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Meta-Analysis
. 2020 Aug 4:11:495.
doi: 10.3389/fendo.2020.00495. eCollection 2020.

Acute and Chronic Effects of Exercise on Continuous Glucose Monitoring Outcomes in Type 2 Diabetes: A Meta-Analysis

Matthew Munan  1   2 , Camila L P Oliveira  2   3 , Alexis Marcotte-Chénard  4   5 , Jordan L Rees  1   2 , Carla M Prado  2   3 , Eléonor Riesco  4   5 , Normand G Boulé  1   2
Affiliations
Meta-Analysis

Acute and Chronic Effects of Exercise on Continuous Glucose Monitoring Outcomes in Type 2 Diabetes: A Meta-Analysis

Matthew Munan et al. Front Endocrinol (Lausanne). .

Abstract

Objective: To examine the acute and chronic effects of structured exercise on glucose outcomes assessed by continuous glucose monitors in adults with type 2 diabetes. Methods: PubMed, Medline, EMBASE were searched up to January 2020 to identify studies prescribing structured exercise interventions with continuous glucose monitoring outcomes in adults with type 2 diabetes. Randomized controlled trials, crossover trials, and studies with pre- and post-designs were eligible. Short-term studies were defined as having exercise interventions lasting ≤2 weeks. Longer-term studies were defined as >2 weeks. Results: A total of 28 studies were included. Of these, 23 studies were short-term exercise interventions. For all short-term studies, the same participants completed a control condition as well as at least one exercise condition. Compared to the control condition, exercise decreased the primary outcome of mean 24-h glucose concentrations in short-term studies (-0.5 mmol/L, [-0.7, -0.3]; p < 0.001). In longer-term studies, mean 24-h glucose was not significantly reduced compared to control (-0.9 mmol/L [-2.2, 0.3], p = 0.14) but was reduced compared to pre-exercise values (-0.5 mmol/L, [-0.7 to -0.2] p < 0.001). The amount of time spent in hyperglycemia and indices of glycemic variability, but not fasting glucose, also improved following short-term exercise. Among the shorter-term studies, subgroup, and regression analyses suggested that the timing of exercise and sex of participants explained some of the heterogeneity among trials. Conclusion: Both acute and chronic exercise can improve 24-h glucose profiles in adults with type 2 diabetes. The timing of exercise and sex of participants are among the factors that may explain part of the heterogeneity in acute glycemic improvements following exercise.

Keywords: continuous glucose monitoring; exercise; meta-analysis; systematic review; type 2 diabetes.

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Figures

Figure 1
Figure 1
PRISMA study flow diagram.
Figure 2
Figure 2
Mean 24-h glucose concentrations in short-term (≤2 weeks) studies. CI, confidence interval; SE, standard error; 1RM, one repetition maximum; HIIT, high-intensity interval training; REHIT, reduced exertion high intensity interval training.
Figure 3
Figure 3
Meta-regression to predict changes in mean 24-h glucose concentrations following exercise according to: (A) mean 24-h glucose concentrations in the control condition, and (B) percentage of females. The correlation coefficients were changed to r = −0.53 (p < 0.001) and r = 0.39 (p = 0.016), respectively, after removing the potential outlier with the largest decrease in mean 24-h glucose.
Figure 4
Figure 4
Mean 24-h glucose concentrations in longer-term (>2 weeks) studies. (A) Exercise vs. control pre-intervention, (B) exercise vs. control post-intervention. CI, confidence interval; SE, standard error; 1RM, one repetition maximum; HIIT, high-intensity interval training.
Figure 5
Figure 5
Mean 24-h glucose concentrations in longer-term (>2 weeks) studies pre- vs. post-exercise. CI, confidence interval; SE, standard error; 1RM, one repetition maximum; HIIT, high-intensity interval training; REHIT, reduced exertion high intensity interval training.
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