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Systematic review
Effects of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control: a systematic review and network meta-analysis
  1. Tong Zhao1,2,3,
  2. Qize Yang2,3,
  3. Joshua F Feuerbacher1,4,
  4. Bizhu Yu1,
  5. Christian Brinkmann5,
  6. Sulin Cheng2,3,6,
  7. Wilhelm Bloch1,
  8. Moritz Schumann4
  1. 1Department of Molecular and Cellular Sports Medicine, German Sport University Cologne, Cologne, Germany
  2. 2Exercise Translational Medicine Centre, Shanghai Centre for Systems Biomedicine Shanghai, Shanghai Jiao Tong University, Shanghai, Shanghai, China
  3. 3Department of Physical Education, Shanghai Jiao Tong University, Shanghai, Shanghai, China
  4. 4Department of Sports Medicine and Exercise Therapy, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
  5. 5Department of Preventive and Rehabilitative Sport Medicine, German Sport University Cologne, Cologne, Germany
  6. 6Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
  1. Correspondence to Dr Moritz Schumann; moritz.schumann{at}hsw.tu-chemnitz.de

Abstract

Objective To compare the efficacy of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control.

Design Systematic review and network meta-analysis.

Data sources Embase, Web of Science, PubMed/MEDLINE and SPORTDiscus.

Eligibility criteria Randomised controlled trials involving exercise, metformin or their combined treatments in individuals with prediabetes or type 2 diabetes mellitus (T2DM) were included. Outcomes included haemoglobin A1c (HbA1c), 2-hour glucose during oral glucose tolerance test, fasting glucose, fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR).

Results 407 articles with 410 randomised controlled trials (n=33 802) were included. In prediabetes, the exercise showed greater efficacy than metformin on HbA1c levels (mean difference −0.16%, 95% CI (−0.23 to −0.09) vs −0.10%, 95% CI (−0.21 to 0.02)), 2-hour glucose (−0.68 mmol/L, 95% CI (−0.97 to −0.39) vs 0.01 mmol/L, 95% CI (−0.38 to 0.41)) and HOMA-IR (−0.54, 95% CI (−0.71 to −0.36) vs −0.23, 95% CI (−0.55 to 0.10)), while the efficacy on fasting glucose was comparable (−0.26 mmol/L, 95% CI (−0.32 to −0.19) vs −0.33 mmol/L, 95% CI (−0.45 to −0.21)). In T2DM, metformin was more efficacious than exercise on HbA1c (−0.88%, 95% CI (−1.07 to −0.69) vs −0.48%, 95% CI (−0.58 to −0.38)), 2-hour glucose (−2.55 mmol/L, 95% CI (−3.24 to −1.86) vs −0.97 mmol/L, 95% CI (−1.52 to −0.42)) and fasting glucose (−1.52 mmol/L, 95% CI (−1.73 to −1.31) vs −0.85 mmol/L, 95% CI (−0.96 to −0.74)); exercise+metformin also showed greater efficacy in improving HbA1c (−1.23%, 95% CI (−2.41 to –0.05)) and fasting glucose (−2.02 mmol/L, 95% CI (−3.31 to –0.74)) than each treatment alone. However, the efficacies were modified by exercise modality and metformin dosage.

Conclusion Exercise, metformin and their combination are efficacious in improving glucose metabolism in both prediabetes and T2DM. The efficacy of exercise appears to be superior to metformin in prediabetes, but metformin appears to be superior to exercise in patients with T2DM.

PROSPERO registration number CRD42023400622.

  • Exercise
  • Physical activity
  • Glucose
  • Endocrine System
  • Pharmacology

Data availability statement

Data are available upon reasonable request. Data are available on reasonable request by contacting the corresponding author.

https://doi.org/10.1136/bjsports-2024-108127

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    Data availability statement

    Data are available upon reasonable request. Data are available on reasonable request by contacting the corresponding author.

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    Footnotes

    • X @moritz_schumann

    • Contributors TZ, CB, SC, WB and MS conceived and designed the study. TZ, QY and MS selected the articles, extracted the data and assessed the risk of bias. TZ and JFF analysed the data. TZ, QY, JFF and BY accessed and verified the data. TZ wrote the first draft of the manuscript. TZ, JFF, CB, SC, WB and MS interpreted the data and contributed to the writing and revising of the final version of the manuscript. All authors agreed with the results and conclusions of this article. MS is the guarantor.

    • Funding This study was funded by the Chinese Scholarship Council (CSC, no. 202206230079). The views expressed are those of the authors and not necessarily those of the CSC.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.