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

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.