Summary: In a trial in elderly patients with type 2 diabetes and sleep disturbance, adding resistance exercise to metformin improved glucose control and sleep quality, and raised melatonin, more than metformin alone over 12 weeks.
PICO Summary
| Element | Detail |
|---|---|
| Population | 180 elderly patients with type 2 diabetes and sleep disturbances; 12-week controlled trial, China. |
| Intervention | Resistance exercise plus metformin. |
| Comparison | Metformin alone. |
| Outcome | The intervention group had greater reductions in fasting glucose, 2-hour postprandial glucose, and HbA1c (p<0.05), better Pittsburgh Sleep Quality Index scores and sleep architecture (p<0.05), and lower fasting insulin and HOMA-IR. Melatonin rose only in the intervention group. No major adverse effects. |
Resistance exercise plus metformin in elderly T2DM with sleep disorders
RCT · type 2 diabetes · 12 weeks
Adding supervised resistance exercise to metformin improved glucose control and sleep quality more than metformin alone over 12 weeks, with a parallel rise in melatonin. Unblinded, single-country, 12-week trial.
Expert Commentary
This is a clinically appealing trial because it targets an under-recognised vicious cycle, where poor sleep worsens glucose metabolism and hyperglycaemia in turn disrupts sleep, and tests whether one accessible intervention can act on both. The results are coherent and the dual signal is the interesting part: resistance exercise added to metformin improved not just glucose measures but objective and subjective sleep, with a parallel rise in melatonin offering a plausible mechanistic thread linking the two. The combination is low-cost and addresses a problem for which elderly patients are often offered sedatives with their own risks, so a non-pharmacological route is attractive. I would temper enthusiasm with the usual caveats: a behavioural intervention cannot be blinded, raising the possibility of expectation effects on self-reported sleep, the trial is single-country and twelve weeks long, and durability and falls or injury risk in an elderly cohort doing resistance work need attention. Can I use this with my patients? Yes, sensibly and with supervision. For an older diabetic patient with disturbed sleep, I would encourage appropriately supervised resistance training as an adjunct that may help both glycaemia and sleep, while introducing it gradually and keeping standard sleep hygiene and diabetes care central.
References
Li X, Sun L, Li R. Effects of resistance exercise combined with metformin on glycemic stability and sleep quality in elderly patients with type 2 diabetes mellitus with sleep disorders. Pak J Pharm Sci. 2025;38(6):2087–2097. doi:10.36721/PJPS.2025.38.6.REG.14487.1