Effects of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control: a systematic review and network meta-analysis

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Paper Summary

Conflicts of Interest

Identified Weaknesses

Rating Explanation

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Paper Summary

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Exercise vs. Metformin for Blood Sugar Control: A Network Meta-Analysis Showdown!

This network meta-analysis found that metformin was more effective than exercise for glucose control in type 2 diabetes, while exercise appeared more effective in prediabetes. Combined exercise and metformin may be more effective than either alone, particularly in type 2 diabetes, but more research is needed. The findings are limited by substantial heterogeneity across studies, variations in control conditions, and a limited number of studies examining combination therapy.

Possible Conflicts of Interest

This study was funded by the Chinese Scholarship Council. No other conflicts were declared.

Identified Weaknesses

Heterogeneous control conditions and blinding issues

The control conditions varied across studies, which could bias the results. Blinding is also an issue since participants know if they are exercising but may not know if they are taking metformin.

Over-reliance on per-protocol analysis

Most studies (81%) used per-protocol analysis, which can overestimate the treatment effects since it excludes participants who didn't adhere to the assigned intervention.

Small number of studies examining combination treatment

Only five studies examined the combination of exercise and metformin, limiting conclusions about the interactive effects.

High heterogeneity

Confidence in the findings is limited due to high heterogeneity (variability) in the results across studies. While subgroup analyses and meta-regressions explored some sources, substantial unexplained heterogeneity remains.

Publication and small-study bias

Publication bias and small-study bias were detected for some outcomes, meaning the available evidence may be skewed towards positive results.

Rating Explanation

This is a well-conducted network meta-analysis that synthesizes a large body of evidence on an important topic. The methodology is generally strong, but the limitations related to heterogeneity, control conditions, and the small number of studies on combination therapy prevent a higher rating.

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Topic Hierarchy

Domain:

Health Sciences

Field:

Medicine

Subfield:

Endocrinology, Diabetes and Metabolism

File Information

Original Title:

Effects of exercise, metformin and their combination on glucose metabolism in individuals with abnormal glycaemic control: a systematic review and network meta-analysis

File Name:

1452.full.pdf

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File Size:

2.50 MB

Uploaded:

August 13, 2025 at 06:13 PM

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