Erickson Melissa L, Little Jonathan P, Gay Jennifer L, McCully Kevin K, Jenkins Nathan T
Department of Kinesiology, University of Georgia, Athens, Georgia;
School of Health and Exercise Science, University of British Columbia Okanagan, Kelowna, British Columbia, Canada; and.
J Appl Physiol (1985). 2017 Aug 1;123(2):444-450. doi: 10.1152/japplphysiol.00213.2017. Epub 2017 May 18.
Metformin is used clinically to reduce fasting glucose with minimal effects on postprandial glucose. Postmeal exercise reduces postprandial glucose and may offer additional glucose-lowering benefit beyond that of metformin alone, yet controversy exists surrounding exercise and metformin interactions. It is currently unknown how postmeal exercise and metformin monotherapy in combination will affect postprandial glucose. Thus, we examined the independent and combined effects of postmeal exercise and metformin monotherapy on postprandial glucose. A randomized crossover design was used to assess the influence of postmeal exercise on postprandial glucose excursions in 10 people treated with metformin monotherapy (57 ± 10 yr, HbA = 6.3 ± 0.6%). Each participant completed the following four conditions: sedentary and postmeal exercise (5 × 10-min bouts of treadmill walking at 60% V̇o) with metformin and sedentary and postmeal exercise without metformin. Peak postprandial glucose within a 2-h time window and 2-h total area under the curve was assessed after a standardized breakfast meal, using continuous glucose monitoring. Postmeal exercise significantly blunted 2-h peak ( = 0.001) and 2-h area under the curve ( = 0.006), with the lowest peak postprandial glucose excursion observed with postmeal exercise and metformin combined ( < 0.05 vs. all other conditions: metformin/sedentary: 12 ± 3.4, metformin/exercise: 9.7 ± 2.3, washout/sedentary: 13.3 ± 3.2, washout/exercise: 11.1 ± 3.4 mmol/l). Postmeal exercise and metformin in combination resulted in the lowest peak postprandial glucose excursion compared with either treatment modality alone. Exercise timed to the postprandial phase may be important for optimizing glucose control during metformin monotherapy. The interactive effects of metformin and exercise on key physiological outcomes remain an area of controversy. Findings from this study show that the combination of metformin monotherapy and moderate-intensity postmeal exercise led to beneficial reductions in postprandial glucose excursions. Postmeal exercise may be a useful strategy for the management of postprandial glucose in people on metformin.
二甲双胍在临床上用于降低空腹血糖，对餐后血糖影响极小。餐后运动可降低餐后血糖，且可能提供超出二甲双胍单独作用的额外降糖益处，但关于运动与二甲双胍相互作用仍存在争议。目前尚不清楚餐后运动与二甲双胍单药联合使用会如何影响餐后血糖。因此，我们研究了餐后运动和二甲双胍单药治疗对餐后血糖的独立及联合作用。采用随机交叉设计评估餐后运动对10例接受二甲双胍单药治疗患者（57±10岁，糖化血红蛋白=6.3±0.6%）餐后血糖波动的影响。每位参与者完成以下四种情况：服用二甲双胍时的静息状态和餐后运动（在60%最大摄氧量下进行5次10分钟的跑步机行走）以及未服用二甲双胍时的静息状态和餐后运动。在标准化早餐后，使用连续血糖监测评估2小时时间窗内的餐后血糖峰值和曲线下2小时总面积。餐后运动显著降低了2小时峰值（P=0.001）和曲线下2小时面积（P=0.006），餐后运动与二甲双胍联合使用时观察到的餐后血糖峰值最低（与所有其他情况相比P<0.05：二甲双胍/静息：12±3.4，二甲双胍/运动：9.7±2.3，洗脱期/静息：13.3±3.2，洗脱期/运动：11.1±3.4 mmol/L）。与单独使用任何一种治疗方式相比，餐后运动与二甲双胍联合使用导致餐后血糖峰值最低。与餐后阶段同步的运动对于在二甲双胍单药治疗期间优化血糖控制可能很重要。二甲双胍和运动对关键生理结果的交互作用仍是一个有争议的领域。本研究结果表明，二甲双胍单药治疗与中等强度餐后运动相结合可使餐后血糖波动得到有益降低。餐后运动可能是二甲双胍治疗患者餐后血糖管理的一种有用策略。
