Does metformin modify the effect on glycaemic control of aerobic exercise, resistance exercise or both?

Boulé, Normand G.; Kenny, Glen P.; Larose, Joanie; Khandwala, Farah; Kuzik, Nicholas; Sigal, Ronald J.

doi:10.1007/s00125-013-3026-6

Cited by 42 publications

(47 citation statements)

References 8 publications

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“…3). However, metformin showed no significant interaction with exercise in a study of the long-term effect of exercise in type 2 diabetes wherein no additional improvement in HbA 1c was seen in the metformin-treated group compared with the group not treated with metformin (31).…”

Section: Discussionmentioning

confidence: 94%

The Effect of Metformin on Glucose Homeostasis During Moderate Exercise

et al. 2014

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OBJECTIVEWe investigated the role of metformin on glucose kinetics during moderate exercise. RESEARCH DESIGN AND METHODSBefore, during, and after a 45-min bout of exercise at 60% VO 2max , glucose kinetics were determined by isotope tracer technique in patients with type 2 diabetes mellitus with metformin treatment (DM2+Met) or without metformin treatment (DM2) and in healthy control subjects (CON) matched for BMI and age. Glucoregulatory hormones and metabolites were measured throughout the study. RESULTSPlasma glucose concentration was unchanged during exercise in CON but decreased in DM2. No significant change was found in DM2+Met. Hormones and metabolites showed no differences among the groups except for elevated exerciseinduced concentrations of lactate in DM2 (area under the curve [AUC] 31 6 1% vs. CON) and glucagon in DM2 (AUC 5 6 1% vs. DM2+Met). Free fatty acid levels were lower in DM2+Met than in DM2 (AUC 214 6 1%). Absolute values of the baseline glucose rate of appearance (Ra) were elevated in DM2 and DM2+Met, but the increase in glucose Ra relative to baseline was blunted in DM2 (19 6 1%) and DM2+Met (18 6 4%) compared with CON (46 6 4%). Glucose rate of disappearance relative to baseline increased more in CON (31 6 3%) than in DM2 (6 6 1%) and DM2+Met (21 6 2%), showing a small increase caused by metformin. Glucose metabolic clearance rate relative to baseline was similar during exercise in DM2 (33 6 1%) and CON (35 6 3%) but was improved in DM2+Met (37 6 3%) compared with DM2.

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Section: Discussionmentioning

confidence: 94%

The Effect of Metformin on Glucose Homeostasis During Moderate Exercise

et al. 2014

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“…No patient reported changing in his dose of medication during the study. Though, recent study showed that metformin did not significantly attenuate the benefits of exercise on glycemic control or fitness [13]. …”

Section: Methodsmentioning

confidence: 99%

Effect of a short-term exercise program on glycemic control measured by fructosamine test in type 2 diabetes patients

Moura

Amorim

Silva

et al. 2014

Diabetol Metab Syndr

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BackgroundGlycated hemoglobin (A1C) and Fasting Plasma Glucose (FPG) are the two monitoring blood glucose tests most frequently used. However, both methods are shown to be insensitive to detect glycemic variations in short duration periods. Therefore, we aimed to assess the effect of a short-term exercise program on glycemic levels measured by fructosamine concentrations in type 2 diabetes patients.MethodsEight volunteers (51.1 ± 8.2 years) underwent a supervised exercise program during eight weeks (3 d.wk-1, 50-60% of VO2 peak for 30–60 minutes). The body composition, VO2 peak, A1C, FPG, fructosamine and capillary blood glucose (CBG) were evaluated. We used ANOVA - One Way for repeated measures followed by Tukey post-hoc test and paired t test. P values <0.05 were considered significant.ResultsWe found statistical differences on the concentrations of fructosamine, VO2 peak and CBG. However, A1C and FPG showed no statistical difference. Fructosamine declined by 15% (57 μmol/L) between the beginning and the end of the study. Individually, 50% of the sample reached the reference values for the normality in fructosamine test. VO2 peak increased by 14.8% (3.8 ml.kg-1.min-1) and CBG decreased on an average of 34.4% (69.3 mg/dL).ConclusionsFructosamine test is effective in the evaluation of glucose with type 2 diabetes patients when undergoing a short exercise program, alternatively to the traditional A1C and FPG assessment. Our results are relevant in clinical practice, because the significant improvement in glycemic status can help to evaluate the inclusion of exercise as adjunct therapy to replace the prescription of additional drugs in poorly controlled patients.

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“…Although most of the studies have proposed that metformin is beneficial for muscle function, recent studies that have evaluated the effects of metformin on aerobic capacity have found a reduction in aerobic capacity with metformin treatment, suggesting that metformin might be attenuating exercise‐induced benefits on insulin sensitivity and cardio‐metabolic health . Another study, however, noted that there was no metformin‐mediated attenuation of exercise benefits on glycemic control …”

Section: Drugs and Musclementioning

confidence: 99%

Diabetes pharmacotherapy and effects on the musculoskeletal system

Kalaitzoglou

Fowlkes

Popescu

et al. 2018

Diabetes Metabolism Res

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Summary Persons with type 1 or type 2 diabetes have a significantly higher fracture risk than age‐matched persons without diabetes, attributed to disease‐specific deficits in the microarchitecture and material properties of bone tissue. Therefore, independent effects of diabetes drugs on skeletal integrity are vitally important. Studies of incretin‐based therapies have shown divergent effects of different agents on fracture risk, including detrimental, beneficial, and neutral effects. The sulfonylurea class of drugs, owing to its hypoglycemic potential, is thought to amplify the risk of fall‐related fractures, particularly in the elderly. Other agents such as the biguanides may, in fact, be osteo‐anabolic. In contrast, despite similarly expected anabolic properties of insulin, data suggests that insulin pharmacotherapy itself, particularly in type 2 diabetes, may be a risk factor for fracture, negatively associated with determinants of bone quality and bone strength. Finally, sodium‐dependent glucose co‐transporter 2 inhibitors have been associated with an increased risk of atypical fractures in select populations, and possibly with an increase in lower extremity amputation with specific SGLT2I drugs. The role of skeletal muscle, as a potential mediator and determinant of bone quality, is also a relevant area of exploration. Currently, data regarding the impact of glucose lowering medications on diabetes‐related muscle atrophy is more limited, although preclinical studies suggest that various hypoglycemic agents may have either aggravating (sulfonylureas, glinides) or repairing (thiazolidinediones, biguanides, incretins) effects on skeletal muscle atrophy, thereby influencing bone quality. Hence, the therapeutic efficacy of each hypoglycemic agent must also be evaluated in light of its impact, alone or in combination, on musculoskeletal health, when determining an individualized treatment approach. Moreover, the effect of newer medications (potentially seeking expanded clinical indication into the pediatric age range) on the growing skeleton is largely unknown. Herein, we review the available literature regarding effects of diabetes pharmacotherapy, by drug class and/or by clinical indication, on the musculoskeletal health of persons with diabetes.

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Does metformin modify the effect on glycaemic control of aerobic exercise, resistance exercise or both?

Cited by 42 publications

References 8 publications

The Effect of Metformin on Glucose Homeostasis During Moderate Exercise

The Effect of Metformin on Glucose Homeostasis During Moderate Exercise

Effect of a short-term exercise program on glycemic control measured by fructosamine test in type 2 diabetes patients

Diabetes pharmacotherapy and effects on the musculoskeletal system

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