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The Effect of Exercise with or Without Metformin on Glucose Profiles in Type 2 Diabetes: A Pilot Study

  • Étienne Myette-Côté
    Affiliations
    Faculty of Physical Education & Recreation, Alberta Diabetes Institute, University of Alberta, Li Ka Shing Center for Health Research Innovation, Edmonton, Alberta, Canada
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  • Tasuku Terada
    Affiliations
    Faculty of Physical Education & Recreation, Alberta Diabetes Institute, University of Alberta, Li Ka Shing Center for Health Research Innovation, Edmonton, Alberta, Canada
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  • Normand G. Boulé
    Correspondence
    Address for correspondence: Normand G. Boulé, PhD, University of Alberta, Li Ka Shing Center for Health Research Innovation, 8602, 112 Ave NW, Edmonton, Alberta T6G 2H9, Canada.
    Affiliations
    Faculty of Physical Education & Recreation, Alberta Diabetes Institute, University of Alberta, Li Ka Shing Center for Health Research Innovation, Edmonton, Alberta, Canada
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Published:December 17, 2015DOI:https://doi.org/10.1016/j.jcjd.2015.08.015

      Abstract

      The study's goals were 1) to confirm the previously observed increase in postprandial glucose levels immediately after exercise in people with type 2 diabetes who are being treated with metformin; 2) to determine how long the increased glucose persists; 3) to examine the effect of skipping a dose of metformin before or after exercise. We recruited 10 participants with type 2 diabetes who were taking metformin. They completed 4 experimental conditions in random order: 1) morning and evening metformin doses, without exercise (M-M); 2) morning and evening metformin doses, with exercise (M-Ex-M); 3) exercise with evening metformin dose only (Ex-M); and 4) morning metformin dose only, with exercise (M-Ex). Exercise consisted of walking for 50 minutes at a moderate intensity at 11 am on the first day of each condition. Glucose was measured for 72 hours using continuous glucose monitoring systems. Standardized breakfasts were provided for 3 days in each condition, and standardized lunches and dinners were provided on the first day. Compared to M-M, M-Ex-M increased the average 2-hour incremental postprandial area under the curve following the 5 standardized meals (p<0.01) but did not affect daily mean glucose or fasting glucose concentrations. M-Ex (p<0.05), but not Ex-M (p=0.08) increased mean glucose concentrations compared to M-Ex-M on day 1. There were no differences among the 3 exercise conditions for fasting or postprandial glucose concentrations. The addition of a bout of exercise to metformin led to an increase in postprandial glucose levels without affecting mean glucose concentrations. Removing a metformin dose before or after exercise did not attenuate this negative effect.

      Résumé

      Les objectifs de l'étude étaient les suivants: 1) confirmer l'augmentation de la glycémie postprandiale précédemment observée immédiatement après l'exercice chez les personnes souffrant du diabète de type 2 qui sont traitées par la metformine; 2) déterminer la durée de l'augmentation de la glycémie; 3) examiner l'effet de l'omission d'une dose de metformine avant ou après l'exercice. Nous avons recruté 10 participants souffrant du diabète de type 2 qui prenaient de la metformine. Ils se soumettaient aux 4 conditions expérimentales selon un ordre aléatoire: 1) doses de metformine le matin et le soir, sans exercice (M-M); 2) doses de metformine le matin et le soir, avec exercice (M-Ex-M); 3) exercice avec une dose de metformine le soir seulement (Ex-M); 4) dose de metformine le matin seulement, avec exercice (M-Ex). L'exercice consistait en une marche de 50 minutes à intensité modérée à 11 h le premier jour de chacune des conditions. La glycémie était mesurée durant 72 heures à l'aide de systèmes de surveillance de la glycémie en continu. Des déjeuners standards étaient fournis durant 3 jours pour chacune des conditions, puis des dîners et des soupers standards étaient fournis le premier jour. Comparativement à la condition expérimentale M-M, la M-Ex-M augmentait l'aire incrémentale moyenne sous la courbe de la glycémie postprandiale 2 heures après les 5 repas standards (p<0.01), mais n'affectait pas la glycémie moyenne quotidienne ou la glycémie à jeun. La condition expérimentale M-Ex (p<0.05), mais non la Ex-M (p=0.08), augmentait la glycémie moyenne comparativement à la M-Ex-M le jour 1. Aucune différence dans la glycémie à jeun et la glycémie postprandiale n'était observée entre les 3 conditions ayant recours à l'exercice. L'ajout d'une période d'exercice à la prise de metformine menait à une augmentation de la glycémie postprandiale sans affecter la glycémie moyenne. La suppression d'une dose de metformine avant ou après l'exercice n'atténuait pas cet effet négatif.

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