Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK.
The Rowett Institute, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK.
J Physiol. 2024 Dec;602(23):6491-6506. doi: 10.1113/JP285722. Epub 2024 Mar 24.
Exercise is recommended in the treatment of type 2 diabetes and can improve insulin sensitivity. However, previous evidence suggests that exercise at different times of the day in people with type 2 diabetes may have opposing outcomes on glycaemia. Metformin is the most commonly prescribed initial pharmacological intervention in type 2 diabetes, and may alter adaptions to exercise. It is unknown if there is an interaction between metformin and diurnal exercise outcomes. We aimed to investigate glycaemic outcomes of moderate intensity morning vs. evening exercise in people with type 2 diabetes being prescribed metformin monotherapy. In this study, nine males and nine females with type 2 diabetes undergoing metformin monotherapy (age 61 ± 8.2 years, mean ± SD) completed a 16-week crossover trial including 2-week baseline recording, 6 weeks randomly assigned to a morning exercise (07.00-10.00 h) or evening exercise (16.00-19.00 h) and a 2-week wash-out period. Exercise arms consisted of 30 min of walking at 70% of estimated max heart rate every other day. Glucose levels were measured with continuous glucose monitors and activity measured by wrist-worn monitors. Food-intake was recorded by 4-day food diaries during baseline, first and last 2 weeks of each exercise arm. There was no difference in exercise intensity, total caloric intake or total physical activity between morning and evening arms. As primary outcomes, acute (24 h) glucose area under the curve (AUC), was lower (P = 0.02) after acute morning exercise (180.6 ± 68.4 mmol/l) compared to baseline (210.3 ± 76.7 mmol/l); and there were no differences identified for glucose (mmol/l) between baseline, morning and evening exercise at any specific time point when data were analysed with two-way ANOVA. As secondary outcomes, acute glucose AUC was significantly lower (P = 0.01) in participants taking metformin before breakfast (152.5 ± 29.95 mmol/l) compared with participants taking metformin after breakfast (227.2 ± 61.51 mmol/l) only during the morning exercise arm; and during weeks 5-6 of the exercise protocol, glucose AUC was significantly lower (P = 0.04) for participants taking metformin before breakfast (168.8 ± 15.8 mmol/l), rather than after breakfast (224.5 ± 52.0 mmol/l), only during morning exercise. Our data reveal morning moderate exercise acutely lowers glucose levels in people with type 2 diabetes being prescribed metformin. This difference appears to be driven by individuals that consumed metformin prior to breakfast rather than after breakfast. This beneficial effect upon glucose levels of combined morning exercise and pre-breakfast metformin persisted through the final 2 weeks of the trial. Our findings suggest that morning moderate intensity exercise combined with pre-breakfast metformin intake may benefit the management of glycaemia in people with type 2 diabetes. KEY POINTS: Morning moderate exercise acutely lowers glucose levels in people with type 2 diabetes being prescribed metformin. This difference appears to be driven by individuals that consumed metformin prior to breakfast rather than after breakfast. Morning exercise combined with pre-breakfast metformin persistently reduced glucose compared to morning exercise combined with post-breakfast metformin through the final week (week 6) of the intervention. Our study suggests it may be possible to make simple changes to the time that people with type 2 diabetes take metformin and perform exercise to improve their blood glucose.
运动被推荐用于 2 型糖尿病的治疗,可以改善胰岛素敏感性。然而,先前的证据表明,2 型糖尿病患者在一天中的不同时间进行运动可能会对血糖产生相反的结果。二甲双胍是 2 型糖尿病最常用的初始药物干预措施,可能会改变对运动的适应。目前尚不清楚二甲双胍和昼夜运动结果之间是否存在相互作用。我们旨在研究在接受二甲双胍单药治疗的 2 型糖尿病患者中,进行适度强度的晨练与晚练对血糖的影响。在这项研究中,9 名男性和 9 名女性 2 型糖尿病患者接受二甲双胍单药治疗(年龄 61±8.2 岁,平均值±标准差),完成了一项为期 16 周的交叉试验,包括 2 周基线记录期、6 周随机分配到晨练(07.00-10.00h)或晚练(16.00-19.00h)和 2 周洗脱期。运动组每天每两天进行 30 分钟的步行,速度为估计最大心率的 70%。使用连续血糖监测仪测量血糖水平,使用腕戴式监测器测量活动量。在基线、第 1 周和第 2 周的最后 2 天,通过 4 天的食物日记记录食物摄入量。晨练和晚练组之间的运动强度、总热量摄入或总体力活动没有差异。作为主要结果,急性(24 小时)血糖曲线下面积(AUC)在急性晨练后(180.6±68.4mmol/l)较基线(210.3±76.7mmol/l)降低(P=0.02);并且当使用双向方差分析分析特定时间点的血糖(mmol/l)数据时,在晨练和晚练时,在任何特定时间点都没有发现差异。作为次要结果,在早餐前服用二甲双胍的参与者(152.5±29.95mmol/l)与早餐后服用二甲双胍的参与者(227.2±61.51mmol/l)相比,急性血糖 AUC 显著降低(P=0.01)仅在晨练期间;并且在运动方案的第 5-6 周,在早餐前服用二甲双胍的参与者(168.8±15.8mmol/l)的血糖 AUC 显著降低(P=0.04),而不是早餐后服用二甲双胍的参与者(224.5±52.0mmol/l),仅在晨练期间。我们的数据显示,在接受二甲双胍治疗的 2 型糖尿病患者中,早晨适度运动可急性降低血糖水平。这种差异似乎是由早餐前服用二甲双胍的个体而不是早餐后服用二甲双胍的个体驱动的。这种在早晨运动和早餐前服用二甲双胍联合作用下对血糖水平的有益影响持续到试验的最后 2 周。我们的研究结果表明,在 2 型糖尿病患者中,早晨适度强度运动与早餐前服用二甲双胍联合治疗可能有助于控制血糖。主要观点:在接受二甲双胍治疗的 2 型糖尿病患者中,早晨适度运动可急性降低血糖水平。这种差异似乎是由早餐前服用二甲双胍的个体而不是早餐后服用二甲双胍的个体驱动的。与早餐后服用二甲双胍联合晨练相比,通过最后一周(第 6 周)的干预,联合晨练和早餐前服用二甲双胍持续降低血糖。我们的研究表明,可能可以通过改变 2 型糖尿病患者服用二甲双胍和进行运动的时间来改善他们的血糖。
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