Effect of exercise training on glycemic control in diabetic peripheral neuropathy: A GRADE assessed systematic review and meta-analysis of randomized-controlled trials

Aims We conducted a systematic review and meta-analysis to investigate the effect of exercise training on HbA1c, and on fasting and postprandial plasma glucose concentrations in patients with diabetic peripheral neuropathy (DPN). Methods Two independent researchers performed a systematic search in the electronic databases of PubMed, Web of Science and Scopus. Studies investigating the effect of exercise training on patients diagnosed with DPN using a randomized-controlled design were included in the meta-analysis. Results Of 1254 retrieved studies, 68 studies were identified to undergo full-text review; out of these a total of 13 randomized trials met the inclusion criteria. Eleven studies assessed HbA1c, 8 fasting plasma-glucose concentration, and 3 postprandial plasma-glucose concentration. Overall, exercise training significantly decreased HbA1c [−0.54% (95% CI −0.78 to −0.31%)], fasting plasma glucose [−32.6 mg/dl [−1.8 mmol/L] (–44.2 to –20.9 mg/dl [−2.4 to −1.1 mmol/L])] and postprandial plasma glucose [−67.5 mg/dl [−3.7 mmol/L] (–129.5 to −5.4 mg/dl [−7.1 to −0.3 mmol/L])]. Studies with aerobic training intervention yielded the largest significant mean reduction in HbA1c (−0.75%) and fasting plasma glucose concertation (34.0 mg/dl). Conclusions aerobic training is the most effective modality to reduces HbA1c, fasting and postprandial plasma glucose concentration in patients with DPN. From a metabolic perspective, the magnitude precision range of the reduction in HbA1c is of clinical importance for patients with DPN. This area of research warrants further attention to investigate the impact of various exercise modalities on glycemic control. Registration number CRD42023413687