Vesnu Publications (Farzanegan Radandish) Journal of Exercise & Organ Cross Talk 2783-2074 6 2 2026 06 01 Effect of combined mobile-based digital education and aerobic-resistance exercise intervention on treatment adherence, blood glucose control, and tissue markers in type 2 diabetes patients 90 98 241747 10.22122/jeoct.2026.570158.1186 EN Zahra Zarrin Juy Alvar Bachelor’s Degree, Department of Nursing, Baqiyatallah University, Tehran, Iran. Romina Hosseinzadeh Bachelor’s Degree, Department of Microbiology, East Tehran Branch, Islamic Azad University, Tehran, Iran Mehdi Tarajian Department of Sport Sciences – Motor Behavior, Humanities and Social Sciences, Islamic Azad University, Science and Research Branch, Tehran, Iran 0000-0001-5776-8625 Seyyedeh Monireh Babaei Mohammadi Department of Physical Education and Sport Sciences, Boroujerd Branch, Islamic Azad University, Boroujerd, Iran 0009-0007-9911-9165 Journal Article 2025 12 01 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. https://www.jeoct.com/article_241747_b510cb4921d9b6551f5b001a0f142638.pdf