Journal of Exercise & Organ Cross Talk
Journal of Eexercise & Organ Cross Talk

Effect of combined mobile-based digital education and aerobic-resistance exercise intervention on treatment adherence, blood glucose control, and tissue markers (lipotoxicity, sarcopenia, necrosis) in type 2 diabetes patients

Articles in Press

Document Type : Original Article

Authors

Zahra Zarrin Juy Alvar 1
Romina Hosseinzadeh 2
Mehdi Tarajian 3
Seyyedeh Monireh Babaei Mohammadi 4

1 Bachelor’s Degree, Department of Nursing, Baqiyatallah University, Tehran, Iran.

2 Bachelor’s Degree, Department of Microbiology, East Tehran Branch, Islamic Azad University, Tehran, Iran

3 Department of Sport Sciences – Motor Behavior, Humanities and Social Sciences, Islamic Azad University, Science and Research Branch, Tehran, Iran

4 Department of Physical Education and Sport Sciences, Boroujerd Branch, Islamic Azad University, Boroujerd, Iran

10.22122/jeoct.2026.570158.1186
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.

What is already known on this subject?

Mobile health (mHealth) and digital education programs can improve diabetes self-management and glycemic control, but evidence from underserved populations is limited.

Combined aerobic and resistance exercise is known to enhance insulin sensitivity, glucose oxidation, and muscle mass, yet its integration with digital education has not been well studied.

Poor treatment adherence is a major barrier to achieving glycemic targets, affecting up to 61% of type 2 diabetes (T2DM) patients.

Lipotoxicity and sarcopenia are recognized as key tissue-level drivers of metabolic dysfunction, but few interventions have targeted these markers in a combined digital-exercise framework.

 

What this study adds?

This randomized controlled trial demonstrates that a combined mobile-based digital education (“DiabetiFit Pro”) and aerobic-resistance exercise intervention significantly improves treatment adherence (MMAS-8: +1.30 points, χ²=22.45, p<.001) and glycemic control (HbA1c: -1.70%, Cohen’s d=1.36, p<.001) compared to usual care in underserved Iranian T2DM patients.

It provides novel evidence of favorable changes in tissue-level biomarkers (lipotoxicity, sarcopenia, necrosis), linking behavioral engagement with biological improvements.

Dose-response analyses show that active engagement (completed modules, app usage hours) explains 11.5% of HbA1c variance (β=-0.34) and 16.8% of adherence variance (β=0.41), confirming exposure-outcome gradients.

The study fills a critical gap by focusing on resource-limited settings with restricted healthcare access, offering a scalable, integrated mHealth-exercise model that meets ADA 2025 clinical standards.

Keywords

Type 2 diabetes
mHealth
Aerobic-resistance exercise
Treatment adherence
HbA1c
Sarcopenia
Underserved populations
Subjects

Acknowledgements

None.

Funding

None.

Data availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Compliance with ethical standards

Conflict of interest The authors declare that there is no conflict of interest in the present research.

Ethical approval 

 

Informed consent Performed.

Author contributions

Conceptualization: Z.ZJA., Methodology: R.H., Software: M.T., Validation: SM.BM.,; Formal analysis: Z. ZJA.,; Investigation: R.H.,; Resources: M.T.,; Data curation: M.T.,; Writing - original draft: SM.BM.,; Writing–review & editing M.T.,; Visualization: R.H.,; Supervision: M.T.; Project administration: M.T.,.; Funding acquisition: M.T.   

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Journal of Exercise & Organ Cross Talk

Articles in Press, Accepted Manuscript
Available Online from 01 June 2026

  • Receive Date 01 December 2025
  • Revise Date 20 February 2026
  • Accept Date 25 February 2026

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