Summary: In elderly patients with type 2 diabetes and sleep disturbance, adding 12 weeks of resistance exercise to metformin improved glycaemic control, sleep quality, insulin resistance, and melatonin levels compared with metformin alone, with no major adverse effects.
PICO Summary
| Element | Detail |
|---|---|
| Population | 180 elderly patients with type 2 diabetes and sleep disorders. |
| Intervention | Metformin plus supervised resistance exercise over 12 weeks. |
| Comparison | Metformin alone, without resistance training. |
| Outcome | Greater reductions in fasting and postprandial glucose, HbA1c, PSQI score, and HOMA-IR, with improved sleep architecture and higher melatonin in the exercise arm (all p<0.05). No major adverse effects. |
Resistance exercise + metformin in elderly T2DM
RCT · type 2 diabetes · 12 weeks
Adding 12 weeks of supervised resistance exercise to metformin produced greater falls in HbA1c, fasting and postprandial glucose, PSQI and HOMA-IR than metformin alone, with higher melatonin and no major adverse effects. Magnitudes were not reported in the abstract.
Expert Commentary
The sleep and glucose relationship is one I see play out constantly in my older patients, where poor sleep and stubborn hyperglycaemia feed each other, so a trial targeting both at once is welcome in principle. The direction of the findings is entirely believable, because resistance training improving insulin sensitivity and sleep is well-grounded physiology, and the melatonin signal adds a plausible mechanistic thread. My enthusiasm is tempered less by the result than by the reporting: the exercise protocol itself, its intensity and frequency, is not adequately described, which makes it hard for me to reproduce or to tell a patient exactly what to do, and the study sits in a regional journal where I cannot fully gauge the rigour. PSQI is also self-reported, so the sleep-architecture claims would be firmer with objective measurement. Can I use this with my patients? Yes, comfortably, because prescribing supervised resistance training to an older patient with diabetes and poor sleep is sound advice on its own merits, and this study reinforces rather than establishes that. I would simply lean on the broader exercise evidence base for the specifics, and treat the melatonin and sleep-architecture findings as encouraging rather than definitive.
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