Combination of Metformin and Exercise in Management of Metabolic Abnormalities Observed in Type 2 Diabetes Mellitus

Filip Jevtovic Department of Kinesiology, College of Health and Human Performance, East Carolina University, Greenville, NC, USACorrespondence: Filip JevtovicEast Carolina University; School of Dental Medicine, Ledyard E. Ross Hall; 1851 MacGregor Downs Road, Mail Stop 701, Greenville, NC, 27834, US...

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Autor principal:	Jevtovic F
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2021
Materias:	exercise metformin glucose control type 2 diabetes mellitus ampk Specialties of internal medicine RC581-951
Acceso en línea:	https://doaj.org/article/de0e74bb84f0467e9bc61745ba791533
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spelling	oai:doaj.org-article:de0e74bb84f0467e9bc61745ba7915332021-12-02T15:03:23ZCombination of Metformin and Exercise in Management of Metabolic Abnormalities Observed in Type 2 Diabetes Mellitus1178-7007https://doaj.org/article/de0e74bb84f0467e9bc61745ba7915332021-09-01T00:00:00Zhttps://www.dovepress.com/combination-of-metformin-and-exercise-in-management-of-metabolic-abnor-peer-reviewed-fulltext-article-DMSOhttps://doaj.org/toc/1178-7007Filip Jevtovic Department of Kinesiology, College of Health and Human Performance, East Carolina University, Greenville, NC, USACorrespondence: Filip JevtovicEast Carolina University; School of Dental Medicine, Ledyard E. Ross Hall; 1851 MacGregor Downs Road, Mail Stop 701, Greenville, NC, 27834, USATel +1 616 844 8323Fax +1 252 737 7024Email jevtovicf21@students.ecu.eduAbstract: Excess nutrient intake and lack of exercise characterize the problem of obesity and are common factors in insulin resistance (IR). With an increasing number of prediabetic, and type 2 diabetic populations, metformin is still the most prescribed glucose-lowering drug and is often accompanied by recommendations for regular physical exercise. Metformin, by the inhibition of complex 1 of the electron transport chain, and exercise, by increasing energy expenditure, both elicit a low cellular energy state that leads to improvements in glucose control via activation of adenosine 5ʹ monophosphate-activated protein kinase (AMPK). An augmented stimulation of the energy-sensing enzyme AMPK by either of the two modalities leads to an increase in glycogenolysis, glucose uptake, fat oxidation, a decrease in glycogen and protein synthesis, and gluconeogenesis in muscle and the liver, which are remarked as having positive effects on metabolic pathophysiology observed in IR and type 2 diabetes mellitus (T2DM). While both modalities exploit the energy-sensing enzyme AMPK to attain glucose homeostasis, the synergistic effect of these two treatments is not distinctly supported by the literature. Further, an antagonistic dynamic has been observed in cases where metformin and exercise were combined. Reduction of insulin-sensitizing effects of exercise and an overall hindrance of exercise performance and adaptations have been reported and could suggest the possible incongruity of these two modalities. The aim of this review is to elucidate the effect that metformin and exercise have on the management of the metabolic abnormalities observed in T2DM and to provide an insight into the interaction of these two modalities.Keywords: exercise, metformin, glucose control, type 2 diabetes mellitus, AMPKJevtovic FDove Medical Pressarticleexercisemetforminglucose controltype 2 diabetes mellitusampkSpecialties of internal medicineRC581-951ENDiabetes, Metabolic Syndrome and Obesity: Targets and Therapy, Vol Volume 14, Pp 4043-4057 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	exercise metformin glucose control type 2 diabetes mellitus ampk Specialties of internal medicine RC581-951
spellingShingle	exercise metformin glucose control type 2 diabetes mellitus ampk Specialties of internal medicine RC581-951 Jevtovic F Combination of Metformin and Exercise in Management of Metabolic Abnormalities Observed in Type 2 Diabetes Mellitus
description	Filip Jevtovic Department of Kinesiology, College of Health and Human Performance, East Carolina University, Greenville, NC, USACorrespondence: Filip JevtovicEast Carolina University; School of Dental Medicine, Ledyard E. Ross Hall; 1851 MacGregor Downs Road, Mail Stop 701, Greenville, NC, 27834, USATel +1 616 844 8323Fax +1 252 737 7024Email jevtovicf21@students.ecu.eduAbstract: Excess nutrient intake and lack of exercise characterize the problem of obesity and are common factors in insulin resistance (IR). With an increasing number of prediabetic, and type 2 diabetic populations, metformin is still the most prescribed glucose-lowering drug and is often accompanied by recommendations for regular physical exercise. Metformin, by the inhibition of complex 1 of the electron transport chain, and exercise, by increasing energy expenditure, both elicit a low cellular energy state that leads to improvements in glucose control via activation of adenosine 5ʹ monophosphate-activated protein kinase (AMPK). An augmented stimulation of the energy-sensing enzyme AMPK by either of the two modalities leads to an increase in glycogenolysis, glucose uptake, fat oxidation, a decrease in glycogen and protein synthesis, and gluconeogenesis in muscle and the liver, which are remarked as having positive effects on metabolic pathophysiology observed in IR and type 2 diabetes mellitus (T2DM). While both modalities exploit the energy-sensing enzyme AMPK to attain glucose homeostasis, the synergistic effect of these two treatments is not distinctly supported by the literature. Further, an antagonistic dynamic has been observed in cases where metformin and exercise were combined. Reduction of insulin-sensitizing effects of exercise and an overall hindrance of exercise performance and adaptations have been reported and could suggest the possible incongruity of these two modalities. The aim of this review is to elucidate the effect that metformin and exercise have on the management of the metabolic abnormalities observed in T2DM and to provide an insight into the interaction of these two modalities.Keywords: exercise, metformin, glucose control, type 2 diabetes mellitus, AMPK
format	article
author	Jevtovic F
author_facet	Jevtovic F
author_sort	Jevtovic F
title	Combination of Metformin and Exercise in Management of Metabolic Abnormalities Observed in Type 2 Diabetes Mellitus
title_short	Combination of Metformin and Exercise in Management of Metabolic Abnormalities Observed in Type 2 Diabetes Mellitus
title_full	Combination of Metformin and Exercise in Management of Metabolic Abnormalities Observed in Type 2 Diabetes Mellitus
title_fullStr	Combination of Metformin and Exercise in Management of Metabolic Abnormalities Observed in Type 2 Diabetes Mellitus
title_full_unstemmed	Combination of Metformin and Exercise in Management of Metabolic Abnormalities Observed in Type 2 Diabetes Mellitus
title_sort	combination of metformin and exercise in management of metabolic abnormalities observed in type 2 diabetes mellitus
publisher	Dove Medical Press
publishDate	2021
url	https://doaj.org/article/de0e74bb84f0467e9bc61745ba791533
work_keys_str_mv	AT jevtovicf combinationofmetforminandexerciseinmanagementofmetabolicabnormalitiesobservedintype2diabetesmellitus
_version_	1718389048766103552

Combination of Metformin and Exercise in Management of Metabolic Abnormalities Observed in Type 2 Diabetes Mellitus

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