Journal of Exercise & Organ Cross Talk

Abstract This randomized controlled trial evaluated the effects of combined mobile-based digital education ("DiabetiFit Pro") and aerobic-resistance exercise on treatment adherence, glycemic control, and tissue markers (lipotoxicity, sarcopenia, and necrosis) among underserved type 2 diabetes patients. In this 12-week RCT, 250 patients (mean age 54.3±10.7 years; HbA1c 9.2%) from underserved Iranian regions were randomized to intervention (n=125; 3 weekly sessions: 10-min app-based education +35-50 min ACSM-guided exercise) or control (n=125; usual care). Primary outcomes were HbA1c and MMAS-8 adherence scores. Secondary outcomes included glycemic variability and tissue biomarkers. Analysis used ITT with ANCOVA, regression, and χ² (α=0.05). Intervention produced superior HbA1c reduction (-1.70% vs -0.70% control; between-group diff: -1.00%, η²=0.18, p<.001) and adherence gains (+1.30 vs +0.40 points; η²=0.16, p<.001). High adherence increased from 23.2% to 48.8% (χ²=22.45, p<.001). Dose-response: modules completed explained 11.5% HbA1c variance (β=-0.34); app hours predicted 16.8% adherence variance (β=0.41). Favorable lipotoxicity/ sarcopenia improvements observed. Combined digital education-exercise interventions significantly enhance adherence, glycemic control, and tissue health in underserved T2DM populations, demonstrating dose-response efficacy and clinical meaningfulness per ADA standards. Health systems should scale such integrated mHealth platforms.