Iranian Journal of

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Background: This review aims to investigate and analyze recent studies related to the effects of various exercise training on adipokines secreted from adipose tissue in patients with type 2 diabetes.
Methods: Search in Persian and Latin databases PubMed, ScienceDirect, Google Scholar, Magiran, and SID with the keywords aerobic exercise, resistance training, High-intensity interval training, diabetes, Adipokine, Leptin, Adiponectin, and Resistin, resistance training, intense interval training, aerobic exercise, combined exercise, adipokine, leptin, adiponectin and resistin were performed to retrieve articles published in the period from 2010 to 2023.
Results: The results obtained from the study showed that aerobic exercise with moderate intensity (60 to 80%) reduces the leptin levels of diabetic patients, however, the effect of combined exercises (aerobic and resistance) is much greater than other types of exercises. In addition, aerobic exercises with moderate intensity (50 to 70%) lead to an increase in adiponectin levels in diabetic patients, however, high-intensity interval training (HIIT) had a greater effect in increasing adiponectin levels than other exercises. Also, studies showed that all three types of activities, aerobic exercise (50-70% intensity), intense intermittent exercise, and resistance exercise (30-70% 1RM) have the same effects in reducing the resistance levels of diabetic patients.
Conclusion: Aerobic exercises with medium and high intensity and especially combined exercises (aerobic and resistance) while improving adipokines, decreasing leptin and resistin levels, and also increasing adiponectin in diabetic patients.

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Background: Despite the increased use of complementary medicine by diabetic patients, there is no clear estimation of complementary and herbal medicine use by these patients in Iran. This study was conducted to investigate the uses of herbal medicine among patients with type II diabetes in Yazd, Iran, in 2022.
Methods: A cross-sectional study was carried out on 633 patients with type II diabetes referred to the Diabetes Research Center in Yazd City from June to September 2022. A questionnaire-based theory of planned behavior developed and validated by the researcher was used for data collection. In addition to demographics and disease-related information, the instrument included questions about using herbal medicine used. Descriptive statistics, Chi-square, Fisher's exact, and linear regression tests were used to analyze the data.
Results: The most common herb used was cinnamon (34.7%). The majority of patients used herbs daily (56.9%). Using herbal medicine was significantly associated with Attitude (r= 0.48, p< 0.001) Subjective norm (r= 0.39, p< 0.001), perceived behavior control (r= 0.38, p< 0.001) and intention (r= 0.4, p< 0.001). Constructs of the theory of planned behavior 73% predicted intention to use herbal medicine. Subjective norm structure had the highest predictive power of intention to consume herbal medicine (ß= 0.49, p< 0.001).
Conclusion: Subjective norm is the most predictor of intention to use Herbal medicines in patients with diabetes. Therefore, it is very important to pay attention to the beliefs, customs, and culture of the surrounding community in the correct self-management of disease control and the use of effective drug control.

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Background: Diabetes is a global epidemic and the most common metabolic disorder caused by impaired insulin secretion and glucose metabolism. The aim of this study was to investigate the effect of 8 weeks of aerobic training on serum levels of asprosin and insulin resistance index in diabetic rats.
Methods: The statistical population of this research included 40 10-week-old mice with an initial weight of 250 ± 20 grams, which were randomly divided into four groups (10 mice in each group): diabetic-exercise group (DT), diabetic group - Control (DC), healthy-training group (HT) and healthy-control group (HC) were divided. The program of aerobic exercises was performed for 8 weeks (5 sessions per week) in the form of running on a treadmill. Independent t-test and one-way analysis of variance (ANOVA) with Tukey's post hoc test were used to compare the groups. All data were analyzed at a significance level of 0.05 using SPSS-25 software.
Results: The results of the present study showed that streptozotocin injection induced diabetes in mice (P= 0.001). Induction of diabetes caused a significant increase in the serum levels of asprosin and insulin resistance in mice (P= 0.048 and P= 0.012, respectively). Eight weeks of aerobic training decreased the serum levels of asprosin and decreased insulin resistance in diabetic rats (P= 0.001 and P= 0.036, respectively).
Conclusion: Induced diabetes causes insulin resistance and increase in serum levels of asprosine, which can be improved by performing aerobic exercises.

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Background: Transcription factor 7-like 2 (TCF7L2) is one of the strongest genetic risk factors associated with type 2 diabetes mellitus (T2DM). The purpose of this study was to investigate the effect of 10 weeks of high intensity interval training (HIIT) on hepatic TCF7L2 expression in T2DM rats.   
Methods: In this experimental study, fourteen males Wistar rats with T2DM induced by streptozotocin-nicotinamide injection were randomly divided into exercise (n=7) and control (n=7) groups. The exercise group performed the HIIT protocol on a treadmill for 10 weeks and 5 days per week. Hepatic TCF7L2 expression, blood glucose level, hemoglobin A1c (HbA1c), insulin and insulin resistance were measured 48 hours after the last training session. Data were analyzed by independent T test at P< 0.05.
Results: Hepatic TCF7L2 expression and serum insulin were significantly higher in the exercise group compared to the control group (P˂0.05). Blood glucose level, HbA1c and insulin resistance were significantly lower in the exercise group than in the control group (P˂0.05).      
Conclusion: Based on these findings, it seems that the improved glycemic control in response to HIIT is partially dependent on the inhibition of gluconeogenesis caused by increased hepatic TCF7L2 expression.  

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Background: Type 2 diabetes is a common disease, which is associated with psychological problems. This study aimed to compare the effectiveness of self-healing on difficulties in emotion regulation and blood sugar index in patients with type 2 diabetes.
Methods: This research was semi-experimental (pre-test, post-test, follow-up with control group). The statistical population consisted of 300 people with type 2 diabetes who visited Sedighe Tahereh Clinic in Isfahan in 2021. Of these, 40 people were selected through purposive sampling and were assigned randomly in the experimental and control groups. Data collection tool was Gratz and Romer’s (2004) Difficulties in Emotion Regulation Scale (DERS) and laboratory equipment to measure blood sugar index. the experimental groups underwent 12 sessions of self-healing therapy and the control group did not receive any treatment. Analysis of variance with repeated measures and Bonferroni’s post hoc test were used to analyze the data. SPSS version 24 was used to analyze the data
Results: The results showed that self-healing has an effect on difficulties in emotion regulation and blood sugar index (P<0.05) and this result is continuous (P<0.05).
Conclusions: According to the results, it can be said that self-healing is effective in manegment of blood sugar of people with type 2 diabetes.

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Background: Endoplasmic reticulum stress leads to unfolded or folded protein response, and ATF4 and CHOP proteins play very important roles in this signalling pathway; Therefore, the aim of this research is the effect of resistance training on the content of ATF4 and CHOP proteins in the left ventricle of the heart of type 2 diabetic rats.
Methods: In this experimental study, 12 two-month-old male Sprague Dawley rats were selected and their weight reached an average of 280±20 gr after four weeks. Type 2 diabetes was induced by injecting nicotinamide solutions (110 mg/kg) and streptozotocin (60 mg/kg). The rats were randomly divided into 2 groups, resistance training and diabetic control; Resistance training consisted of 8 weeks and 3 sessions per week of climbing a vertical ladder with an 85-degree slope, one meter long with 26 steps and 2 cm space between each step. To analyze data, independent t-test was used in SPSS version 29 and Graphpad Prism version 10.2.3. A significance level of P≤0.05 is considered.
Results: The content of ATF4 and CHOP proteins after 8 weeks of resistance training showed a significant change compared to the control group in the left ventricle of the heart (P=0.001).
Conclusion: The increase of ATF4 and CHOP proteins can lead to increased cell death of cardiomyocytes in the left ventricle of the heart of type 2 diabetic subjects through increasing the endoplasmic reticulum stress and initiating the unfolded or folded protein response.

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Background: Type 2 diabetes is characterized by insulin resistance and hyperglycemia and can lead to heart disease. Therefore, the aim of the present study is to investigate the effect of MIIT on the S6K1 pathway in the myocardium, which is related to the control of cell growth and proliferation.
Methods: In this study, 12 two-month-old male Sprague Dawley rats with an average weight of 280±30 grams participated. To induce diabetes, nicotinamide and streptozotocin solutions were injected with a dose of 110 mg/kg and 60 mg/kg, respectively. The blood sugar of rats was determined between 126-260 mg/dL as an indicator of type 2 diabetes. After the induction of diabetes, the rats were randomly divided into diabetic training group (6 heads) and diabetic control group (6 heads). The diabetic training group trained for 4 weeks and 4 sessions every week. 24 hours after the last training session, the left ventricle of heart was isolated and the amount of protein was measured by western blotting method. Variables were analyzed through independent t-tests. The significance level of study was considered P≤0.05.
Results: Data analysis showed that the intracellular content of total (P=0.62), phosphorylated (P=0.85), and total to phosphorylated (P=0.77) S6K1 protein did not show significant changes after 4 weeks of MIIT.
Conclusion: It seems that after 4 weeks of MIIT, S6K1 protein does not change significantly, so it seems that the duration and intensity of training and nutritional conditions to increase S6K1 phosphorylation should be considered in future research

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Background: The purpose of this study was to investigate the effectiveness of self-compassion training on distress tolerance, anxiety sensitivity and emotional self-control in women with type 2 diabetes.
Methods: This research was experimental and semi-experimental using the pre-test-post-test method with a control group. The statistical population of the intended research included all women with type 2 diabetes in 1402 who visited endocrinologists' offices in Sari, who were selected using a targeted method and then were placed randomly divided into two experimental and control groups. The data were collected using the Distress Tolerance Questionnaire of Simmons and Gaher (2005), anxiety sensitivity of Reis et al. (1986) and emotional self-control by Tanji (2004). Then, the data were analyzed using multivariate and univariate covariance methods in SPSS-24 software.
Results: The results showed that the treatment focused on compassion is effective on distress tolerance, anxiety sensitivity and emotional self-control of women with type 2 diabetes.
Conclusion: In fact, the treatment focused on compassion makes the person distance himself from blaming, condemning and self-criticism, which are all examples of lack of emotional self-control, and instead stabilizes his emotional self-control in the first stage and gradually be strengthened. Focused training on compassion can be one of the effective options in improving the quality of life and psychological distress, along with other medical interventions.
 

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Background: Diabetes can disrupt the balance of cell death through different cell pathways, and exercise or consumption supplements can be effective in maintaining the balance of cell death types; Therefore, the purpose of this research is the effect of magnesium supplementation and exercise training on the content of CREB2 and C/EBP homologous protein (CHOP) in the left ventricle of the heart of type 2 diabetic rats.
Methods: In this experimental study, 24 2-month-old male Sprague-Dawley rats with an average weight of 280±20 grams were selected. Type 2 diabetes was induced by injecting nicotinamide and streptozotocin solutions. The rats were randomly divided into four groups, 1) control, 2) supplement, 3) training and 4) training+supplement; Resistance training consisted of 8 weeks and 3 weekly sessions of climbing a ladder. Magnesium supplement was given to rats once a day. To analyze the data, one-way ANOVA and Tukey's post hoc tests were used in SPSS version 29.
Results: Eight weeks of magnesium supplementation and resistance training led to a significant change in the content of CREB2 and CHOP proteins between groups in the left ventricle of the heart (P= 0.001). A significant decrease was observed in the groups of resistance training + magnesium supplement and magnesium supplement compared to the control group (P≥ 0.05); But the resistance training group had increased compared to the control group (P≥ 0.05).
Conclusion: The increase and decrease of CREB2 and CHOP proteins in the left ventricle of the heart can lead to improvement and physiological adaptation, like a bilateral mechanism.

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Background: The current study aimed to ascertain the impact of pulsed magnetic therapy, multicomponent exercise, and a combination of both modalities on bone markers type 2 diabetic patients with osteoporotic.
Methods: In a randomized controlled clinical trial study, 56 older patients with type 2 diabetic osteoporosis (age: 68.18±3.67 yr; weight: 78.13±7.65 kg, body mass index: 28.40±1.76 kg/m2) were randomly assigned to either the multicomponent exercise + Full-body pulsed electromagnetic field (MCEx+PEMF, n= 18) multicomponent exercise + placebo full-body PEMF (MCEx+PPEMF, n=17) and a full-body PEMF alone (PEMF, n= 21). PEMF was applied for the whole body using a full-body mat three times per week, 60 minutes for 12 weeks, with a multicomponent exercise protocol that includes flexibility, aerobic exercise, strengthening, weight-bearing, and balance exercises followed by whole-body vibration (WBV) training. The body composition, bone mineral density (BMD), bone metabolism markers (phosphorus, calcium, sclerostin, osteocalcin, Bone-specific alkaline phosphatase (BALP)) before and after the intervention. The data were analyzed using the dependent t test and the two-way repeated measures ANOVA at the level of less than 0.05.
Results: After 12 weeks of intervention, there is a significant difference in the serum levels of bone mineral density and bone metabolism markers (phosphorus, calcium, sclerostin, BALP) between the groups (P< 0.05). However, the bonferoni post-test showed an increase in serum levels of BMD, phosphorus, sclerostin, BALP with a significant decrease in calcium in the MCEx+PEMF group in compared to alone PEMF group.
Conclusion: The findings showed that the PEMF rehabilitation method combined with multicomponent exercise is more effective and safer than exercise or PEMF only for improving BMD and bone metabolism markers in the type 2 diabetic population with osteoporosis. Therefore, exercise rehabilitation clinics should be encouraged to consider exercise rehabilitation as a treatment method for type 2 diabetic patients with osteoporosis. More studies with long-term follow-up should be considered to confirm these findings.
 

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Background: Today, obesity is closely related to metabolic syndrome and especially type 2 diabetes, which changes the secretion and release of adipocytokines, and different training programs have different results on these indicators. Therefore, the aim of the present study is to investigate the durability of changes caused by exercise programs on adipocytokine indices of obese type 2 diabetic patients.
Methods: In this semi-experimental study, 45 obese men with type 2 diabetes were randomly divided into a control group (no exercise) and 4 exercise groups (aerobic, combined, resistance and high-intensity interval). The exercise program of the groups was considered based on the calories consumed in each session. The participants performed 12 weeks of training programs and 12 weeks of non-training. Physiological, anthropometric indicators and inflammatory and pro-inflammatory indicators (IL-6, TNF-α, resistin and leptin) and anti-inflammatory indicators (adiponectin and SFRP5) were measured before the program and at weeks 6, 12, 18 and 24. became.
Results: After 12 weeks of combined, aerobic, high intensity and resistance training, anti-inflammatory indices (adiponectin and SFRP5) showed a significant increase compared to the baseline (before starting the training program) (P< 0.05). Regarding pro-inflammatory and anti-inflammatory indicators (IL-6, TNF-α, resistin and leptin), a significant decrease was observed in all groups after 12 weeks of training program (P< 0.05). In this study, a significant improvement in weight loss and blood glucose was observed after 12 weeks of exercise program in all 4 exercise groups (P< 0.05). In the second part of the findings (non-training or durability of training effect), it was resistance training that showed a lower percentage decrease (P< 0.05) in anti-inflammatory indices and an increase in pro-inflammatory and inflammatory indices after 12 weeks of non-training, which showed the durability It shows more recovery in obese type 2 diabetic patients (P< 0.05).
Conclusion: The findings of the research showed that high-intensity interval training after 12 weeks can cause a greater effect on inflammatory, pro-inflammatory and anti-inflammatory indicators compared to aerobic, combined and resistance training. But this is the resistance exercise that caused the reduction in inflammatory, pro-inflammatory indicators and increase in anti-inflammatory indicators in obese type 2 diabetic patients to be more permanent. Therefore, the effectiveness of resistance training in non-training conditions from three methods of high-intensity interval training, aerobic and combined (aerobic + resistance) has a greater effect on low-grade inflammation and results in a longer recovery in obese type 2 diabetic patients.
 

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Background: Metabolic syndrome is characterized by a cluster of conditions such as abdominal obesity, high triglycerides, high blood pressure, high blood sugar, and low levels of healthy fat. Therefore, this study aimed to investigate the effect of endurance training on PGC1α protein content, glycosylated hemoglobin and metabolic syndrome indices in obese rats with type 2 diabetes.
Methods: Eighteen male Wistar rats with an average weight of 200±20 g were selected and placed on a high-fat diet for four weeks. Then 12 rats were randomly selected and induced type 2 diabetes by injecting nicotinamide (110 mg/kg) and streptozotocin (50 mg/kg) solutions. Diabetic rats were randomly divided into two groups of training and control patients. The samples of the training group performed endurance training on the treadmill for 8 weeks and 5 sessions every week with an intensity of about 50 to 70% of the maximum speed. 48 hours after the last training session, mice were sacrificed and variables were measured. To analyze the data, one-way ANOVA and Tukey's post hoc tests were performed in SPSS software version 29.
Results: Endurance training led to a significant decrease in fasting blood sugar levels, HbA1c and triglyceride levels (P= 0.0001). On the other hand, it did not show any effect on HDL levels (P= 0.087). On the contrary, it led to an increase in the intracellular amount of PGC-1α (P= 0.0001).
Conclusion: The results show that endurance training can be considered as an adjuvant drug by regulating the factors related to metabolic syndrome.

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Background: Moderate and intense aerobic exercise increases the production of free radicals, and on the other hand, the use of antioxidant supplements such as grape seed extract (GSE) has been suggested as one of the ways to deal with oxidative stress. Based on this, the aim of this study was to determine the interventions effect of combined exercise and consumption of GSE on some factors of oxidative and antioxidant stress in postmenopausal women with type 2 diabetes.
Methods: The current study was conducted as a clinical trial on the 80 women with type 2 diabetes, who were randomly divided into four groups (20 people): control, exercise, GSE supplement, exercise + GSE supplement. The combined exercise protocol consisted of aerobic (20 minutes of treadmill running at an intensity of 60–70% of reserve heart rate) and strength training (at an intensity of 70% of one repetition maximum), which was performed for eight weeks (five days/week). GSE supplement was taken in the form of 200 mg capsules daily (morning and noon). Samples (five cc) were taken before and after eight weeks of interventions. In order to determine the acceptance or rejection of the null hypothesis of intragroup and intergroup changes, was used the two-way AVOVA, and then Tukey's post hoc test to determine different groups by SPSS version 25 (P≤ 0.05).
Results: The values of total antioxidant capacity (TAC) and serum glutathione reduction (GSH) in the GSE and exercise + GSE groups increased significantly compared to the control and exercise groups (P= 0.001). Serum malondialdehyde (MDA) levels in the GSE group showed a significant decrease compared to the control and exercise groups (P= 0.001).
Conclusion: It seems that the intervention of grape seed extract is more effective in reducing oxidative stress than combined exercise. The consumption of this extract alone, as well as with combined exercise, has a significant effect on increasing the total antioxidant capacity and reducing GSH (glutathione).

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Background: Inflammatory protein C3 and IL-1β are significantly involved in the pathophysiology of type 2 diabetes (T2D) and Alzheimer's disease. Moreover, examining the importance of aerobic exercise timing (light vs. dark phase) can provide a better understanding of how exercise timing affects inflammatory markers associated with neurological diseases in older adult women with T2D. Therefore, this study aimed to investigate the effect of aerobic exercise timing on C3 and IL-1β levels in older adults’ women with T2D.
Methods: In this semi-experimental study, 45 women with T2D with an average age of 60 ± 5.07 years were divided into training groups (light and dark phase) and control (15 people in each group). Aerobic exercise was performed for 12 weeks at a moderate intensity (60-70% of heart rate reserve). Protein levels (C3 and IL-1β) were measured before and after the intervention using the ELISA method. Data were analyzed using SPSS27 software and ANOVA with a significance level of 0.05.
Results: Complement C3 was significantly lower in the dark phase exercise group compared to the control group (P= 0.0083). Additionally, the results showed that dark phase aerobic exercise significantly decreased C3 (P= 0.0028) and IL-1β (P= 0.0045) levels compared to baseline.
Conclusion: Aerobic exercise performed during the dark phase effectively reduced inflammatory protein levels of C3 and IL-1β in older adult women with T2D, suggesting it could be considered as a crucial strategy in managing this disease.

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Background: This study aimed to investigate the relationship between stigma associated with type 2 diabetes and subjective well-being measures (life satisfaction and positive/negative affect) mediated by emotional stress and illness perception in people with type 2 diabetes.
Methods: The present research was descriptive based on correlation models. The statistical population included patients with type 2 diabetes who referred to the diabetes clinic of Ayatollah Taleghani hospital in Kermanshah, 207 adults were selected using the convenient sampling method and data were collected using questionnaires Type 2 Diabetes Stigma Assessment Scale (DSAS-2) (Browne et al., 2016), life satisfaction (Diener, 1985), Positive/Negative Affect Schedule (Watson et al., 1988), Illness Perception (Broadbent et al., 2006) then analyzed with SPSS and Amos software.
Results: The results showed that there was a significant relationship between stigma, life satisfaction, and positive/negative affect (P < 0.01). Stigma was also able to predict life satisfaction indirectly and negatively through emotional distress, and negative affect indirectly and positively through emotional distress and illness perception.
Conclusion: The results indicate the need for interventions to reduce the stigma associated with type 2 diabetes and improve the mental well-being of people with this disease.

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Background: The increasing trend of diabetes patients requires lifestyle interventions to improve the self-management ability of these patients, and achieving this requires the use of valid tools in this field. This study aimed to determine the psychometric properties of the Comprehensive Diabetes Self-Management Scale (CDSMS) in patients with type 2 diabetes.
Methods: The present study was methodological research that was conducted in 2023. At the beginning of the work, the CDSMS questionnaire was translated into Persian using the standard translation-back translation method. Then, face validity, content validity, convergent validity, internal consistency, and instrument stability were determined. Data analysis was performed using descriptive statistics, Cronbach's alpha calculation, Kappa index, Pearson correlation coefficient, and intra-cluster correlation coefficient in SPSS software version 24.
Results: Based on the results, all the items of the instrument were retained. The total content validity index score of the Persian version of this questionnaire was 0.987. Also, the Kuder-Richardson and Kappa indices were 0.704 and 0.730, respectively. The level of agreement at two measurement times, two weeks apart, ranged from 0.503 to 0.990. The intra-cluster correlation index was also observed to be in the range of 0.625 to 0.952 and was significant (P < 0.001). The Cronbach's alpha coefficient of the instrument was also 0.83.
Conclusion: The results of the present study showed that the Persian version of the CDSMS questionnaire with 14 items has good validity and reliability and can be used to evaluate the self-management status of patients with type 2 diabetes in Iran.

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Background: Exercise training represents an effective approach that contributes substantially to lowering chemerin and vaspin levels, enhancing body composition, and preventing complications related to overweight and obesity. In this context, the present study sought to examine the effects of exercise training on chemerin, vaspin, and body composition in individuals with type 2 diabetes.
Methods: A systematic review and meta-analysis was conducted to evaluate the effects of exercise interventions on various outcomes in patients with type 2 diabetes. A comprehensive search for English and Persian articles published up to )January 4, 2025( was performed across the following databases: PubMed, Web of Science, Scopus, Google Scholar, IranDoc, Magiran, Noormags, and SID (Scientific Information Database). Fifteen studies, including 19 exercise interventions and 440 participants with type 2 diabetes, were included. Data were analyzed using a random-effects model, and the mean differences with 95% confidence intervals (CI) were calculated. Heterogeneity was assessed using the I² statistic, and publication bias was evaluated through visual inspection of funnel plots and Egger’s test.
Results: A total of 15 studies (with 19 exercise interventions) involving 440 participants with type 2 diabetes were included in the meta-analysis. The results indicated that exercise interventions led to non-significant changes in c-Merlin [SMD= −0.967, 95% CI: −2.453 to 0.518, P= 0.202], body mass index (BMI) [SMD= −0.228, 95% CI: −0.470 to 0.013, P= 0.064], waist-to-hip ratio (WHR) [SMD= −0.038, 95% CI: −0.773 to 0.007, P= 0.054], and body fat percentage [SMD= 0.080, 95% CI: −0.524 to 0.685, P= 0.795] compared with the control group in individuals with type 2 diabetes.
Conclusion: The results of the present study demonstrated that exercise training significantly reduces vaspin levels in patients with type 2 diabetes, while it has no significant effect on chemerin, body composition, or body composition indices (including body mass index, body fat percentage, and waist-to-hip ratio). It appears that physical exercise may play an effective role in improving the metabolic status of patients with type 2 diabetes through the modulation of vaspin levels.

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Background: Type 2 diabetes is a major public-health threat of the present century, imposing substantial clinical and economic burdens on health systems. Accurate forecasting of disease incidence can support resource allocation and the design of targeted interventions.
Methods: In this study, we developed a hybrid model that integrates Cellular Learning Automata (CLA) with a Susceptible–Infected–Recovered (SIR) framework to predict the 20-year spread of type 2 diabetes using real patient data from Kerman province. The dataset comprised demographic and laboratory features of patients with diabetes collected during the Persian calendar years 2005– 2013. After preprocessing and imputation of missing values, the proposed model was implemented in MATLAB.
Results: Results indicate that the CLA–SIR combination models the disease trajectory with high accuracy. Moreover, factors such as blood pressure, cholesterol, and body mass index were identified as key drivers influencing the activation states of model cells.
Conclusion: These findings suggest that intelligent hybrid approaches can be effective for health-data analysis and long-term prediction of chronic diseases.
 

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Background: Type 2 diabetes is rapidly increasing, particularly in the Middle East where central obesity is a major contributor to disease burden. Identifying high-risk individuals requires indices that assess visceral adiposity more effectively than body mass index (BMI). This study compared nine anthropometric indices in relation to diabetes and determined their predictive capacity and optimal cut-off values.
Methods: This cross-sectional analysis included 10,103 adults aged 35–70 years from the FASA cohort. Diabetes was defined as fasting glucose ≥126 mg/dL or antidiabetic medication use. Measurements included BMI, waist circumference (WC), hip circumference (HC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body roundness index (BRI), body adiposity index (BAI), a body shape index (ABSI), abdominal volume index (AVI), and weight-adjusted waist index (WWI). Associations were examined using logistic regression (crude and adjusted models). Discriminatory accuracy was assessed using receiver operating characteristic (ROC) curves, area under the curve (AUC), and Youden's index. 
Results: Individuals with diabetes exhibited higher values across anthropometric indices (p< 0.05). In adjusted models, WC, WHR, WHtR, AVI, and WWI remained significant predictors (p< 0.05). WHR demonstrated the highest AUC (0.651, p< 0.001). Optimal cut-off values with high sensitivity and specificity included WHR= 0.91, WHtR= 0.53, and BRI= 4.1. 
Conclusion: Central obesity indices—particularly WHR, WHtR, and BRI—demonstrated superior discriminatory capacity for diabetes and support the use of simple waist-based indices for early screening.

 

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Background: Type 2 diabetes is a common chronic metabolic disease whose effective management requires attention to psychological and interpersonal factors. This study aimed to examine the relationship between the Perceived Spousal Sacrificial Behavior and self-efficacy with behavior management in patients with type2 diabetes.
Methods: This descriptive-correlational and cross-sectional study was conducted among married patients with type 2 diabetes who were referred to endocrinology and metabolism centers and primary health care units in Sari, Iran. Based on inclusion and exclusion criteria, 97 participants were selected using purposive sampling. The research instruments included the Perceived Spousal Sacrifice Scale (Harper & Figuerres, 2008), the Diabetes Self-Efficacy Scale (Fappa et al 2016), and the Behavioral Management Scale (Toobert et al., 2000). Data were analyzed using SPSS version 24 through descriptive statistics (mean, standard deviation) and inferential statistics (Pearson correlation coefficient and multiple regression analysis).
Results: Perception of the Perceived Spousal Sacrificial Behavior and self-efficacy showed a significant positive correlation with behavioral management among diabetic patients (p < 0.01). Together, these variables explained 30% of the variance in behavioral management, with Perceived Spousal Sacrificial Behavior making a greater contribution to prediction.
Conclusion: The findings highlight the significant role of Perceived Spousal Sacrificial Behavior and self-efficacy in improving behavioral management among patients with type 2 diabetes. Enhancing spousal support and strengthening patients’ self-efficacy through educational and psychological interventions may promote better self-care behaviors and disease control.