摘要:
目的 探究不同运动处方对东亚人群2型糖尿病患者血糖代谢作用的效果，并比较人群特征和运动要素对血糖代谢影响的差异。方法 系统检索PubMed、Cochrane Library、EmBase、Web of Science、中国知网、万方数据知识服务平台，获取从建库至2024年6月15日东亚人群中运动对2型糖尿病患者血糖代谢影响的相关文献。文献类型限定为随机对照研究，其中试验组进行运动干预，对照组不进行运动干预。由2名研究人员按照纳入与排除标准对文献进行筛选，并提取相关数据。采用Stata 17.0软件的Egger检验及RevMan 5.3软件的漏斗图评估发表偏倚，采用RevMan 5.3软件进行Meta分析。结果 共纳入21篇随机对照研究，包含1289例研究对象。其中试验组675例、对照组614例。经发表偏倚风险评估，文献质量整体良好。随机效应模型显示，试验组患者经运动干预后空腹血糖（MD=-1.31 mg/L,95% CI：-1.55～-1.07,P<0.001）、糖化血红蛋白（MD=-0.34,95% CI：-0.45～-0.22,P<0.001）、胰岛素抵抗指数（MD=-0.39,95% CI：-0.54～-0.23,P<0.001）、空腹胰岛素（MD=-0.71 uIU/mL,95% CI：-1.18～-0.24,P=0.003）均显著降低。不同运动方式改善血糖代谢的作用存有异质性，其中有氧运动（MD=-1.49 mg/L,95% CI：-2.53～-0.44,P=0.005）和联合运动（MD=-1.41 mg/L,95% CI：-1.87～-0.95,P<0.001）降低空腹血糖的效果优于抗阻运动；联合运动（MD=-0.47,95% CI ：-0.81～-0.31,P=0.007）降低糖化血红蛋白的效果优于有氧运动和抗阻运动；仅有氧运动（MD=-0.48，95% CI：-0.89～-0.07，P=0.004）和联合运动（MD=-0.35，95% CI：-0.69～-0.01，P=0.040）降低胰岛素抵抗指数的作用具有统计学意义，且有氧运动的效应优于联合运动。按照年龄组、运动周期、运动时间、运动频率、运动强度进行亚组分析显示，每周进行小于5次、每次不超过1小时的有氧运动对于改善东亚人群2型糖尿病患者空腹血糖有显著效果。结论 运动干预可降低东亚人群2型糖尿病患者血糖，减轻胰岛素抵抗，其中有氧运动和联合运动是更适合东亚人群2型糖尿病患者降糖的运动处方。
Abstract:
Objective To explore the effects of different exercise prescriptions on glycemic metabolism in East Asian patients with type 2 diabetes mellitus (T2DM) and to compare the differences in the impact of population characteristics and exercise components on glycemic metabolism. Methods A systematic search was conducted in PubMed, Cochrane Library, EmBase, Web of Science, CNKI, and Wanfang Data Knowledge Service Platform to identify relevant studies published from database inception to June 15, 2024, on the effects of exercise on glycemic metabolism in East Asian patients with T2DM. The study type was limited to randomized controlled trials (RCTs), where the intervention group received exercise interventions and the control group did not. Two researchers independently screened the literature based on inclusion and exclusion criteria and extracted relevant data. Publication bias was assessed using Egger’s test in Stata 17.0 and funnel plots in RevMan 5.3. Meta-analysis was performed using RevMan 5.3. Results A total of 21 RCTs involving 1289 participants (675 in the intervention group and 614 in the control group) were included. Publication bias assessment indicated overall good quality of the included studies. The random-effects model showed that exercise interventions significantly reduced fasting blood glucose (MD = -1.31 mg/L, 95% CI: -1.55 to -1.07, P < 0.001), glycated hemoglobin (HbA1c) (MD = -0.34, 95% CI: -0.45 to -0.22, P < 0.001), homeostatic model assessment of insulin resistance (HOMA-IR) (MD = -0.39, 95% CI: -0.54 to -0.23, P < 0.001), and fasting insulin (MD = -0.71 uIU/mL, 95% CI: -1.18 to -0.24, P = 0.003) in the intervention group. Heterogeneity was observed in the effects of different exercise modalities on glycemic metabolism. Aerobic exercise (MD = -1.49 mg/L, 95% CI: - 2.53 to -0.44, P = 0.005) and combined exercise (MD = -1.41 mg/L, 95% CI: -1.87 to -0.95, P < 0.001) were more effective than resistance exercise in reducing fasting blood glucose. Combined exercise (MD = -0.47, 95% CI: -0.81 to -0.31, P = 0.007) was superior to aerobic and resistance exercise in reducing HbA1c. Only aerobic exercise (MD = -0.48, 95% CI: -0.89 to -0.07, P = 0.004) and combined exercise (MD = -0.35, 95% CI: -0.69 to -0.01, P = 0.040) significantly reduced HOMA-IR, with aerobic exercise showing a greater effect than combined exercise. Subgroup analyses based on age group, exercise duration, session length, frequency, and intensity revealed that aerobic exercise performed less than 5 times per week for no more than 1 hour per session significantly improved fasting blood glucose in East Asian patients with T2DM. Conclusions Exercise interventions can improve glycemic control and reduce insulin resistance in East Asian patients with T2DM. Aerobic exercise and combined exercise are more effective exercise prescriptions for glycemic management in this population.
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