Effects of Resistance Exercise Combined with Nutritional Intervention on Blood Glucose Stability in Elderly Patients with Type 2 Diabetes Mellitus with Sarcopenia

doi:10.12114/j.issn.1007-9572.2024.0422

Chinese General Practice ›› 2025, Vol. 28 ›› Issue (21): 2604-2610.DOI: 10.12114/j.issn.1007-9572.2024.0422

Special Issue: 内分泌代谢性疾病最新文章合辑；老年人群健康最新文章合辑

• Original Research • Previous Articles Next Articles

Effects of Resistance Exercise Combined with Nutritional Intervention on Blood Glucose Stability in Elderly Patients with Type 2 Diabetes Mellitus with Sarcopenia

1. Health Management Clinic, Shanghai Huangpu District Yuyuan Community Health Service Center, Shanghai 200010, China
2. Ward Area 2, Shanghai Huangpu District Geriatric Care Hospital, Shanghai 200010, China
3. Department of Rehabilitation Medicine, Shanghai Huangpu District Geriatric Care Hospital, Shanghai 200010, China
4. Department of Endocrinology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China

Received:2024-06-10 Revised:2024-10-10 Published:2025-07-20 Online:2025-06-05
Contact: JIANG Boren

抗阻力运动联合营养干预对老年2型糖尿病合并肌少症患者血糖稳定性影响的临床研究

1．200010　上海市黄浦区豫园街道社区卫生服务中心健康管理门诊
2．200010　上海市黄浦区老年护理医院二病区
3．200010　上海市黄浦区老年护理医院康复医学科
4．200011　上海市，上海交通大学医学院附属第九人民医院内分泌科

通讯作者: 姜博仁
作者简介:
作者贡献：
王颖提出主要研究目标，负责研究的构思与设计，撰写论文；颜轶隽负责研究对象的选取；刘蕾、胡毓敏、张扬、刘凯负责研究过程的实施，进行数据收集与整理；姜博仁负责统计学分析，文章的质量控制与审查，对文章整体负责，监督管理。
基金资助:
中华国际医学交流基金(Z-2017-26-1902); 上海市黄浦区卫生健康委员会科研项目(HLM202135)

Abstract

Abstract:

Background

Type 2 diabetes mellitus (T2DM) and sarcopenia are common conditions that significantly impact the health of elderly individuals. However, clinical intervention studies focusing on T2DM with sarcopenia are relatively limited in China.

Objective

To investigate the effects of resistance exercise combined with nutritional intervention on skeletal muscle mass and blood glucose stability in elderly T2DM patients with sarcopenia at a primary care hospital.

Methods

A total of 61 elderly T2DM patients with sarcopenia (aged≥65) who attended the Shanghai Huangpu District Yuyuan Community Health Service Center between February 2022 and May 2024 were enrolled in the study. The patients were randomly assigned to a control group (n=30) and an intervention group (n=31) . All patients were managed by routine diabetes education, and those in the intervention group additionally received resistance exercise combined with nutritional intervention. A 12-week intervention was performed to compare the time in glucose target range (TIR) , mean amplitude of glycemic excursions (MAGE) , appendicular skeletal muscle mass index (ASMI) , grip strength, and 6-meter walking speed. The correlations between grip strength, 6-meter walking speed, ASMI with TIR and MAGE were assessed before and after the intervention.

Results

Before the intervention, there was no significant difference in parameters between the two groups (P<0.05) . After the 12-week intervention, significantly decreased TIR was detected in the control group (P<0.05) , and significantly improved glycated hemoglobin (HbA_1c) , TIR, MAGE, and 6-meter walking speed and grip strength were found in the intervention group (P<0.05) , with statistical differences between groups (P<0.05) . Before and after intervention, the change of HbA1c, TIR, MAGE, and 6-meter walking speed, ASMI, and grip strength showed statistically significant differences between control and intervention group (P<0.05) . The change in 6-meter walking speed was positively correlated with the change in TIR (r_s=0.411, P<0.05) , and negatively correlated with changes in MAGE (r_s=-0.472, P<0.05) and HbA_1c (r_s=-0.315, P<0.05) . No adverse events were reported.

Conclusion

Resistance exercise combined with nutritional intervention can not only increase muscle mass and physical function, but also improve blood glucose stability and TIR in elderly T2DM patients with sarcopenia. Our interventions are simple, easy to implement, with high safety, making them valuable for promotion in primary healthcare setting.

Key words: Resistance training, Exercise therapy, Diabetes mellitus, type 2, Sarcopenia, Muscle, skeletal, Glycemic control, Blood glucose stability, Community, Randomized controlled trial

摘要：

背景

2型糖尿病与肌少症是两种危害老年人健康的常见病，目前国内关于2型糖尿病合并肌少症的临床干预研究较少。

目的

探讨在基层医院开展抗阻力运动联合营养干预对合并肌少症的老年2型糖尿病患者骨骼肌质量及血糖稳定性的影响。

方法

选取2022年2月—2024年5月于上海市黄浦区豫园街道社区卫生服务中心就诊的61例老年2型糖尿病合并肌少症的老年患者（≥65岁）作为研究对象，随机分为对照组（30例）及试验组（31例）。对照组进行常规糖尿病健康教育，试验组在对照组基础上进行抗阻力运动联合营养干预，干预12周后，比较两组患者的葡萄糖在目标范围内的时间（TIR）、平均血糖波动幅度（MAGE）、四肢骨骼肌质量指数（ASMI）、握力（kg）、6 m步速（m/s），并分析干预前后ASMI、握力、6 m步速改善程度与TIR、MAGE改善程度的相关性。

结果

干预前，两组一般资料比较，差异均无统计学意义（P>0.05）。干预12周后，对照组TIR较干预前降低（P<0.05）；试验组糖化血红蛋白（HbA_1c）、TIR、MAGE、6 m步速、优势手握力较干预前改善（P<0.05）。干预12周后，两组HbA_1c、TIR、MAGE、ASMI、6 m步速、优势手握力变化幅度比较，差异均有统计学意义（P<0.05）。6 m步速变化幅度与TIR变化幅度呈正相关（r_s=0.411，P<0.05），与MAGE（r_s=-0.472，P<0.05）和HbA_1c（r_s=-0.315，P<0.05）变化幅度呈负相关。两组均无不良事件发生。

结论

对合并肌少症的老年2型糖尿病患者，抗阻力运动联合营养干预不但可以增加肌肉量和身体功能，而且可以改善血糖稳定性和血糖达标时间。抗阻力运动和营养干预简便易行，安全性高，值得在基层医院推广应用。

关键词: 抗阻训练, 运动疗法, 糖尿病，2型, 肌少症, 肌，骨骼, 血糖控制, 血糖稳定性, 社区, 随机对照试验

CLC Number:

R 455

WANG Ying,YAN Yijun,LIU Lei, et al. Effects of Resistance Exercise Combined with Nutritional Intervention on Blood Glucose Stability in Elderly Patients with Type 2 Diabetes Mellitus with Sarcopenia[J]. Chinese General Practice, 2025, 28(21): 2604-2610. DOI: 10.12114/j.issn.1007-9572.2024.0422.
王颖,颜轶隽,刘蕾等. 抗阻力运动联合营养干预对老年2型糖尿病合并肌少症患者血糖稳定性影响的临床研究[J]. 中国全科医学, 2025, 28(21): 2604-2610. DOI: 10.12114/j.issn.1007-9572.2024.0422.

Figures/Tables 4

References 34

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组别	例数	性别[例（%）]		年龄（±s，岁）	受教育程度[例（%）]			病程[例（%）]
组别	例数	男	女	年龄（±s，岁）	小学及以下	中学	大学及以上	1~<5年	5~10年	>10年
对照组	30	18（60.0）	12（40.0）	76.8±7.8	6（20.0）	18（60.0）	6（20.0）	2（6.7）	1（3.3）	27（90.0）
试验组	31	14（45.2）	17（54.8）	73.5±5.3	1（3.2）	24（77.4）	6（19.4）	6（19.4）	2（6.5）	23（74.2）
t（χ²）值		1.346^a		1.927	4.413^a			2.638^a
P值		0.246		0.060	0.110			0.267
组别	体脂率（±s，%）	BMI （±s，kg/m²）	血红蛋白（±s，g/L）	空腹血糖（±s，mmol/L）	丙氨酸氨基转移酶（±s，U/L）	肌酐（±s，μmol/L）
对照组	27.60±6.70	21.0±2.3	128.77±10.87	7.41±1.44	18.97±10.98	75.13±25.09
试验组	27.79±5.35	21.3±1.8	126.03±12.36	7.30±1.69	28.48±27.91	70.26±16.55
t（χ²）值	-0.123	-0.501	0.916	0.291	-1.763	0.884
P值	0.903	0.618	0.363	0.772	0.086	0.380

组别	例数	性别[例（%）]		年龄（±s，岁）	受教育程度[例（%）]			病程[例（%）]
组别	例数	男	女	年龄（±s，岁）	小学及以下	中学	大学及以上	1~<5年	5~10年	>10年
对照组	30	18（60.0）	12（40.0）	76.8±7.8	6（20.0）	18（60.0）	6（20.0）	2（6.7）	1（3.3）	27（90.0）
试验组	31	14（45.2）	17（54.8）	73.5±5.3	1（3.2）	24（77.4）	6（19.4）	6（19.4）	2（6.5）	23（74.2）
t（χ²）值		1.346^a		1.927	4.413^a			2.638^a
P值		0.246		0.060	0.110			0.267
组别	体脂率（±s，%）	BMI （±s，kg/m²）	血红蛋白（±s，g/L）	空腹血糖（±s，mmol/L）	丙氨酸氨基转移酶（±s，U/L）	肌酐（±s，μmol/L）
对照组	27.60±6.70	21.0±2.3	128.77±10.87	7.41±1.44	18.97±10.98	75.13±25.09
试验组	27.79±5.35	21.3±1.8	126.03±12.36	7.30±1.69	28.48±27.91	70.26±16.55
t（χ²）值	-0.123	-0.501	0.916	0.291	-1.763	0.884
P值	0.903	0.618	0.363	0.772	0.086	0.380

组别	例数	BMI（±s，kg/m²）					HbA_1c（±s，%）
组别	例数	干预前	干预后	变化幅度（%）	t_配对值	P值	干预前	干预后	变化幅度（%）	t_配对值	P值
对照组	30	21.0±2.3	21.0±2.2	-0.57±4.82	0.723	0.475	6.98±0.87	7.26±1.40	4.30±18.20	-1.268	0.215
试验组	31	21.3±1.8	21.6±2.0	1.54±3.78	-2.192	0.036	7.23±0.92	6.75±0.99	-6.34±10.80	3.398	0.002
t（Z）值		-0.501	-1.140	-1.900			-1.100	1.656	2.762
P值		0.618	0.259	0.062			0.276	0.103	0.008
组别	TIR（±s，%）					MAGE（±s）					ASMI[M（P₂₅，P₇₅），kg/m²]
组别	干预前	干预后	变化幅度（%）	t_配对值	P值	干预前	干预后	变化幅度（%）	t_配对值	P值	干预前	干预后	变化幅度（%）	Z_配对值	P值
对照组	75.58± 16.80	61.62± 23.14	-16.53± 27.87	3.243	0.003	5.86± 1.73	6.19± 1.88	8.70± 28.11	-1.232	0.228	5.60 （5.18，6.53）	5.60 （5.20，6.50）	0 （-1.96，0）	-1.620^a	0.105
试验组	69.58± 18.74	76.77± 15.54	15.72± 27.60	-2.532	0.017	6.80± 2.12	5.37± 2.01	-17.91± 30.57	3.444	0.002	6.60 （5.40，6.98）	6.60 （5.50，6.90）	0 （0，1.85）	-0.708^a	0.479
t（Z）值	1.319	-3.011	-4.540			-1.901	1.634	3.536			-1.601^a	-2.167^a	-2.269^a
P值	0.192	0.004	<0.001			0.062	0.107	0.001			0.109	0.030	0.023
组别	优势手握力[M（P₂₅，P₇₅），kg]					6 m步速（m/s）
组别	干预前	干预后	变化幅度（%）	Z_配对值	P值	干预前（±s）	干预后（±s）	变化幅度[M（P₂₅，P₇₅），%]	t_配对值	P值
对照组	18.85（16.38，26.78）	19.05（16.50，25.55）	0（-3.59，1.07）	-1.343 ^a	0.179	0.95±0.11	0.95±0.11	0（-2.06，2.05）	-0.224	0.824
试验组	20.20（15.80，27.10）	22.10（16.80，28.00）	3.70（1.43，8.57）	-4.255^a	<0.01	0.95±0.09	1.03±0.10	5.10（3.77，12.50）	5.479	<0.01
t（Z）值	-0.289^a	-1.184^a	-4.263^a			-0.213	-3.111	-4.550^a
P值	0.236	<0.01				0.832	0.003	<0.01

组别	例数	BMI（±s，kg/m²）					HbA_1c（±s，%）
组别	例数	干预前	干预后	变化幅度（%）	t_配对值	P值	干预前	干预后	变化幅度（%）	t_配对值	P值
对照组	30	21.0±2.3	21.0±2.2	-0.57±4.82	0.723	0.475	6.98±0.87	7.26±1.40	4.30±18.20	-1.268	0.215
试验组	31	21.3±1.8	21.6±2.0	1.54±3.78	-2.192	0.036	7.23±0.92	6.75±0.99	-6.34±10.80	3.398	0.002
t（Z）值		-0.501	-1.140	-1.900			-1.100	1.656	2.762
P值		0.618	0.259	0.062			0.276	0.103	0.008
组别	TIR（±s，%）					MAGE（±s）					ASMI[M（P₂₅，P₇₅），kg/m²]
组别	干预前	干预后	变化幅度（%）	t_配对值	P值	干预前	干预后	变化幅度（%）	t_配对值	P值	干预前	干预后	变化幅度（%）	Z_配对值	P值
对照组	75.58± 16.80	61.62± 23.14	-16.53± 27.87	3.243	0.003	5.86± 1.73	6.19± 1.88	8.70± 28.11	-1.232	0.228	5.60 （5.18，6.53）	5.60 （5.20，6.50）	0 （-1.96，0）	-1.620^a	0.105
试验组	69.58± 18.74	76.77± 15.54	15.72± 27.60	-2.532	0.017	6.80± 2.12	5.37± 2.01	-17.91± 30.57	3.444	0.002	6.60 （5.40，6.98）	6.60 （5.50，6.90）	0 （0，1.85）	-0.708^a	0.479
t（Z）值	1.319	-3.011	-4.540			-1.901	1.634	3.536			-1.601^a	-2.167^a	-2.269^a
P值	0.192	0.004	<0.001			0.062	0.107	0.001			0.109	0.030	0.023
组别	优势手握力[M（P₂₅，P₇₅），kg]					6 m步速（m/s）
组别	干预前	干预后	变化幅度（%）	Z_配对值	P值	干预前（±s）	干预后（±s）	变化幅度[M（P₂₅，P₇₅），%]	t_配对值	P值
对照组	18.85（16.38，26.78）	19.05（16.50，25.55）	0（-3.59，1.07）	-1.343 ^a	0.179	0.95±0.11	0.95±0.11	0（-2.06，2.05）	-0.224	0.824
试验组	20.20（15.80，27.10）	22.10（16.80，28.00）	3.70（1.43，8.57）	-4.255^a	<0.01	0.95±0.09	1.03±0.10	5.10（3.77，12.50）	5.479	<0.01
t（Z）值	-0.289^a	-1.184^a	-4.263^a			-0.213	-3.111	-4.550^a
P值	0.236	<0.01				0.832	0.003	<0.01

项目	TIR变化幅度		MAGE变化幅度		HbA_1c变化幅度
项目	r_s值	P值	r_s值	P值	r_s值	P值
ASMI变化幅度	0.24	0.063	-0.139	0.286	-0.236	0.067
6 m步速变化幅度	0.411	0.001	-0.472	<0.001	-0.315	0.013

Effects of Resistance Exercise Combined with Nutritional Intervention on Blood Glucose Stability in Elderly Patients with Type 2 Diabetes Mellitus with Sarcopenia

抗阻力运动联合营养干预对老年2型糖尿病合并肌少症患者血糖稳定性影响的临床研究

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