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Endocrine

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23.07.2021 | Original Article

The relationship between the level of exercise and hemoglobin A₁c in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

verfasst von: Yutaka Igarashi, Nobuhiko Akazawa, Seiji Maeda

Erschienen in: Endocrine | Ausgabe 3/2021

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Abstract

Purpose

The aim of the study was to evaluate the relationship between changes in hemoglobin A₁c (HbA_1c) and exercise levels in type 2 diabetes mellitus (T2DM) patients when performing various types of exercise.

Methods

The inclusion criteria were randomized controlled trials involving adults with T2DM, intervention involving exercise alone, the overall duration of intervention ≥12 weeks, and reporting HbA_1c. Weighted mean difference (WMD) was defined as the mean difference between the intervention group and the control group weighted by the inverse of the squared standard error for each study, and all WMDs were pooled as overall effects. A meta-regression analysis was performed to evaluate the relationship between the exercise level and the WMD in HbA_1c.

Results

Forty-eight studies (2395 subjects) were analyzed. The pooled WMD in HbA_1c decreased significantly (−0.5% [95% confidence intervals: −0.6 to −0.4]) but contained significant heterogeneity (Q = 103.8, P < 0.01; I² = 36.6%). A meta-regression analysis showed that the intensity (metabolic equivalents [METs]), time (min/session), or frequency (sessions/week) of the exercise was not associated with the HbA_1c. However, the overall duration of exercise (weeks) was significantly associated with the WMD in HbA_1c (meta-regression coefficient: 0.01 [95% confidence intervals: 0.002−0.016]; R² = 70.0%), and that result did not contain significant heterogeneity (P > 0.05; I² = 14.7%).

Conclusions

The exercise intervention decreases HbA_1c in T2DM patients. In addition, exercise for an extended duration was associated with an increase in HbA_1c, so the effects of exercise may be evident early on, but results suggested that exercise for a prolonged period alone may increase HbA_1c.

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International Diabetes Federation: IDF Diabetes Atlas 9th (eds.). https://www.diabetesatlas.org (2019). Accessed: 15 June 2021

M. Fujishima, Y. Kiyohara, I. Kato, et al., Diabetes and cardiovascular disease in a prospective population survey in Japan: The Hisayama Study. Diabetes 45, S14–S16 (1996). https://doi.org/10.2337/diab.45.3.s14CrossRefPubMed

I.M. Stratton, A.I. Adler, H.A. Neil, et al., Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321, 405–412 (2000). https://doi.org/10.1136/bmj.321.7258.405CrossRefPubMedPubMedCentral

A.K. Wright, E. Kontopantelis, R. Emsley, et al., Cardiovascular risk and risk factor management in type 2 diabetes mellitus. Circulation 139, 2742–2753 (2019). https://doi.org/10.1161/CIRCULATIONAHA.118.039100CrossRefPubMed

C.J. Currie, J.R. Peters, A. Tynan, et al., Survival as a function of HbA(1c) in people with type 2 diabetes: a retrospective cohort study. Lancet 375, 481–489 (2010). https://doi.org/10.1016/S0140-6736(09)61969-3CrossRefPubMed

J.I. Chiang, P. Hanlon, T.C. Li, et al., Multimorbidity, mortality, and HbA1c in type 2 diabetes: a cohort study with UK and Taiwanese cohorts. PLoS Med. 17, e1003094 (2020). https://doi.org/10.1371/journal.pmed.1003094CrossRefPubMedPubMedCentral

E. Selvin, S. Marinopoulos, G. Berkenblit, et al., Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann. Intern. Med. 141, 421–431 (2004). https://doi.org/10.7326/0003-4819-141-6-200409210-00007CrossRefPubMed

Z. Shan, Y. Li, G. Zong, et al., Rotating night shift work and adherence to unhealthy lifestyle in predicting risk of type 2 diabetes: results from two large US cohorts of female nurses. BMJ 363, k4641 (2018). https://doi.org/10.1136/bmj.k4641CrossRefPubMedPubMedCentral

T. Honda, H. Kishimoto, N. Mukai, et al., Objectively measured sedentary time and diabetes mellitus in a general Japanese population: The Hisayama Study. J. Diabetes Investig. 10, 809–816 (2019). https://doi.org/10.1111/jdi.12968CrossRefPubMed

10.

E.G. Wilmot, C.L. Edwardson, F.A. Achana, et al., Sedentary time in adults and the association with diabetes, cardiovascular disease and death: systematic review and meta-analysis. Diabetologia 55, 2895–2905 (2012). https://doi.org/10.1007/s00125-012-2677-zCrossRefPubMed

11.

B.E. Ainsworth, W.L. Haskell, M.C. Whitt, et al., Compendium of physical activities: an update of activity codes and MET intensities. Med. Sci. Sports Exerc. 32, S498–S504 (2000). https://doi.org/10.1097/00005768-200009001-00009CrossRefPubMed

12.

American Diabetes Association: Standards of Medical Care in Diabetes-2019, Abridged for primary care providers. Clin. Diabetes 37, 11–34 (2019). https://doi.org/10.2337/cd18-0105CrossRef

13.

H. Sone, S. Tanaka, S. Tanaka, et al., Leisure-time physical activity is a significant predictor of stroke and total mortality in Japanese patients with type 2 diabetes: analysis from the Japan Diabetes Complications Study (JDCS). Diabetologia 56, 1021–1030 (2013). https://doi.org/10.1007/s00125-012-2810-zCrossRefPubMed

14.

K. Okada, T. Hayashi, K. Tsumura, C. Suematsu, G. Endo, S. Fujii, Leisure-time physical activity at weekends and the risk of type 2 diabetes mellitus in Japanese men: the Osaka Health Survey. Diabet. Med. 17, 53–58 (2000). https://doi.org/10.1046/j.1464-5491.2000.00229.xCrossRefPubMed

15.

J.E. Manson, E.B. Rimm, M.J. Stampfer, et al., Physical activity and incidence of non-insulin-dependent diabetes mellitus in women. Lancet 338, 774–778 (1991). https://doi.org/10.1016/0140-6736(91)90664-bCrossRefPubMed

16.

J.E. Manson, D.M. Nathan, A.S. Krolewski, M.J. Stampfer, W.C. Willett, C.H. Hennekens, A prospective study of exercise and incidence of diabetes among US male physicians. JAMA 268, 63–67 (1992). https://doi.org/10.1001/jama.1992.03490010065031CrossRefPubMed

17.

P. Huai, H. Han, K.H. Reilly, X. Guo, J. Zhang, A. Xu, Leisure-time physical activity and risk of type 2 diabetes: a meta-analysis of prospective cohort studies. Endocrine 52, 226–230 (2016). https://doi.org/10.1007/s12020-015-0769-5CrossRefPubMed

18.

Y. Zhang, X.F. Pan, J. Chen, et al., Combined lifestyle factors and risk of incident type 2 diabetes and prognosis among individuals with type 2 diabetes: a systematic review and meta-analysis of prospective cohort studies. Diabetologia 63, 21–33 (2020). https://doi.org/10.1007/s00125-019-04985-9CrossRefPubMed

19.

R.S. Delevatti, C.G. Bracht, S.D.C. Lisboa, et al., The role of aerobic training variables progression on glycemic control of patients with type 2 diabetes: a systematic review with meta-analysis. Sports Med. Open 5, 22 (2019). https://doi.org/10.1186/s40798-019-0194-zCrossRefPubMedPubMedCentral

20.

S. Qiu, X. Cai, U. Schumann, M. Velders, Z. Sun, J.M. Steinacker, Impact of walking on glycemic control and other cardiovascular risk factors in type 2 diabetes: a meta-analysis. PLoS One 9, e109767 (2014). https://doi.org/10.1371/journal.pone.0109767CrossRefPubMedPubMedCentral

21.

S. Qiu, X. Cai, X. Chen, B. Yang, Z. Sun, Step counter use in type 2 diabetes: a meta-analysis of randomized controlled trials. BMC Med. 12, 36 2014). https://doi.org/10.1186/1741-7015-12-36CrossRefPubMedPubMedCentral

22.

Y. Liu, W. Ye, Q. Chen, Y. Zhang, C.H. Kuo, M. Korivi, Resistance exercise intensity is correlated with attenuation of HbA1c and insulin in patients with type 2 diabetes: a systematic review and meta-analysis. Int. J. Environ. Res. Public Health 16, 140 (2019). https://doi.org/10.3390/ijerph16010140CrossRefPubMedCentral

23.

P. Acosta-Manzano, M. Rodriguez-Ayllon, F.M. Acosta, D. Niederseer, J. Niebauer, Beyond general resistance training. Hypertrophy versus muscular endurance training as therapeutic interventions in adults with type 2 diabetes mellitus: a systematic review and meta-analysis. Obes. Rev. 21, e13007 (2020). https://doi.org/10.1111/obr.13007CrossRefPubMed

24.

J.X. Liu, L. Zhu, P.J. Li, N. Li, Y.B. Xu, Effectiveness of high-intensity interval training on glycemic control and cardiorespiratory fitness in patients with type 2 diabetes: a systematic review and meta-analysis. Aging Clin. Exp. Res. 31, 575–593 (2019). https://doi.org/10.1007/s40520-018-1012-zCrossRefPubMed

25.

D. Umpierre, P.A. Ribeiro, B.D. Schaan, J.P. Ribeiro, Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia 56, 242–251 (2013). https://doi.org/10.1007/s00125-012-2774-zCrossRefPubMed

26.

D. Umpierre, P.A. Ribeiro, C.K. Kramer, et al., Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA 305, 1790–1799 (2011). https://doi.org/10.1001/jama.2011.576CrossRefPubMed

27.

M. Chao, C. Wang, X. Dong, M. Ding, The effects of tai chi on type 2 diabetes mellitus: a meta-analysis. J. Diabetes Res. 2018, 7350567 (2018). https://doi.org/10.1155/2018/7350567CrossRefPubMedPubMedCentral

28.

R. Ramamoorthi, D. Gahreman, T. Skinner, S. Moss, The effect of yoga practice on glycemic control and other health parameters in the prediabetic state: a systematic review and meta-analysis. PLoS One 14, e0221067 (2019). https://doi.org/10.1371/journal.pone.0221067CrossRefPubMedPubMedCentral

29.

T. Xia, Y. Yang, W. Li, et al., Meditative movements for patients with type 2 diabetes: a systematic review and meta-analysis. Evid. Based Complement. Alternat. Med. 2020, 5745013 (2020). https://doi.org/10.1155/2020/5745013CrossRefPubMedPubMedCentral

30.

L.W. Pai, T.C. Li, Y.J. Hwu, S.C. Chang, L.L. Chen, P.Y. Chang, The effectiveness of regular leisure-time physical activities on long-term glycemic control in people with type 2 diabetes: A systematic review and meta-analysis. Diabetes Res. Clin. Pract. 113, 77–85 (2016). https://doi.org/10.1016/j.diabres.2016.01.011CrossRefPubMed

31.

J.L. Rees, S.T. Johnson, N.G. Boulé, Aquatic exercise for adults with type 2 diabetes: a meta-analysis. Acta. Diabetol. 54, 895–904 (2017). https://doi.org/10.1007/s00592-017-1023-9CrossRefPubMed

32.

L. Shamseer, D. Moher, M. Clarke, et al., Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation. BMJ 350, g7647 (2015). https://doi.org/10.1136/bmj.g7647CrossRefPubMed

33.

PROSPERO: International Prospective Register of Systematic Reviews (Centre for reviews and dissemination, University of York, 2011), https://www.crd.york.ac.uk/prospero. Accessed: 15 June 2021.

34.

American Diabetes Association, 6. Glycemic targets: standards of medical care in diabetes-2020. Diabetes Care 43, S66–S76 (2020). https://doi.org/10.2337/dc20-S006CrossRef

35.

Cochrane Skin Group: Data collection forms for intervention reviews: RCTs only, version 3. https://skin.cochrane.org/resources (2014). Accessed: 15 June 2021

36.

L. Vanhees, N. Geladas, D. Hansen, et al., Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors: recommendations from the EACPR. Part II. Eur. J. Prev. Cardiol. 19, 1005–1033 (2012). https://doi.org/10.1177/1741826711430926CrossRefPubMed

37.

J.A.C. Sterne, J. Savović, M.J. Page, et al., RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366, l4898 (2019). https://doi.org/10.1136/bmj.l4898CrossRefPubMed

38.

Y. Igarashi, Y. Nogami, Running to lower resting blood pressure: a systematic review and meta-analysis. Sports Med. 50, 531–541 (2020). https://doi.org/10.1007/s40279-019-01209-3CrossRefPubMed

39.

R.M. Harbord, J.P.T. Higgins, Meta-regression in Stata. Stata J. 8, 493–519 (2008). https://doi.org/10.1177/1536867X0800800403CrossRef

40.

R.J. Hardy, S.G. Thompson, A likelihood approach to meta-analysis with random effects. Stat. Med. 15, 619–629 (1996). https://doi.org/10.1002/(SICI)1097-0258(19960330)15:63.0.CO;2-ACrossRefPubMed

41.

D. Langan, J.P.T. Higgins, D. Jackson, et al., A comparison of heterogeneity variance estimators in simulated random-effects meta-analyses. Res. Synth. Methods 10, 83–98 (2019). https://doi.org/10.1002/jrsm.1316CrossRefPubMed

42.

A.M. Aloe, B.J. Becker, T.D. Pigott, An alternative to R(2) for assessing linear models of effect size. Res. Synth. Methods 1, 272–283 (2010). https://doi.org/10.1002/jrsm.23CrossRefPubMed

43.

J.P. Higgins, S.G. Thompson, J.J. Deeks, D.G. Altman, Measuring inconsistency in meta-analyses. BMJ 327, 557–560 (2003). https://doi.org/10.1136/bmj.327.7414.557CrossRefPubMedPubMedCentral

44.

M. Egger, S.G. Davey, M. Schneider, C. Minder, Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629–634 (1997). https://doi.org/10.1136/bmj.315.7109.629CrossRefPubMedPubMedCentral

45.

S. Duval, R. Tweedie, Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 56, 455–463 (2000). https://doi.org/10.1111/j.0006-341x.2000.00455.xCrossRefPubMed

46.

G.H. Guyatt, A.D. Oxman, R. Kunz, et al., What is “quality of evidence” and why is it important to clinicians?. BMJ 336, 995–998 (2008). https://doi.org/10.1136/bmj.39490.551019.BECrossRefPubMedPubMedCentral

47.

G. Jabardo-Camprubí, R. Donat-Roca, M. Sitjà-Rabert, R. Milà-Villarroel, J. Bort-Roig, Drop-out ratio between moderate to high-intensity physical exercise treatment by patients with, or at risk of, type 2 diabetes mellitus: a systematic review and meta-analysis. Physiol. Behav. 215, 112786 (2020). https://doi.org/10.1016/j.physbeh.2019.112786CrossRefPubMed

48.

R.E. Ashton, G.A. Tew, J.J. Aning, S.E. Gilbert, L. Lewis, J.M. Saxton, Effects of short-term, medium-term and long-term resistance exercise training on cardiometabolic health outcomes in adults: systematic review with meta-analysis. Br. J. Sports Med. 54, 341–348 (2020). https://doi.org/10.1136/bjsports-2017-098970CrossRefPubMed

49.

G.A. Silverii, L. Botarelli, I. Dicembrini, et al., Low-carbohydrate diets and type 2 diabetes treatment: a meta-analysis of randomized controlled trials. Acta. Diabetol. 57, 1375–1382 (2020). https://doi.org/10.1007/s00592-020-01568-8CrossRefPubMed

50.

L.J. Orozco, A.M. Buchleitner, G. Gimenez-Perez, M.R.I. Figuls, B. Richter, D. Mauricio, Exercise or exercise and diet for preventing type 2 diabetes mellitus. Cochrane Database Syst. Rev. 2008, CD003054 (2008). https://doi.org/10.1002/14651858.CD003054.pub3CrossRef

51.

K.I. Stanford, L.J. Goodyear, Exercise and type 2 diabetes: molecular mechanisms regulating glucose uptake in skeletal muscle. Adv. Physiol. Educ. 38, 308–314 (2014). https://doi.org/10.1152/advan.00080.2014CrossRefPubMedPubMedCentral

52.

H. Ohnishi, S. Saitoh, S. Takagi, et al., Incidence of insulin resistance in obese subjects in a rural Japanese population: the Tanno and Sobetsu study. Diabetes Obes. Metab. 7, 83–87 (2005). https://doi.org/10.1111/j.1463-1326.2004.00381.xCrossRefPubMed

53.

T. Okura, R. Nakamura, Y. Fujioka, et al., Body mass index ≥23 is a risk factor for insulin resistance and diabetes in Japanese people: a brief report. PLoS One 13, e0201052 (2018). https://doi.org/10.1371/journal.pone.0201052CrossRefPubMedPubMedCentral

54.

Y. Hayashino, J.L. Jackson, T. Hirata, et al., Effects of exercise on C-reactive protein, inflammatory cytokine, and adipokine in patients with type 2 diabetes: a meta-analysis of randomized controlled trials. Metabolism 63, 431–440 (2014). https://doi.org/10.1016/j.metabol.2013.08.018CrossRefPubMed

55.

T. Suzuki, J. Imai, T. Yamada, et al., Interleukin-6 enhances glucose-stimulated insulin secretion from pancreatic beta-cells: potential involvement of the PLC-IP3-dependent pathway. Diabetes 60, 537–547 (2011). https://doi.org/10.2337/db10-0796CrossRefPubMedPubMedCentral

56.

R.J.S. Costa, R.M.J. Snipe, C.M. Kitic, P.R. Gibson, Systematic review: exercise-induced gastrointestinal syndrome-implications for health and intestinal disease. Aliment. Pharmacol. Ther. 46, 246–265 (2017). https://doi.org/10.1111/apt.14157CrossRefPubMed

Titel: The relationship between the level of exercise and hemoglobin A1c in patients with type 2 diabetes mellitus: a systematic review and meta-analysis
verfasst von: Yutaka Igarashi
Nobuhiko Akazawa
Seiji Maeda
Publikationsdatum: 23.07.2021
Verlag: Springer US
Erschienen in: Endocrine / Ausgabe 3/2021
Print ISSN: 1355-008X
Elektronische ISSN: 1559-0100
DOI: https://doi.org/10.1007/s12020-021-02817-8

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The relationship between the level of exercise and hemoglobin A₁c in patients with type 2 diabetes mellitus: a systematic review and meta-analysis

Abstract

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Methods

Results

Conclusions

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