Type 2 Diabetes (T2D) is a significant healthcare challenge. Engaging in physical exercise is beneficial for the treatment of T2D and can improve insulin sensitivity (Gabriel & Zierath, 2017). However, previous evidence suggests that exercise at different times of the day in people with T2D may have opposing outcomes on blood glucose levels throughout the exercise day (Savikj et al., 2019). This may be especially important for those concurrently taking metformin medication (Gabriel & Zierath, 2021). We hypothesise that afternoon/evening moderate intensity exercise is more efficacious than morning exercise at lowering glycaemia in people who are also being prescribed metformin. To test this hypothesis, we conducted a remote crossover exercise intervention using wearable technology. Within this exercise intervention we aimed to monitor adherence and compliance to the exercise protocol. Nine male and nine females with T2D undergoing metformin treatment completed the trial with 2-week baseline recording, six weeks randomly assigned to a morning exercise (7-10am) or afternoon/evening exercise (4-7pm), with a two-week wash-out period. To monitor trial adherence, we assessed step count per day and heart rate (HR). Physical activity was monitored using the Garmin Vivosmart 4 (Garmin Ltd, Olathe, KS, US). Participants were asked to perform 30 minutes of walking at 70% of their estimated max-HR every other day. Glucose levels were measured with continuous glucose monitors FreeStyle Libre 2 sensor (Abbott Diabetes Care Inc, Alameda, CA, US). 24 h hourly mean glucose was estimated. Participants were asked to fill 4-day food diaries during baseline, first and last 2 weeks of each exercise arm. Metformin doses were registered by participants on food diaries. Results are expressed as Mean ± SEM. Eighteen participants (age 61±2 year) completed the trial with satisfactory adherence. The estimated 70% of max-HR was 111.4±5.5 bpm. During exercise, average HR was 117.2±8.2 bpm and 117.3±11.5 bpm, during morning and evening, respectively (p>0.05). During walking days participants completed an average of 10814±2251 steps and 10373±2183 steps during morning and evening, respectively (p>0.05). During resting days participants walked an average of 6843±2383 steps and 6344±2182 steps during morning and evening, respectively (p>0.05). Thus, no significance change in exercise intensity or compensatory activity was found between the arms of the trial. When analysing the 24 h hourly mean glucose area under the curve (AUC), a significant difference of (p=0.02) was found between baseline (210.3±76.68 mmol/L) and morning exercise (180.6±68.37 mmol/L). AUC glucose was significantly lower (p=0.01) in participants taking metformin before breakfast (148±11.05 mmol/L) compared with participants taking metformin after breakfast (220.2±23.58 mmol/L) only when they performed morning exercise. In summary, our data show lower glucose levels after morning moderate intensity exercise in people with T2D also being prescribed metformin. Metformin taken prior to breakfast seems to have a positive effect on AUC glucose levels compared with metformin taken after breakfast when morning exercise is performed. Contrary to our hypothesis and previous findings (Savikj et al., 2019), our data suggest that the time-of-day effect of exercise on glycemia in people with T2D may be exercise-intensity, and modality-dependent.
Physiology 2023 (Harrogate, UK) (2023) Proc Physiol Soc 54, C38
Oral Communications: Morning exercise reduces glycaemia in people with Type 2 Diabetes also being prescribed metformin
Brenda Pena Carrillo1, Oscar Duval1, Emily Cope1, Amber Kenny1, Sati Gurel1, Sam Philip1, Frank Thies1, Dimitra Blana1, Brendan Gabriel1,
1The Rowett Institute, University of Aberdeen Aberdeen United Kingdom, 2Grampian Diabetes Research Unit, Diabetes Centre, Aberdeen Royal Infirmary Aberdeen United Kingdom, 3Centre for Health Data Science, Institute of Applied Health Sciences, University of Aberdeen Aberdeen United Kingdom, 4Department of Physiology and Pharmacology, Integrative Physiology, Karolinska Institutet Stockholm Sweden,
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