Exercise improves metformin 72-h glucose control by reducing the frequency of hyperglycemic peaks.

Publisher: Springer Verlag Country of Publication: Germany NLM ID: 9200299 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1432-5233 (Electronic) Linking ISSN: 09405429 NLM ISO Abbreviation: Acta Diabetol Subsets: MEDLINE

Publication: Berlin : Springer Verlag
Original Publication: Berlin : Springer International, c1991-

Blood Glucose/*drug effects ; Diabetes Mellitus, Type 2/*therapy ; Exercise/*physiology ; Glucose Intolerance/*therapy ; Hyperglycemia/*prevention & control ; Metformin/*pharmacology ; Overweight/*therapy; Blood Glucose/metabolism ; Blood Glucose Self-Monitoring ; Combined Modality Therapy ; Diabetes Mellitus, Type 2/blood ; Diabetes Mellitus, Type 2/drug therapy ; Exercise Therapy/methods ; Extracellular Fluid/chemistry ; Extracellular Fluid/drug effects ; Extracellular Fluid/metabolism ; Female ; Glucose/analysis ; Glucose/metabolism ; Glucose Intolerance/blood ; Glucose Intolerance/drug therapy ; Glucose Tolerance Test ; High-Intensity Interval Training ; Humans ; Hyperglycemia/blood ; Insulin Resistance/physiology ; Male ; Metformin/therapeutic use ; Middle Aged ; Overweight/blood ; Overweight/complications ; Overweight/drug therapy ; Prediabetic State/blood ; Prediabetic State/drug therapy ; Prediabetic State/therapy

Purpose: To determine the separated and combined effects of metformin and exercise on insulin sensitivity and free-living glycemic control in overweight individuals with prediabetes/type 2 diabetes (T2DM).
Methods: We recruited 16 adults with BMI of 32.7 ± 4.3 kg m ^-2 and insulin resistance (HOMA-IR 3.2 ± 0.4) under chronic metformin treatment (1234 ± 465 g day ^-1 ) enrolled in a high-intensity interval training (HIIT) program. Participants underwent four 72-h experimental trials in a random-counterbalanced order: (1) maintaining their habitual metformin treatment (MET); (2) replacing metformin treatment by placebo (CON); (3) placebo plus two HIIT sessions (EX + CON), and (4) metformin plus two HIIT sessions (MET + EX). We used intermittently scanned continuous glucose monitoring (isCGM) during 72 h in every trial to obtain interstitial fluid glucose area under the curve (IFG AUC ) and the percentage of measurements over 180 mg dL ^-1 (% IFG PEAKS ). Insulin sensitivity was assessed on the last day of each trial with HOMA-IR index and calculated insulin sensitivity (C SI ) from intravenous glucose tolerance test.
Results: IFG AUC was lower in MET + EX and MET than in CON (P = 0.011 and P = 0.025, respectively). In addition, IFG AUC was lower in MET + EX than in EX + CON (P = 0.044). %IFG PEAKS were only lower in MET + EX in relation to CON (P = 0.028). HOMA-IR and C SI were higher in CON in comparison with MET + EX (P = 0.011 and P = 0.022, respectively) and MET (P = 0.006 and P < 0.001, respectively). IFG AUC showed a significant correlation with HOMA-IR.
Conclusion: Intense aerobic exercise in patients with diabetes and prediabetes under metformin treatment reduces free-living 72-h blood hyperglycemic peaks. This may help to prevent the development of cardiovascular complications associated with diabetes.

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DEP-2017-83244-R Ministerio de Economía, Industria y Competitividad, Gobierno de España

Keywords: Continuous glucose monitoring; Exercise; Hyperglycemia; Insulin sensitivity; Metformin; Type 2 diabetes mellitus

0 (Blood Glucose)
9100L32L2N (Metformin)
IY9XDZ35W2 (Glucose)

Date Created: 20200206 Date Completed: 20200820 Latest Revision: 20220601

20240513

10.1007/s00592-020-01488-7

32020414