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Exercise OK in Diabetes Patients on Metformin

By Reuters Staff

NEW YORK - Moderate-intensity exercise doesn't appear to cause hypoglycemia or worsen glycemic control in patients taking metformin for type 2 diabetes (DM2), new research from Denmark shows.

"Thus there is no reason that patients with type 2 diabetes treated with metformin should avoid taking up exercise," Dr. Merethe Hansen and colleagues from the University of Copenhagen write in Diabetes Care, online December 2. "The decrease in plasma glucose during moderate-intensity exercise is modest, not influenced by ongoing metformin treatment, and far from hypoglycemic concentrations."

Patients with DM2 have higher gluconeogenesis when at rest and fasting than people without the condition, the researchers note in their report. However, during moderate-intensity exercise, plasma glucose concentrations seem to drop.

"How the combination of metformin and exercise exerts an effect on glucose homeostasis is not clear, and to our knowledge, no studies have applied isotopic measurement of HGP during a single bout of moderate exercise in patients with type 2 diabetes treated with and without metformin," Dr. Hansen and colleagues add.

Given that both metformin and exercise are widely recommended and used in DM2 patients, they add, "we aimed to investigate whether one treatment negates or amplifies the other, ultimately to avoid the recommendation of combined treatment modalities, which could induce hypoglycemia or worsen glycemic control."

The study included 11 men with DM2 and 10 healthy controls. All study participants completed 45-minute bouts of exercise, and the DM patients exercised once without metformin and once with metformin treatment.

Baseline glucose concentrations were higher in DM2 patients, whether or not on metformin (9.6 and 8.9 mmol/L, respectively), than in controls (5.9 mmol/L). During exercise glucose levels didn't change in the control group, but they dropped both during and after the workout in patients.

While absolute glucose concentrations were never significantly different in patients according to their metformin status, the decline during exercise was slightly less pronounced while they were on the drug, "showing a small glucose-stabilizing effect of metformin," the researchers say.

Relative to baseline, glucose metabolic clearance rate was similar during exercise in untreated patients (33 +/- 1%) and controls (35 +/- 3%), but improved when patients were taking metformin (37 +/- 3%).

"Thus, it can be concluded that during moderate-intensity exercise, the contraction-induced glucose uptake rate is impaired in patients with type 2 diabetes, but this impairment is, to some extent, alleviated by concomitant metformin treatment," the authors write. "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 HbA1c was seen in the metformin-treated group compared with the group not treated with metformin."

SOURCE: https://bit.ly/1E7hdhu

Diabetes Care 2014.

 

(c) Copyright Thomson Reuters 2014. Click For Restrictions - https://about.reuters.com/fulllegal.asp

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