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However, acute effects\/benefits of cold-induced shivering on glucose homeostasis in metabolically compromised individuals are unknown. Here, we aimed to determine whether cold exposure at two different intensities improves 24 h glucose homeostasis in individuals with prediabetes and type 2 diabetes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      In a randomised crossover trial conducted in the South Limburg\/Maastricht region of the Netherlands, men and postmenopausal women with prediabetes (\n                      <jats:italic>n<\/jats:italic>\n                      =12) and stable type 2 diabetes (\n                      <jats:italic>n<\/jats:italic>\n                      =12), aged 40\u201375 years, body mass index \u226527 and \u226435 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      , non-smoking and sedentary, underwent two whole-body cold exposure sessions using a water-perfused suit. Session order was randomised using an online randomisation tool (randomizer.org); participants were masked to the cold exposure intensity received, but investigators were not. Sessions were designed to elicit ~1.5-fold (mild, 15\u00b0C) and ~2.5-fold (moderate, 4\u00b0C) increases in resting metabolic rate (RMR). Continuous glucose monitoring assessed interstitial glucose concentrations over 24 h periods before and after each intervention, with controlled diet and activity. Shivering was confirmed via indirect calorimetry and electromyography.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      In both study groups and periods, RMR increased significantly vs baseline (\n                      <jats:italic>p<\/jats:italic>\n                      &lt;0.001 for all). In prediabetes, the increase in the final 1 h of cold was 1.53\u00a0\u00d7\u00a0RMR in mild and 1.94\u00a0\u00d7\u00a0RMR in moderate cold. In type 2 diabetes, the increase was 1.57\u00a0\u00d7\u00a0RMR and 2.09\u00a0\u00d7\u00a0RMR in the final 1 h of mild and moderate cold, respectively. In prediabetes, neither mild nor moderate cold exposure altered mean 24 h glucose levels. In contrast, after mild cold exposure the type 2 diabetes group exhibited a significant reduction in mean 24 h glucose levels (\u22120.6\u00a0\u00b1\u00a00.5 mmol\/l,\n                      <jats:italic>p<\/jats:italic>\n                      =0.003) and fasting glucose (\u22120.6\u00a0\u00b1\u00a00.8 mmol\/l,\n                      <jats:italic>p<\/jats:italic>\n                      =0.019), as well as an increase in time in normal range (+8.8\u00a0\u00b1\u00a010.3%,\n                      <jats:italic>p<\/jats:italic>\n                      =0.013) and reduced time in hyperglycaemia (\u221210.9\u00a0\u00b1\u00a012.9%,\n                      <jats:italic>p<\/jats:italic>\n                      =0.014). Moderate cold did not significantly affect any of the glucose outcomes in type 2 diabetes. Baseline fasting glucose, age and ALT levels were predictors of the glucose-lowering response, suggesting greater benefits in individuals who have higher baseline glucose levels, are younger and\/or have more optimal liver health, i.e. lower ALT.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions\/interpretation<\/jats:title>\n                    <jats:p>Acute mild cold exposure with shivering reduced 24 h glucose levels in individuals with type 2 diabetes. No changes were observed in prediabetes. The observed effects appear to depend on baseline metabolic status rather than acute substrate utilisation during cold exposure. These findings support the potential of cold exposure as an adjunct non-pharmacological therapy for type 2 diabetes, although further mechanistic studies and validation in larger cohorts are warranted.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration<\/jats:title>\n                    <jats:p>ClinicalTrials.gov NCT05576025<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Funding<\/jats:title>\n                    <jats:p>Dutch Organisation for Knowledge and Innovation in Health, Healthcare and Well-being (ZonMw): 09120012010062<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00125-026-06809-z","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T12:40:20Z","timestamp":1784551220000},"page":"2922-2937","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Acute mild cold exposure with shivering reduces 24 h glucose levels in individuals with type 2 diabetes but not prediabetes"],"prefix":"10.1007","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6216-9485","authenticated-orcid":false,"given":"Dzhansel","family":"Hashim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna A.","family":"J\u00f6rgensen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3485-7881","authenticated-orcid":false,"given":"Tineke","family":"van de Weijer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6805-0985","authenticated-orcid":false,"given":"Denis P.","family":"Blondin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0973-847X","authenticated-orcid":false,"given":"Patrick","family":"Schrauwen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0265-0870","authenticated-orcid":false,"given":"Joris","family":"Hoeks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"key":"6809_CR1","doi-asserted-by":"publisher","first-page":"109119","DOI":"10.1016\/j.diabres.2021.109119","volume":"183","author":"H Sun","year":"2022","unstructured":"Sun H, Saeedi P, Karuranga S et al (2022) IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. 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Hutten and D. Flengas to data collection and thank them for their valuable assistance (Department of Nutrition and Movement Sciences, NUTRIM Institute of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands). The content of this article was partially presented during the 1st EASD Early Career Academy Meeting and the Dutch Translational Metabolism Conference in 2025.","order":1,"name":"Ethics","label":"Acknowledgements","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"The current study was registered at ClinicalTrials.gov on 12 December 2022 (registration no. NCT05576025; URL:\n                      \n                      ). Information regarding the trial protocol, statistical analysis plan, randomisation list, source data and any other study materials can be accessed upon request to the corresponding author.","order":2,"name":"Ethics","label":"Data availability","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Funded by the Dutch Organisation for Knowledge and Innovation in Health, Healthcare and Well-being (ZonMw):\u00a009120012010062.","order":3,"name":"Ethics","label":"Funding","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"PS is a member of the editorial board of\n                      Diabetologia.\n                      He was not involved in the handling or decision-making process of the manuscript. The authors declare that there are no other relationships or activities that might bias, or be perceived to bias, their work.","order":4,"name":"Ethics","label":"Authors' relationships and activities","group":{"name":"EthicsHeading","label":"Ethics"}},{"value":"Co-authors contributed to this work as follows: JH, PS, DPB and DH conceptualised the study; DH and TVDW collected the data; DH and JAJ curated and analysed the data; JAJ performed the plasma metabolite measurements; DH drafted the manuscript; JH, PS, DPB, DH, JAJ and TVDW interpreted the data and reviewed and edited the manuscript. All authors approved the final version of the manuscript. JH is responsible for the integrity of the work as a whole.","order":5,"name":"Ethics","label":"Contribution statement","group":{"name":"EthicsHeading","label":"Ethics"}}]}}