with more increment in serum triglyceride levels after the 3-year follow-up (10.6±2.3 vs. 4.4±2.3 percent in the fourth and first quartile, respectively, P<0.01). After adjustment for all of the potential confounding variables, the risk of metabolic syndrome, in the highest quartile of fast foods compared with the lowest, was 1.85 (95% CI= 1.17-2.95). Conclusion: We demonstrated that higher consumption of fast foods had undesirable effects on metabolic syndrome after 3-years of follow-up in Iranian adults.

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Background: There is increasing interest about the relationship between metabolism, obesity and function of thyroid hormones in recent decades. This study aimed to determine the validity of a “thyroid and metabolism questionnaire” and its relationship with metabolism status and function of thyroid hormones. Methods: It was a descriptive cross-sectional study on 164 people aged 20-64 years who were selected randomly from nutrition clinic. “Thyroid and Metabolism questionnaire” including 25 questions were completed for everyone. Biochemical parameters including serum level of T3, T4 and TSH were measured. Resting energy expenditure [REE] was measured by indirect calorimeter. Results: The mean measured REE and calculated with Harris-Benedict formula were 1826.7 ± 475.34 and 2277.6 ± 454.54 kcal in men and 1410.8 ± 205.5 and 1670.73 ± 136.10 kcal in women respectively. The final score of this questionnaire had no significant association with measured REE. REE showed indirect relationship with serum level of T3, T4, T3/T4 and inverse relationship with TSH. Metabolism status of every participant was obtained via measuring and calculating REE with set and formula. The metabolism status of participants showed no agreements with metabolism status that predicted from “Thyroid and Metabolism” questionnaire. There was no significant association between metabolism status that was measured by indirect calorimeter and calculated from “Thyroid and Metabolism” questionnaire. From 25 questions of this questionnaire, only questions number 1, 4, 16 and 23 showed significant association with measured REE [P< 0.05]. Conclusion: Results of this study showed that “Thyroid and Metabolism” questionnaire had internal consistency, but not validity.

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Background: The purpose of this study is to the comparison of the effect of 12 weeks of sprint training and concurrent aerobic and strength training on high sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor alpha (TNF-α) and insulin resistance in women with diabetes mellitus (T2DM)

Methods: 52 overweight female type 2 diabetic patients (age; 45-60 years old and fasting blood glucose ≥ 126 mg/dl (7.0 mmol/l)) were assessed for eligibility. Participants were assigned to intense interval training group (N=17), concurrent resistance- endurance training group (N=17) and control group (N=18). The combined strength-endurance group did 12 weeks, three sessions per week endurance training with 60 % of maximal heart rate and two session resistance training with 70 % 1-RM. Intense interval training group did three session/week of 4-10 repetition of all out 30s Wingate on ergometer were included 10 weeks of concurrent resistance- endurance training and intense interval training.

Results: The results showed that following sprint training, there were significant changes in hs-CRP (p<0.001), but it wasn’t significant following concurrent training (p=0.062). According to results, TNF-α change were not significant in intense sprint (p=0.11) and concurrent training (p=0.23). Differences were not significant for the fasting blood glucose in the intense interval training groups (p=0.000). Serum insulin levels showed significant increases in the SIT (p<0.000) and concurrent training (p=0.000) significantly. The data showed significant differences in insulin resistance index (HOMA-IR) in intense interval training (p=0.000) and concurrent resistance- endurance training (p=0.008). ANCOVA test showed no significant difference in fasting blood glucose concentrations (P=0.171).

Conclusion: Intense sprint training compare to concurrent strength-endurance training can have better inflammatory status for patients with type 2diabete.

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Background: Gestational diabetes in on of common complications of pregnancy which has different complications for fetus and mother. Aim of present study was to review the effect of six weeks aqua training in second trimester of pregnancy on visfatin and glucose tolerance of gestational diabetic women.
Methods: In this semi experimental research 24 gestational diabetic mothers who recourse to hafez clinic of shiraz city which were in 23- 24 week of pregnancy select as sample and divided in two groups of 12 persons of aqua training and control. Aqua training group trained aqua trainings 6 weeks, 3 sessions per week and 45 minutes per session. In this period of the time control group has just their daily activities. For measure the research variables fasting blood sample gathered from antecubital vein in pretest and post test.
Results: Six weeks aqua training in second trimester of pregnancy has significant effect on increase of visfatin and decrease of glucose tolerance of gestational diabetic women (p=0.001).
Conclusion: It seems that for improvement of visfatin levels and glucose tolerance of gestational diabetic women can use six weeks aqua training in second trimester of pregnancy.
 

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Background: Hemodialysis is the most common treatment in patients with end stage of renal disease (ESRD). Patients undergoing hemodialysis due to multiple drug treatments, special food programs and being able to cope with their illness need to self-care activities. Due to lack of information about the role of health literacy in effectiveness of self-care in these patients, this research aimed to determine the correlation between self-care and health literacy in patients undergoing hemodialysis in Valiasr Hospital of Arak in 2015.
Methods:  In this descriptive correlational study, 93 undergoing hemodialysis patients selected by objective sampling method. Data collecting instruments were "demographic questionnaire", "self-care questionnaire " and "Health Literacy for Iranian Adults questionnaire". The content and face validity of questionnaires was assessed. Reliability assessed through internal consistency (Cronbach's alpha) and Intra- Class Correlation Coefficient. Data were analyzed by SPSS, version 21, using, Kolmogorov–Smirnov test, Descriptive Statistics and Kolmogorov–Smirnov test. 
Results: The results showed that 79/6% of patients were male and 20/4% were female with an average age of 54/18 ± 13/9 year. The mean score of self-care and health literacy were 146/90± 45/46, 88/14± 36/42 and were at a moderate level. The lowest score of self-care and health education related to the field of fluid intake and decision-making and behavior. There was a significant positive correlation between self-care and health literacy (p<0/0001, r= 0/6).
Conclusion: The existence of a significant positive correlation between self-care and health literacy showed that the hospital managers and the nurses must pay more attention to what patients undergoing hemodialysis need. Considering the importance of health literacy in the care of patients undergoing hemodialysis, it seems necessary to nursing administrators and Politicians use educational programs tailored to the patient's health literacy level in order to promote their health and quality of life.
 

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Background: The main problem of modern humans is non-communicable diseases such as diabetes, cardiovascular disease, etc. Diabetes has the highest prevalence. It imposes many costs on society and the patient. Diabetics have special needs for a better life; hence, the researcher's aim is to accomplish them by defining researches and technology missions. Our purpose was to understand the real needs of a diabetic patient. Previous studies were evaluated to find out which one was effective.
Methods: In this research, 120 diabetic children's parents were requested to write a letter entitled "Hi Inventor" and describe any efficient inventions, which could make life easier for their children. Besides, research papers and patents from Iran over the past ten years have been evaluated in terms of their compliance with patients' needs.
Results: Parent's statements gathered in the form of 12 real needs. The main concern was the invasive method of blood glucose testing and they were asking for innovative method to measure blood glucose with less pain. Among published articles by Iranian researchers over the past ten years, 3% of the articles were in some way related to the actual needs of patients with diabetes. A total of 1017 patents from Iran was looked for, there were 3 diabetes-related patents.
Discussion: To sufficiently support the conducting research and identifying research priorities in the country, it is necessary to consider a balanced ratio between fundamental and applied research so that the patients' community can benefit from the early results of research as well.
 

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Background: The proinflammatory cytokines of tumor necrosis factor alpha TNF-α and anti-inflammatory interleukin-10 have important roles in inducing and preventing systemic inflammation, respectively. The purpose of this study was to the synergistic effect of High-Intensity Interval training and resveratrol consumption on IL-10 and TNF- α in diabetic rats.
Methods: In this experimental study, 32 diabetic rats 225± 10 g based on Cohen's sample size estimation table diabetic with combination of high-fat diet and streptozotocin (STZ) injection, were randomly divided into four groups: control(C), supplement(M), training (T)and training + supplement(TM). The training groups were exposed to high-intensity interval training with an intensity of 90 to 100% VO2max for 8 weeks, 5 sessions per week, each session for 18 minutes. The supplement groups received 10 mg / kg of resveratrol daily for eight weeks, three times a week by gavage. Blood samples were taken 48 hours after the last training session. Data were analyzed using one-way analysis of variance and SPSS software version 24 (ANOVA).
Results: Results showed that IL-10 increased in the experimental groups but was not significant (P=0.109). TNF-α levels decreased in the TM group, whereas it increased in the T and M groups, which was significant compared to the TM group (P=.000). Fasting glucose, insulin and insulin resistance index decreased significantly in experimental groups (P=.000).
Conclusion: Eight weeks of high-intensity interval training plus resveratrol can have a positive effect on inflammation and insulin resistance by increasing IL-10 and decreasing TNF-α.

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Background: Diabetes mellitus is one of the most common endocrine diseases. Cardiovascular disease (CVD) is one of the leading causes of death in patients with type 2 diabetes. The aim of this study was to investigate the metabolic profile of plasma amino acids in diabetic patients with cardiovascular disease.
Methods: The present study is a descriptive-analytical cross-sectional study on 140 patients including 35 patients with type 2 diabetes and cardiovascular disease (CVD.DM), 35 patients with type 2 diabetes and non-cardiovascular disease (DM). 35 non-diabetic patients with cardiovascular disease (CVD.nDM) and 35 non-diabetic patients with non-cardiovascular disease (HS) were referred to Diabetes Clinic No. 1 of Tehran University of Medical Sciences.
Results: 76 (54.3%) were male and 64 (45.7%) were female. The highest concentrations of glutamine and isoleucine were observed in DM.CVD, asparagine, serine, arginine, threonine, alanine, tyrosine, valine in DM.nCVD and methionine in CVD.nDM. The lowest concentrations of tyrosine and tryptophan in DM.CVD has been detected , and  methionine has been detected in DM.nCVD. The amino acids alanine, glutamine, tyrosine, valine, methionine, leucine, lysine and arginine significantly increased the chances of developing DM.nCVD. For each increase in Z-score per plasma concentration of isoleucine, the chances of developing cardiovascular disease without diabetes were significantly increased.
Conclusion: The amino acids alanine, glutamine, tyrosine, valine, methionine, leucine, lysine and arginine are involved in predicting the risk of DM.nCVD and isoleucine and methionine are involved in predicting the risk of CVD.nDM.

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Background: TORC1 protein is an important factor in regulating adipose tissue metabolism. Type 2 diabetes can lead to dysfunction and the development of obesity. Therefore, the aim of the present study was to investigate the effect of eight weeks of high-intensity interval training (HIIT) and endurance on blood glucose and TORC1 protein content in subcutaneous adipose tissue of obese with type 2 diabetes rats.
Methods: In this study, 18 head 2 Sprague-Dawley male rats with a mean weight of 270±30 g were selected. After becoming type 1 diabetic through streptozotocin and Nicotine amide solution, they were randomly divided into 3 groups: 1) HIIT training 2) endurance training and 3) control (6 heads per group). Exercise groups exercised 4 days a week for 8 weeks according to HIIT and endurance training programs. SPSS software version 23, one-way ANOVA and Tukey post hoc test were used to analyze the data.
Result: Eight weeks of HIIT and endurance training resulted in a significant decrease in blood glucose level (p<0.0001) and a significant increase in TORC1 protein content (P<0.0001) compared to the control group.
Conclusion: HIIT and endurance training lowered blood glucose levels and increase TORC1 protein content, which this training can be a suitable and non-invasive treatment to control diabetes and also regulate adipose tissue metabolism in type 2 diabetics who are prone to obesity.
 

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Background: NRF1 and TFAM are proteins that affect mitochondrial biogenesis and play an important role in diabetes. The aim of the present study was to investigate the effect of high intensity training (HIT) training and beetroot consumption on NRF1 and TFAM in visceral adipose tissue of aged type 2 diabetic rats.
Method: In this experimental study, 40 male rats (weight range 270-300 grams and age 12-14 weeks) diabetic with streptozotocin were randomly divided into 5 groups (healthy control, diabetic control, supplement, exercise, exercise + complement) were divided. The training groups were subjected to intense interval training with an intensity of 50 to 90% of the maximum speed for 4 weeks and 4 sessions each week and 44 minutes each session. The groups receiving the supplement received 10 mg of beetroot per kilogram of body weight daily for 4 weeks and 4 times a week orally. The data are statistically significant using two-way ANONA test and (P < 0.05) was evaluated.
Results: The results of the study showed that the induction of diabetes led to a significant decrease in the protein levels of NRF1 and TFAM, so that in the exercise group, beetroot had a significant effect on the changes of NRF1 in the visceral fat tissue of elderly rats with diabetes. (P=0.001), but the interaction of HIT training and beetroot supplement in NRF1 changes is not significant (P=0.56) and also the factor of exercise and beetroot supplement, as well as the interaction of HIT training and beetroot also has a significant effect on TFAM changes in visceral adipose tissue of elderly rats with diabetes. (P=0.001).
Conclusion: Based on the findings of the present research, it seems that high interval training with beetroot consumption can lead to an increase in NRF1 and TFAM gene expression and thus help to improve and control diabetes in the elderly.

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Background: Control of Type 2 Diabetes Mellitus (T2DM) is influenced by lifestyle. The aim of this research was to determine the predictors of treatment adherence behaviors among T2DM based on Social Cognitive Theory (SCT).
Methods: This descriptive-analytical research was done among 500 T2DM patients in Tehran during 2021. Simple random sampling was performed among patients based their medical records in the Diabetes Control Clinic of Tehran's District Five. The data collection tools were written questionnaire based on the SCT determinants. Data were analyzed using descriptive statistics (frequency, percentage, mean, standard deviation) and analytical statistics (Pearson's correlation and linear regression) in SPSS software version 16. Results: The mean score of treatment adherence behaviors was 56.34 [SD: 10.41], ranged from 16 to 80. The outcome expectations, perceived self-efficacy, and social support accounted for 43% of the variation in the outcome measure of the treatment adherence behaviors. Self-efficacy was the strongest predictor (Beta = 0.430 and P<0.001). Increasing age (ß= -0.126 and P= 0.004), insulin treatment (ß= -0.250 and P<0.001) and smoking (ß= -0.146 and P= 0.001) conversely and having health insurance (ß= 0.181 and P<0.001) were positively predictive of treatment adherence behaviors.
Conclusion: The development, implementation and evaluation of educational interventions based on SCT with emphasis on promoting perceived self-efficacy can lead to useful findings in promoting treatment adherence behaviors among T2DM patients.

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Background: Animal studies have shown maternal low/ high-calorie diet during pregnancy can alter metabolism of offspring through change in Sirtuin 1 (SIRT1) expression, as a metabolic sensor. However, there is no study on the effects of isocalorie diet. Herein, effects of two isocalorie diets with different amounts of fat were assessed on SIRT1 gene and protein level in the liver of male and female offspring.
Methods: The control group received AIN93G diet. In this diet, 16% and 64% of total calorie were prepared from fat and carbohydrate, respectively. The intervention group received high fat AIN93G diet contained 48% and 32% of calorie from fat and carbohydrate, respectively. In both diets, fat was prepared from soy oil. Diets were isocaloric and 20% of total calorie was provided from protein. Mothers categorized to one of these diets and offspring received the control diet after weaning (3 weeks after the birth).
Results: SIRT1 gene and protein levels were lower in male and female offspring born from mothers received high-fat diet than the controls (p<0.001).
Conclusion: Change in maternal dietary fat, without increase in calorie, effects on gene and protein levels of SIRT-1 in the liver of next generation. 

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Background: Fatty liver disease and its relationship with cardiovascular diseases is one of the concerns of today's society, therefore the present study was conducted to investigate the effect of eight weeks of endurance training and growth hormone injections on Cardiac mitochondrial PGC1α content and some oxidative stress indices in mice with hepatic damage.
Methods: In this experimental study, 21 male mice were, randomly, divided into three groups (n=7): control (C), Exercise (E), Exercise + Growth Hormone (EGH) group. The Medium intensity endurance training program was performed for eight weeks and 5 sessions with an intensity of 50% VO2max of per week. The somatropin injection protocols were 1 mg/ kilogram/body weight, respectively. Statistical analysis of the data was performed using the software SPSS, using One-Way ANOVA and post hoc Tukey tests.
Results: PGC1a levels increased in both groups compared to the control group. SOD and MDA levels increased and decreased in both groups compared to the control group, respectively. The reduction of HOMA levels was significant only in E group compared to the control group. Also, the difference between E and E-GH group was significant. ALT/AST ratio decreased in both groups compared to the control group. The reduction of LDL/HDL ratio was significant only in group E compared to the control group.
Conclusion: Endurance training has produced a more effective response in improving NAFLD markers than GH peptides. Growth hormone injection can have negative consequences on some indicators of this abnormality.

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Background: Diabetes is a serious global health problem, and effective methods for its prediction and management are essential. Conventional diagnostic approaches typically rely on tests such as oral glucose tolerance test (OGTT), fasting plasma glucose (FPG) and glycated hemoglobin (HbA1c). Machine learning has the potential to enhance diagnostic accuracy; however, its performance and alignment with clinical guidelines require thorough evaluation.
Methods: This narrative review examines the effectiveness of machine learning in the early diagnosis of diabetes. Articles were selected based on predefined criteria and analyzed in terms of algorithm classification, output measures, involvement of clinical experts, and interpretability. Evaluation metrics such as accuracy, area under the curve (AUC), specificity and sensitivity were used to assess algorithmic performance. Relevant studies comparing prediabetes diagnosis using artificial intelligence and conventional methods were reviewed, and clinical guidelines from both domains were extracted and compared.
Results: Analysis of 41 articles showed that ANN, LR, and DNN were the most frequently used algorithms. Only 2% of the studies incorporated clinical rules and physician involvement, and 12% demonstrated model interpretability. While conventional methods rely on HbA1c and FPG tests, no clinical guidelines currently exist for AI-based diagnosis. Machine learning algorithms outperformed traditional methods, showing 29% higher sensitivity and 23% higher specificity.
Conclusion: Although artificial intelligence demonstrates superior performance in prediabetes diagnosis, limitations such as lack of interpretability and the absence of standardized clinical guidelines hinder its current clinical application. Addressing these challenges could enable AI to become a more efficient and reliable diagnostic tool.