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Accepted manuscript

Exercise, nutrition, and medicine timing in metabolic health: implications for management of Type 2 Diabetes

Published online by Cambridge University Press:  18 November 2024

Brenda J. Peña Carrillo
Affiliation:
Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK, AB25 2ZD The Rowett Institute, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
Rashmi Sivasengh
Affiliation:
Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK, AB25 2ZD The Rowett Institute, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
Alexandra M. Johnstone
Affiliation:
The Rowett Institute, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
Brendan M. Gabriel*
Affiliation:
Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK, AB25 2ZD The Rowett Institute, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, AB25 2ZD, UK
*
*Corresponding author: Dr B.M. Gabriel, The Rowett Institute, University of Aberdeen, Ashgrove Road West, Aberdeen, AB25 2ZD, UK; [email protected]
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Abstract

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Chrono-medicine considers circadian biology in disease management, including combined lifestyle and medicine interventions. Exercise and nutritional interventions are well-known for their efficacy in managing Type 2 Diabetes, and metformin remains a widely used pharmacological agent. However, metformin may reduce exercise capacity and interfere with skeletal muscle adaptations, creating barriers to exercise adherence. Research into optimising the timing of exercise has shown promise, particularly for glycaemic management in people with Type 2 Diabetes. Aligning exercise timing with circadian rhythms and nutritional intake may maximise benefits. Nutritional timing also plays a crucial role in glycaemic control. Recent research suggests that not only what we eat but when we eat significantly impacts glycaemic control, with strategies like time-restricted feeding (TRF) showing promise in reducing caloric intake, improving glycaemic regulation, and enhancing overall metabolic health. These findings suggest that meal timing could be an important adjunct to traditional dietary and exercise approaches in managing diabetes and related metabolic disorders. When taking a holistic view of Diabetes management and the diurnal environment, one must also consider the circadian biology of medicines. Metformin has a circadian profile in plasma, and our recent study suggests that morning exercise combined with pre-breakfast metformin intake reduces glycaemia more effectively than post-breakfast intake. In this review, we aim to explore the integration of circadian biology into Type 2 Diabetes management by examining the timing of exercise, nutrition, and medication. In conclusion, chrono-medicine offers a promising, cost-effective strategy for managing Type 2 Diabetes. Integrating precision timing of exercise, nutrition, and medication into treatment plans requires considering the entire diurnal environment, including lifestyle and occupational factors, to develop comprehensive, evidence-based healthcare strategies.

Type
Review Article
Copyright
© The Authors 2024. Published by Cambridge University Press on behalf of The Nutrition Society