Iranian Journal of

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Background: Imbalance of apoptotic factors plays important role in pathogenesis of diabetes. Considering the role of curcumin supplementation and high-intensity interval training (HIIT) on these factors, the aim of this study was to investigate effects of four weeks of HIIT with curcumin supplementation on Bax and Bcl-2 gene expression in the soleus muscle of diabetic rats.
Methods: Present study was experimental research. 30 male Wistar rats were divided into one normal control (NC), and four diabetic groups: control (DC), supplement (SDC), high-intensity interval training (DHIIT) and high-intensity interval training supplement (SDHIIT). The training protocol was performed five days a week for four weeks, which included five to seven two-minute intervals at 80 to 90% of maximum power until exhaustion and one-minute recovery at 30% of maximum power until exhaustion. At the same time, Curcumin gavage at a dose of 100 mg/kg was performed daily. Bax and BCL-2 gene expression levels were measured by the qReal-TimePCR method and data were analyzed by two-way analysis of variance at a significant level of p≥0.05.
Results: Bcl-2 gene expression was significantly increased in DHIIT and SDHIIT groups compared to DC (P= 0.000). Also, a significant decrease in Bax gene expression was observed in DHIIT and SDHIIT groups compared to DC (P=0.000). There was a significant difference between DHIIT and SDHIIT in Bcl-2 (P=0.000) and Bax (P=0.013) gene expression.
Conclusion: It seems that HIIT in combination with curcumin supplementation, is more effective in improving the balance between apoptosis factors than any of these interventions alone.
 

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Background: One of the most common problems in diabetic patients is muscle atrophy. Therefore, the present study aimed to investigate the synergistic effect of endurance training with probiotic supplementation on Atrogin-1 and MuRF-1 genes gene expression in the soleus muscle of diabetic rats.
Methods: In this study, 32 male Wistar rats were randomly divided into one normal control (NC) and four diabetic groups: diabetic control (DC), diabetic supplement (SDC), diabetic training (TD), and diabetic supplement training (STD). The training protocol was performed with 60 to 65% of maximum speed reached five days a week for four weeks. At the same time, rats took two grams of probiotic dissolved in 30 ml of water daily. Expression of Atrogin-1 and MuRF-1 genes was measured by the qReal-TimePCR method. Data were analyzed by two-way analysis of variance at the significant level of P≤0.05.
Results: Atrogin-1 gene expression was significantly reduced in TD (P=0.001) and STD (P=0.000) groups compared to DC group. There was a significant difference between TD and STD groups in the expression of the Atrogin-1 gene (P=0.028). MuRF-1 gene expression was significantly reduced in TD (P=0.04) and STD (P=0.01) groups compared to DC. But there was no significant difference between TD and STD groups in MuRF-1 gene expression (P=0.36).
Conclusion: It seems that performing the aerobic exercise with probiotic supplementation is more effective in reducing the expression of the Atrogin-1 gene than any of these interventions alone. However, aerobic exercise with probiotic supplementation does not have a synergistic effect on reducing MuRF-1 gene expression in the soleus muscle of diabetic rats compared to aerobic exercise alone.

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Background: Diabetes is an important factor in heart defects that can lead to atrophy of heart cells. Exercise can prevent the complications of diabetes by regulating cellular factors. Therefore, the aim of the present study was to evaluate the effect of endurance and high-intensity interval training on the content MSTN and Follistatin proteins in the left ventricular tissue of the heart of type 1 and 2 diabetic rats
Methods: In this study, 36 head 2-month-old male Sprague-Dawley male rats with a mean weight of 280±30 g were selected.
After induction of type 1 (18 head) and 2 (18 head) diabetics through streptozotocin and nicotinamide solution, each type of diabetes was randomly divided into 3 groups: endurance training, HIIT and control (6 heads per group); The training groups performed endurance (50 to 70% of maximum speed) and HIIT (intensity 85 to 95% of maximum speed) training program 4 days a week for 4 weeks; Data analysis was performed by one-way ANOVA and Tukey post hoc tests in SPSS software.
Results: Endurance training and HIIT in diabetic training groups led to a significant decrease in MSTN protein content (P=0.0001) and an increase in Follistatin protein content (P=0.0001).
Conclusion: It seems that four weeks of endurance training and HIIT can prevent excessive myocardial atrophy by decreasing the MSTN content and increasing Follistatin. Therefore, exercise training with the intensity, duration and type can be a good defense and treatment mechanisms for diabetics to prevent or reduce heart complications.

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Background: Adipulin is a hormone secretd by fat cells that acts as a metabolic regulator with anti-inflammatory properties and is reduced through obesity, diabetes and inflammation. Therefore, the aim of this study was to compare the effect of high and moderate intensity aerobic exercise on serum adipolin levels and some indicators of metabolic syndrome in obese women.
Methods: In this quasi-experimental study, 36 people were randomly divided into three groups of 12 people (2 experimental groups and one control group). Aerobic exercise group with an intensity of 85-95% of maximum heart rate performed intermittent walking and running on the treadmill for 33 minutes per session and exercise group with an intensity of 50-70% of maximum heart rate walked continuously for 41 minutes. (Training duration for 2 groups was 8 weeks and 3 sessions per week, The control group was not active during this period). One-way analysis of variance statistical and Bonferroni post hoc tests were used at the significant level (P> 0.05).
Results: High intensity aerobic exercise significantly increased serum adipolin levels (P= 0.001) and decreased total cholesterol (P= 0.020), triglyceride (P= 0.021) and insulin resistance (P= 0.001). The results also showed no significant differences in the levels of high-density lipoprotein (P= 0.615), low-density lipoprotein (P= 0.604), and blood pressure (P= 0.269) in the three groups. Medium-intensity aerobic exercise had no effect on serum adipoline levels (P= 0.192), only glucose, (P= 0.025), triglycerides (P= 0.010), systolic blood pressure (P= 0.028) and insulin (P= 0.043) decreased and the levels of cholesterol, low-density lipoprotein and high-density lipoprotein did not change significantly.
Conclusion: In the end, it can be said that it seems that individuals can use high-intensity aerobic exercise to increase the amount of adipolin as an indicator of improving insulin sensitivity and also improving the indicators of metabolic syndrome.

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Background: BDNF protein is the important neurotrophin that is involved in cognitive function. Diabetes can lead to impaired function and is a neurocognitive disorder's factor in hippocampus. Therefore, the purpose of this study was to evaluate the effect of 8 weeks of concurrent training on BDNF levels in the brain hippocampus and cognitive function of streptozotocin-induced diabetic rats.
Methods: 40 of Sprague-Dawn rats were randomly divided into four groups: healthy inactive, non-healthy concurrent exercise, diabetic group without exercise, and diabetic concurrent exercise. Rats in the training groups performed concurrent training for 8 weeks. After 8 weeks, subjects' memory was assessed using a cognitive function test in a water maze. BDNF levels in the hippocampus were measured by Western blotting. One-way analysis of variance and LSD post hoc test were used to analyze the data.
Findings: The present study showed that eight weeks of concurrent exercise resulted in a significant reduction in fasting blood sugar in the healthy exercise group compared to the diabetic group. A significant decrease in BDNF levels of the cerebral hippocampus was also observed in the diabetic exercise group compared to the diabetic group. In addition, the level of memory function in healthy exercise and diabetic exercise groups was significantly higher than healthy control and patient control.
Conclusion: Concurrent exercise reduces BDNF hippocampus and increased cognitive function in the exercise group compared to the control group. As a result, it can be said that this type of exercise is very effective in improving the complications of type 2 diabetes.

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Background: Chronic hyperglycemia is associated with an increase in cellular damage due to oxidative stress and increases insulin resistance and also increases in p53 and p16 beta cells, leading to the induction of senescence in pancreatic insulin-secreting cells. The aim of this study was the effect of eight weeks of aerobic exercise on the expression of senescence proteins P53 and P16 in the pancreatic tissue of diabetic mice.
Methods: In this study, 15 NMRI mice (26.3 ±3.22 g) were divided into three groups randomly: healthy control, diabetic control and diabetic exercise. They were diabetic by HFD for 5 weeks and intraperitoneal injection of STZ. The aerobic training protocol (50-60% Vmax) was 5 days a week for 8 weeks. After anesthesia, blood and pancreatic tissue were removed. Insulin resistance, P53 and P16 protein concentrations in pancreatic beta cells were measured. Data were analyzed by ANOVA with a significance level of p <0.05.
Results: According to the results of eight weeks of aerobic exercise by mice diabetic type 2, a significant decrease in insulin resistance (p = 0.005), protein concentrations of P53 (p = 0.002) and P16 (p = 0.010) in pancreatic tissue was observed.
Conclusion: Aerobic exercise may improve insulin sensitivity and delay cellular senescence due to diabetes by reducing cell senescence factors such as P53 and P16 in beta cells. Therefore, this type of exercise can be considered as a therapeutic approach to improve the condition of these patients.

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Background: Myogenin (MyoG) and Myostatin (Mstn) play role in muscle growth and wasting, respectively. The present study aimed to investigate the combined effect of High-intensity Interval Training (HIIT) and Metformin drug (Metf) on gene expression of MyoG and Mstn in skeletal muscle of type 2 diabetic mice.
Methods: 25 mice (C57BL/6) were assigned to two groups, including 1) Control © (n=5), and 2) HFD (n=20). The mice of the HFD group were fed a high-fat diet for 16 weeks. After 16 weeks, the mice with over 200 mg/dl were selected as diabetic mice. Then, the diabetic mice were divided into four groups including 1) Control Diabetic (CD) (n=5), 2) Diabet with Metf (DM) (n=5), 3) Diabet with HIIT (DH) (n=5) 4) Diabet with Metf and HIIT (DMH) (n=5). The mice of experimental groups underwent the interventions for eight weeks. The Real-Time–PCR methods were used to measure the mRNA expression of MyoG and Mstn in the Rectus-Femoris muscle.
Results: HIIT (but no Metf) upregulated the gene expression of MyoG (p=0.05). Metformin did not affect Mstn expression (p=0.45), However, HIIT downregulated the expression of Mstn (p=0.001). Metformin did not affect decreasingly or incrementally the downregulating effect of HIIT on Mstn expression (p=0.95).
Conclusion: Metf may not positively or negatively affect the expression changes of MyoG and Mstn induced by HIIT in skeletal muscle of mice with type 2 diabetes.

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Background: The present study was conducted with the aim of comparing lifestyle education based on the Bezenf model and the World Health Organization model on FBS, 2HPPBS, HbA1c in patients with type II diabetes.
Methods: The research method was a semi-experimental and multi-group expanded type with pre-test-post-test designs and a control group with a follow-up period. The statistical population of this research included all patients with type II diabetes referred to the endocrinology department of Imam-Khomeini Hospital in 1400. In this research, from a list of 100 people with diabetes, 60 diabetic patients who met the entry criteria were identified. Then 45 people were randomly selected and replaced by random replacement in two experimental groups and one control group. Each experimental group received group psychological interventions separately, and at the end, both groups were subjected to a post-test. The obtained data were analyzed using mixed analysis with repeated measurements.
Results: The results indicate the effect of lifestyle education based on the Bezenf model and the World Health Organization model on FBS (P=0/001), 2HPPBS (P=0/001) and HbA1c (P=0/006) and the stability of this effect was in the follow-up phase. Also, compared to lifestyle education based on the World Health Organization model, lifestyle education based on the Bezenf model was a more effective method to reduce HbA1c in type 2 diabetes patients but the difference in the effect of the two groups on FBS and 2HPPBS was not significant.
Conclusion: The results indicated the effectiveness of both educational models and the superiority of the BAZENF educational model. Therefore, Lifestyle education based on the Bezenf model and the World Health Organization model can be used by therapists as adjunctive treatments in interventions for people with type 2 diabetes.

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Background: The release of adipokines from adipose tissue depots plays a key role in regulating metabolic homeostasis and several other physiological processes, including diabetes, obesity, and vascular diseases. This study investigated the effect of eight weeks of high intensity interval training (HIIT) on asprosin, lipid profile and insulin resistance in type 2 diabetic male rats.
Methods: 24 male Sprague Dawley rats were randomly divided into four equal groups: control (C), control traning (C+T), diabet (D) and diabet traning (D+T). Diabetes was induced by the combined method of high fat diet and low dose strepotozocin injection. The traning group performed the HIIT program on the treadmill for eight weeks. Data were analyzed using one-way ANOVA and bonferroni post hoc test at a significance level of P<0.05.
Results: The results showed increased plasma asprosin in D group compared to C (P=0.0001) and decreased in C+T group compared to C (P=0.03) and D+T group compared to D (P=0.04). There was no significant difference in HOMA-IR between the C and C+T group (P=0.9) but decreased in D+T compared to D (P=0.0001). HDL increased in D+T group compared to the D (P=0.0001) and decreased TG and LDL (P=0.001). There was no significant difference between TG and LDL in the C group compared to the C+T, but HDL increased in C+T (P=0.01).
Conclusion: Plasma asprosin increases in rats with type 2 diabetes and HIIT can reduce the complications of diabetes by improved lipid profile and reduce asprosin and insulin resistance.

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Impaired insulin function with exogenous changes is a major cause of heart failure. The purpose of this study was to investigate the effect of four weeks of high intensity interval training with curcumin supplement on the expression of IRS-1 and IRE-1α gene in the Left ventricle of type 2 diabetic rats.
Methods: In the present experimental study, 30 male mice with diabetes were divided into five groups of 6; high intensity interval training (HIIT), High intensity interval Training+Curcumin(S+HIIT), Diabetic control+curcumin(S+DC), Diabetic Control (DC), Normal control (NC). The High intensity interval training protocol was performed five days a week for four weeks. Curcumin gavage at a dose of 100 mg/kg was performed daily. The expression of IRS-1 and IRE-1α were measured by the qReal-TimePCR method, and data were analyzed by one-way ANOVA at the alpha level of 0.05.
Results: IRS-1 gene expression in the S+HIIT group compared to the DC (P=0.003) and S+DC (P=0.001) groups and in the HIIT group compared to the DC (P=0.002), and S groups +DC had a significant decrease (P=0.019). IRE-1α gene was significantly decreased in S+HIIT group compared to DC (P=0.003), S+DC (P=0.001) and HIIT (P=0.008) groups.
Conclusion: It seems that HIIT with curcumin supplement can reduce the process of myocardial apoptosis in diabetic patients by improving metabolic conditions and genetic factors.

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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.

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Background: Diabetic nephropathy is the main cause of end-stage kidney disease in diabetic patients. Several inflammatory markers related with diabetic nephropathy have been investigated so far. It is necessary to identify easily available and cost-effective indices. We aimed to determine the relationship between the neutrophil to lymphocyte ratio and mean platelet volume with diabetic nephropathy.
Methods: This cross-sectional study was performed from 2021 to 2022 in diabetes clinic of Ghaem hospital, Mashhad.  Patients with type II diabetes were categorized into two groups: without and with nephropathy (urinary albumin excretion greater than 30 mg/24h or GFR less than 60). Patients’ data, including demographic data, past medical and drug history and lab data were gathered and analyzed.
Results: In total, 100 diabetic patients including 50 with (mean age=64.04±7.40 years) and 50 without nephropathy (mean age=56.06±6.36 years), were studied. Patients with nephropathy were older, had a longer history of diabetes and a higher blood pressure (P < 0.05). However, the distribution of gender, weight, height, and BMI was not significantly different the two groups (P>0.05). The absolute neutrophil count was not significantly different between the two groups (P>0.05), while the mean platelet volume, neutrophil% and neutrophil/lymphocyte ratio were significantly higher in patients with nephropathy (P<0.05).
Conclusion: According to our findings, patients with diabetic nephropathy had higher mean platelet volume, neutrophil%, and neutrophil/lymphocyte ratios compared to diabetic patients without nephropathy.

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Background: Sirtuin-1 is known as a key metabolic sensor in various tissues, including skeletal muscle and tissue, which can play a pivotal role in regulating glucose and lipid metabolism through diacetylase activity. The aim of the present study was to investigate the role of licorice extract and swimming exercise on SIRT1 signaling pathways in the soleus muscle of diabetes male rats.
Methods: The research is of an experimental and fundamental type, and the working method is an experimental work with a descriptive-solution nature. Fifty mice were bought and divided into 5 groups of 10. The main training program consisted of swimming in the rodent tank of the special swimming water tank for 6 weeks and 5 sessions per week. In order to induce diabetes in the mice, streptozotocin was injected. Seven days after the injection, the blood sugar of the mice was measured, and the mice with blood sugar more than 250 ml/dL were selected as diabetes samples. Licorice root extract was given to two groups of rats. In order to analyze, two-way analysis of variance was used using SPSS26 software.
Results: The results showed that the interaction effect of swimming training and consumption of licorice extract on SIRT1 signaling pathways is statistically significant (P= 0.002).
Conclusion: SIRT1 plays an important role in the control of glucose homeostasis. In fact, under certain conditions, the activity and expression level of SIRT1 gene decreases in different SI tissues due to its important metabolic role. Swimming training along with licorice supplement may be used for prevention and treatment of diabetes by positive regulation of SIRT1 gene expression.

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Background: Mitophagy is a type of cell death that regulates the quality of mitochondria and can lead to disorders in diseases such as diabetes. Therefore, the purpose of this study was to investigate the effect of high-intensity interval training (HIIT) on the content of proteins related to the mitophagy pathway (LC3 and BNIP3L) in muscle tissue soleus of rats with type 2 diabetes.
Methods: In this experimental study, 18 three-month-old male Sprague Dawley rats with an average weight of 270±30 g were selected. Rats were infected with type 2 diabetes by intraperitoneal injection of a streptozotocin and nicotinamide solution. Rats were randomly divided into two groups: diabetic and diabetic. A healthy control group was also included. The training group performed HIIT for eight weeks at an intensity of 85-95% of the maximum speed. Data analysis was performed using a one-way ANOVA test in GraphPad Prism version 9.5 software. A significance level of P≤ 0.05 was considered statistically significant.
Results: The levels of LC3 and BNIP3L proteins significantly increase after eight weeks of HIIT compared to both the diabetic and healthy control groups (P= 0.0001).
Conclusion: It can be concluded that HIIT by increasing the factors related to mitophagy can cause the cleaning of dysfunctional mitochondria in the muscle of diabetic subjects; However, excessive mitophagy can also cause functional defects in regulating the quality of mitochondria.

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Background: Type 1 diabetes is characterized by persistent hyperglycemia and leads to impaired protein synthesis and ultimately muscle breakdown and reduction in muscle function. Therefore, this research was conducted with the aim of investigating the effect of moderate intensity continuous training (MICT) on the amount of 4EBP1 in the biceps muscle of type 1 diabetic rats.
Methods: The present study is of experimental-fundamental type in which 12 2-month-old male Sprague Dawley rats with an average weight of 280±30 grams participated. To induce type 1 diabetes, streptozotocin (STZ) solution was injected intraperitoneally at a dose of 65 mg/kg. 3 days after the injection, blood sugar above 300 mg/dl was considered as an indicator of type 1 diabetes. After the induction of diabetes, the rats were randomly divided into 2 diabetic training groups (6 heads) and diabetic control groups (6 heads). The continuous training program (32 minutes with an intensity of 50-70% of maximum speed) was 8 weeks and 3 sessions every week. Data analysis was done through independent t-tests. Data analysis was done using GraphPad Prism software version 10.2.2. The significance level of the present study was considered P≤0.05.
Results: In the training group after 8 weeks of MICT, the intracellular content of phosphorylated (P=0.0001), total (P=0.0001) and the ratio of phosphorylated to total (P=0.002) protein 4EBP1 showed a significant change compared to the control group in the twin muscle tissue.
Conclusion: 4EBP1 protein seems to increase through 8 weeks of MICT and this mechanism can increase muscle synthesis in muscle tissue.

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Background: Clinical studies have demonstrated that diabetes, as a metabolic disorder, can significantly impact the quality of life of individuals affected by the condition. Physical activity has been identified as a potentially effective therapeutic intervention for managing diabetes in these individuals. This study examined the correlation between serum levels of GLP-1 and the hormones thyroxine, TSH, insulin, glucose, HbA1c, VO2max, as well as various anthropometric indicators after eight weeks of calisthenics exercises.
Methods: This semi-experimental study involved 14 sedentary children with type 1 diabetes, averaging 12.42±1.28 years, selected through non-random sampling. The participants performed calisthenics exercises for eight weeks (three sessions per week). Physiological assessments and blood samples were collected 48 hours before and after the training period. The relationship was analyzed using Pearson's correlation test, and intra-group changes were assessed using paired t-tests.
Results: The findings demonstrated a positive and significant correlation between GLP-1 and insulin both before (r= 0.703, P= 0.005) and after the exercise intervention (r= 0.668, P= 0.009). Additionally, an inverse and significant correlation was observed between GLP-1 and waist circumference (WC) levels before (r= 0.633, P= 0.019) and after exercise (r= 0.575, P= 0.043), as well as between GLP-1 and body fat percentage after exercise (r= 0.676, P= 0.007). In terms of intra-group changes, the results indicated a significant increase in GLP-1, insulin, and VO2max, along with a significant decrease in WC.

Conclusion: The findings of this study show that engaging in calisthenics exercises can be effective in reducing the negative effects of type 1 diabetes and increasing the health of diabetic children.

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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: This study investigated the efficacy of the “Rehacom” cognitive rehabilitation software on five key cognitive domains—working memory, information processing speed, attention, inhibition, and executive functions—in patients diagnosed with Type 1 and Type 2 Diabetes Mellitus.
Methods: A pre-test/post-test experimental design with a control group was employed. A sample of 30 diabetic patients was recruited via convenience sampling and randomly allocated to either the experimental group (receiving Rehacom software intervention for 12 sessions) or the control group. Cognitive performance was assessed using the Rehacom software itself and the Barkley Deficits in Executive Functioning Scale (BDEFS). Each session lasted 45 minutes.
Results: Multivariate Analysis of Covariance (MANCOVA) revealed a significant overall effect of the intervention on the composite of dependent variables (Wilks’ Lambda= 0.184, F (5.24)= 7.978, P< 0.001). Subsequent Analysis of Covariance (ANCOVA) indicated that the intervention significantly enhanced “attention” (η²= 0.236, P= 0.016) and “executive functions” (η²= 0.621, P< 0.001). However, no significant impact was observed on working memory, information processing speed, or inhibition.
Conclusion: The findings suggest that the Rehacom software serves as an effective tool for improving attention and executive functions in diabetic patients. The notable effect sizes for these two domains underscore its clinical utility in cognitive rehabilitation programs for chronic patients. The absence of effects on other components may be attributable to factors such as the limited duration of the intervention, specific software exercises, or the underlying neurochemical and pathophysiological characteristics of diabetes, warranting further investigation with more robust designs.
 

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Background: Decision-making is a cognitive process with complex neural underpinnings, fundamental to all human behavior. This study reviewed existing research to present a comprehensive model of this process, integrating the functions of specific brain regions with cognitive and emotional factors to create a complete framework.
Methods: Using a qualitative approach, we conducted a literature review across reputable databases. Neurocognitive factors were extracted and validated through a series of expert panel sessions with eight specialists. The final conceptual model was designed, and its validity was confirmed through a multi-stage consensus process.
Results: The model provides a comprehensive framework for understanding the neurocognitive mechanisms of decision-making. It integrates cognitive, emotional, and motivational factors—such as intention, emotion, and cognitive reserve—to explain how choices are made and outcomes are evaluated. The model emphasizes the key roles of the prefrontal cortex and the limbic system, and demonstrates how external stimuli influence this process.
Conclusion: This validated model offers an integrated framework for the decision-making process, highlighting the interplay between key brain regions and cognitive and emotional factors. The model has important applications in education, psychotherapy, and designing interventions to improve decision-making skills.
 

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Background: National Document for the Prevention and Control of Non-Communicable Diseases (NCDs) and Related Risk Factors, developed in 2015, serves as Iran’s roadmap for guiding health policies to manage NCDs. After a decade, assessing its implementation and progress is essential. We aimed to review and synthesize existing evidence on the implementation status of the document’s interventions, and identify facilitators, barriers, and strategies to enhance its execution.
Methods: Following the PRISMA-ScR 2020 checklist, a systematic search was conducted in PubMed, Scopus, Web of Science, SID databases, Google Scholar, organizational repositories, and reference lists of related studies in Persian and English. Research or review studies that evaluated at least one objective or intervention of the national document—using health or health system indicators in Iran—were included. Three researchers independently performed screening and data extraction. Data were analyzed narratively and organized into thematic categories.
Results: Overall, 78 studies, reports, and national documents were included. Implemented actions encompassed establishing committees, developing action plans, integrating services into the health system, revising standards, producing educational materials, launching registries, and signing multisectoral cooperation agreements. Facilitators included legal support, intersectoral collaboration capacities, service delivery structures, and community capabilities. Major challenges were deficiencies in the national document, limited resources, weak coordination, and external disruptions such as COVID-19 and sanctions. Recommended strategies emphasized strengthening cost-effective interventions, continuous monitoring, securing sustainable resources, improving service delivery models, and enhancing multi-sectoral approaches.
Conclusion: Successful implementation of NCD prevention and control policies requires evidence-informed policymaking, prioritization of cost-effective interventions, ongoing evaluation, and sustained managerial support.