Iranian journal of diabetes and metabolism

A Scientific Critique of the Article "The Effect of Combined Training and Grape Seed Extract on Some Oxidative Stress and Antioxidant Factors in Postmenopausal Women with Type 2 Diabetes"

Ali Bozorgi — 2026-06-28

The Article Abstract is not available.

Comparison of the International Working Group on Diabetic Foot (IWGDF) Guidelines: Review of Similarities and Differences Between the 2019 and 2023 Versions on the Prevention and Management of Diabetic Foot

Mahin Nomali — 2026-06-28

Background: Since 1999, the International Working Group on the Diabetic Foot (IWGDF) has consistently provided evidence-based guidelines aimed at the prevention and management of diabetic foot (DF). The latest version of these guidelines was published in 2023. Despite similarities such as being compiled by a working group, based on systematic reviews, and using the GRADE methodology to grade recommendations, it has some differences from the 2019 version. Awareness of these similarities and differences facilitates the faster implementation of evidence into clinical practice. The aim was to compare the similarities and differences between the 2019 and 2023 versions of the IWGDF guidelines.

Methods: In this comparative review study, both guideline versions were reviewed as primary sources. Data were extracted in two domains: structural (methodology) and content (number of chapters and recommendations, and key points). A comparison was then conducted on the data both quantitatively and qualitatively, whereby the similarities and differences between the two versions were identified and analyzed by juxtaposing the extracted information.

Results: The 2019 version consists of six guidelines, while the 2023 version includes seven separate guidelines. Both versions contain individual guidelines for prevention of foot ulcers (14 recommendations in 2023 vs. 16 in 2019), classification of foot ulcers (5 recommendations in both versions), diagnosis and treatment of foot infections (26 recommendations in 2023 vs. 27 in 2019), diagnosis and treatment of peripheral artery disease (25 recommendations in 2023 vs. 17 in 2019), offloading interventions (12 recommendations in 2023 vs. 9 in 2019), and wound healing interventions (29 recommendations in 2023 vs. 9 in 2019). A significant difference in the 2023 version compared to 2019 is the addition of a guideline for the diagnosis and treatment of active Charcot neuro- osteoarthropathy, which includes 26 recommendations.

Conclusion: Despite content similarities, the 2023 version differs from the 2019 version in the number of recommendations, with the most notable difference being the inclusion of a guideline for the diagnosis and treatment of active Charcot neuro-osteoarthropathy

Meta-Analysis of Studies on the Effect of High-Intensity Interval Training (HIIT) on Metabolic Indices, Body Composition, and Aerobic Capacity in Patients with Type 2 Diabetes or Obesity

Omid Zafarmand — 2026-06-28

Background: The aim of the present study was to investigate the effect of high-intensity interval training on lipid profile, fasting blood glucose, body composition, and Vo2max in patients with type 2 diabetes or obesity.

Methods: The type of research conducted is a systematic meta-analysis review. A systematic search of published articles was conducted from PubMed, Web of Science, Scopus, Sid, and Magiran databases up to January 2024. The mean difference and 95% confidence interval (CI) were calculated using a random-effects model. Heterogeneity was assessed using the (I2) test and publication bias was assessed using visual analysis of funnel plots and Egger's test.

Results: The results showed that high-intensity interval training significantly reduced body fat percentage [standard mean difference (SMD)=-0.796, P=0/001], BMI (SMD=-0.378, P=0/001), WHR (SMD=-0.424, P=0/001), LDL (SMD=-0.694, P=0/001), TC (SMD=-0.495, P=0/001), TG (SMD=-0.317, P=0/001) and fasting blood glucose (SMD=-0.557, P=0/001) in patients group compared to the control group had a significantly higher VO2max. However, high-intensity interval training significantly increased Vo2max (WMD=-0.997, P=0/001), and HDL (WMD=-0.558, P=0/001) in patients group compared to the control group.

Conclusion: Based on the results obtained, high-intensity interval training can have a positive effect on metabolic indices, body composition, and aerobic capacity in patients with type 2 diabetes or obesity and improve the condition of these individuals. Therefore, it is suggested that in medical centers for diabetic and obese patients, under the supervision of sports and medical specialists, the beneficial effects of high-intensity interval training should be utilized and used as an auxiliary strategy for the treatment and improvement of these individuals

Cognitive Changes in Metabolic Syndrome: A Narrative Review of Neuroimaging Evidence and Molecular Pathway

Yunus Soleymani — 2026-06-28

Background: Metabolic syndrome (MetS) is associated with a higher risk of cognitive dysfunction and brain structural alterations, yet the specific contributions of its components and underlying mechanisms remain unclear.

Methods: This narrative review integrates findings from neuroimaging, clinical, and molecular studies to provide a conceptual understanding of how MetS affects cognition. A non-systematic and targeted search was conducted up to June 2025 using terms such as metabolic syndrome, cognition, and magnetic resonance imaging (MRI). Studies were selected based on their relevance and conceptual contribution.

Results: Evidence converges on inflammation, oxidative stress, vascular injury, and insulin resistance as key mechanisms linking MetS to gray and white matter changes and cognitive impairment. Structural and functional MRI studies demonstrate disrupted brain connectivity and reduced hippocampal volume in individuals with MetS. Gender and genetic differences may also influence the strength of this association. The coexistence of metabolic syndrome and cognitive dysfunction is linked to reduced health-related quality of life.

Conclusion: The narrative synthesis highlights how metabolic and vascular factors jointly drive neurocognitive decline and underscores the need for longitudinal and mechanistic research

Common Misconceptions Regarding Diabetes Mellitus among Clients Attending Comprehensive Health Service Centers: A Qualitative Study

Ali Fakhri — 2026-06-28

Background: Diabetes is a prevalent chronic disease accompanied by numerous misconceptions among the general population. This qualitative study aimed to identify and categorize misconceptions about diabetes among individuals visiting healthcare centers.

Methods: The findings of this study are part of a research project to design a tool aimed at assessing awareness regarding diabetes. To identify misconceptions about diabetes, 12 semi-structured interviews were conducted with individuals of both genders. The data were analyzed using qualitative content analysis.

Results: Out of 420 identified codes, 64 were extracted as misconceptions about diabetes. These misconceptions were categorized into domains including general characteristics of diabetes, risk factors, symptoms, complications, prevention and management of diabetes, and other beliefs.

Conclusion: Findings revealed misunderstandings regarding diagnostic criteria, risk factors, unrealistic symptoms, and unscientific care practices. The results underscore the need for targeted educational programs to correct misconceptions and enhance public awareness.

A Comparative Study of Face-to-Face and Social Media-Based Education on Self-Efficacy and Health Literacy in Women with Gestational Diabetes

Marzieh Torshizi — 2026-06-28

Background: Gestational diabetes is one of the most common pregnancy-related disorders and is associated with adverseoutcomes for both mother and fetus. Enhancing health literacy and self-efficacy in these patients plays a key role in better diseasemanagement. This study aimed to compare the effects of face-to-face education and social media-based education on self-efficacy and health literacy among pregnant women with gestational diabetes.

Methods: This quasi-experimental study was conducted with the participation of 75 pregnant women diagnosed with gestationaldiabetes, who were randomly assigned to three groups: face-to-face education, virtual (social media-based) education, and control(25 participants in each group). The educational intervention lasted four weeks for the two intervention groups. Researchinstruments included self-efficacy and health literacy questionnaires, which were completed before and after the intervention.

Results: The mean scores of self-efficacy and health literacy significantly increased in both the face-to-face and social media-based education groups after the intervention (p < 0.05), whereas no significant change was observed in the control group. Posthoc analysis revealed that the mean changes in the intervention groups were significantly greater than those in the control group;however, no significant difference was found between the two intervention groups.

Conclusion: Both face-to-face and social media-based education are effective approaches to improving self-efficacy and healthliteracy in pregnant women with gestational diabetes. Given the widespread accessibility of technology, virtual education can beconsidered a complementary method to promote health indicators in this patient population.

Diabetic Nephropathy and the Risk of Cardiac Arrhythmia: Association between Macroalbuminuria and QTc Interval

Benyamin Fazayeli rad — 2026-06-28

Background: Diabetic nephropathy is a major complication of diabetes, linked to cardiovascular disorders. QTc intervalprolongation on electrocardiography increases the risk of cardiac arrhythmias and sudden death. This study evaluated therelationship between diabetic nephropathy severity and QTc prolongation.

Methods: In this prospective cohort study, 180 patients with type 1 or type 2 diabetes at teaching hospitals of Kerman Universityof Medical Sciences were enrolled. Based on albuminuria, patients were classified into microalbuminuria (30–300 mg/g) andmacroalbuminuria (>300 mg/g) groups. QTc was measured using a standard 12-lead electrocardiogram and corrected withBazett’s formula. Demographic, clinical, and laboratory data were analyzed with appropriate statistical tests.

Results: Among 180 patients, 14(7.8%) had microalbuminuria and 166(92.2%) had macroalbuminuria. Mean age was 59.65 ±10.59 years. QTc was significantly longer in the macroalbuminuria group compared with the microalbuminuria group (436.07 ±39.97 vs. 411.64 ± 23.63 ms, p= 0.002). Albumin excretion rate showed a weak positive correlation with QTc (r=0.182, p=0.016). Logistic regression revealed macroalbuminuria was associated with a 10.5- fold higher odds of abnormal QTc (95% CI:1.33–82.79, p=0.026).

Conclusion: Macroalbuminuria, indicating advanced diabetic nephropathy, is significantly associated with QTc prolongation.Regular electrocardiographic monitoring in diabetic patients with macroalbuminuria is recommended for early detection ofcardiac electrophysiological abnormalities and prevention of cardiovascular complications

Association between Dietary Acid Load and the Incidence of Metabolic Syndrome and Its Components: A Population-Based Study

Najmeh Seifi — 2026-06-28

Background: Dietary acid load is thought to contribute to the development of metabolic syndrome through effects on acid–base balance with evidence being inconsistent. This study aimed to examine the associations between dietary acid load indices, Dietary Acid Load (DAL), Potential Renal Acid Load (PRAL), and Net Endogenous Acid Production (NEAP) and risk of metabolic syndrome and its components in an Iranian adult cohort.
Methods: 6,482 adults aged 35-65 years were enrolled from the Mashhad Stroke and Atherosclerosis Study. Dietary intake was assessed using a validated food frequency questionnaire, and dietary acid load indices were calculated. Participants were followed for nearly 10 years. Logistic regression models were used to evaluate associations of DAL, PRAL, and NEAP with the incidence of metabolic syndrome, diabetes, hypertension, and dyslipidemia, adjusting for major confounders.
Results: Following adjustment, no significant associations were found between DAL indices and the incidence of metabolic syndrome or its components. DAL odds ratio (OR) for the highest versus lowest tertile was 0.984 [95% confidence interval (CI): 0.815–1.188; p= 0.868]. For PRAL, the OR was 1.024 (95% CI: 0.865–1.212; p= 0.782), and for NEAP, the OR was 0.902 (95% CI: 0.763–1.066; p= 0.227). None of the indices were significantly related to new cases of diabetes, hypertension, or dyslipidemia (all p> 0.05).
Conclusion: In this Iranian adult cohort, DAL indices were not associated with the risk of metabolic syndrome or its components. Further studies in populations with different dietary habits are needed to clarify potential threshold effects or effect modifiers.

Potential of Fumaria Officinalis Bioactive Compounds for α-Glucosidase Inhibition and Diabetes Prevention: Toxicity, Pharmacokinetic, and Molecular Docking Studies

Anita Rezaee — 2026-06-28

Background: Diabetes mellitus is recognized as a complex metabolic syndrome primarily characterized by elevated blood glucose levels (hyperglycemia). α-glucosidase, located in the microvilli of the small intestine, play a pivotal role in the hydrolysis of complex carbohydrates into absorbable monosaccharides. However, the use of common chemical inhibitors of this enzyme, such as metformin, is frequently associated with undesirable side effects. The present research aims to evaluate the inhibitory potential of compounds isolated from Fumaria officinalis on α-glucosidase activity, utilizing computational (in silico) approaches.
Methods: This study was designed and executed with a descriptive-analytical approach, based on computational methodologies. Initially, the 3D structures of key compounds identified from Fumaria officinalis were retrieved from the PubChem database. Simultaneously, the crystal structure of the α-glucosidase was downloaded from the Protein Data Bank (PDB). The toxicity profile of the compounds was predicted using Toxtree and Protox II tools, and drug-likeness properties, based on Lipinski’s rules, were assessed via the SwissADME server. Finally, molecular docking studies were conducted to investigate the interactions between the enzyme and the compounds of interest, employing AutoDock Tools 1.5.6 and Molegro Virtual Docker 6.0 software. Analysis of the molecular interactions resulting from docking was performed with Discovery Studio 3.5 software.
Results: The findings of this research indicate that all selected compounds from Fumaria officinalis, while adhering to Lipinski’s rules and showing no predicted toxicity, exhibited favorable binding energies, positioning them as potential candidates for α- glucosidase inhibition. Among the evaluated compounds, Fumaricine and Chlorogenic Acid demonstrated the lowest binding energies, -7.18 and -7.83 kcal/mol, respectively, thus exhibiting the highest inhibitory potential compared to other compounds. Notably, the binding energies of these two compounds were significantly more negative than that of the standard inhibitor, metformin, indicating their stronger binding affinity to the enzyme’s active site.
Conclusion: Based on the results obtained from this computational study, it can be inferred that Fumaricine and Chlorogenic Acid, as the most prominent compounds found in Fumaria officinalis, act as more effective inhibitors due to their ability to form stronger hydrogen and hydrophobic interactions with key amino acids in the α-glucosidase enzyme’s active site. Therefore, it is suggested that further in vitro and in vivo studies be conducted on these compounds to comprehensively validate their potential in the prevention and management of diabetes mellitus

Mindfulness and Intolerance of Uncertainty: Pathways to Diabetes Self-Care Management through Perceived Social Support

Farangis Demehri — 2026-06-28

Background: Type 2 Diabetes Mellitus (T2DM) Poses a Global Health Challenge, Requiring Effective Self-Care Management and Active Patient Engagement. Self-Care in Diabetes Management Is a Critical Determinant of Successful Outcomes. This Study Aimed to Predict Diabetes Management Self-Care Based on Intolerance of Uncertainty and Mindfulness, with Perceived Social Support as a Mediator, in Patients with T2DM.
Methods: This descriptive-correlational study utilized structural equation modeling (SEM). The statistical population consisted of patients referred to the Yazd Diabetes Association in the first half of 2024. A sample of 350 participants was selected using convenience sampling. Data were collected using the Intolerance of Uncertainty Scale (Carleton et al., 2007), the Mindful Attention Awareness Scale (Brown & Ryan, 2003), the Multidimensional Scale of Perceived Social Support (Zimet et al., 1988), and the Type 2 Diabetes Self-Care Questionnaire (Neamatizadeh et al., 2022). Data analysis was performed using SPSS-24 and AMOS software.
Results: The findings revealed that mindfulness had a significant direct (β= 0.343, p< 0.001) and indirect effect, mediated by perceived social support (β= 0.133, p< 0.001), on diabetes management Self-Care. Intolerance of uncertainty had a significant direct and negative effect on Self-Care (β= -0.191, p= 0.025); however, the mediating role of perceived social support in this relationship was not confirmed. The model fit indices (CFI= 0.97, RMSEA= 0.07) indicated a good fit of the proposed model.
Conclusion: The results suggest that mindfulness enhances Self-Care in diabetes management both directly and indirectly by boosting perceived social support. Conversely, intolerance of uncertainty acts as a direct barrier to Self-Care. Therefore, developing educational interventions focused on enhancing mindfulness and reducing intolerance of uncertainty could improve Self-Care management and lead to better glycemic control in patients with T2DM.