{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T18:47:03Z","timestamp":1792435623268,"version":"4.5.0"},"reference-count":32,"publisher":"Wiley","issue":"23","license":[{"start":{"date-parts":[[2024,3,24]],"date-time":"2024-03-24T00:00:00Z","timestamp":1711238400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009708","name":"Novo Nordisk Fonden","doi-asserted-by":"publisher","award":["NNF19OC0055072"],"award-info":[{"award-number":["NNF19OC0055072"]}],"id":[{"id":"10.13039\/501100009708","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["physoc.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Physiology"],"published-print":{"date-parts":[[2024,12]]},"abstract":"\n Abstract<\/jats:title>\n \n Exercise is recommended in the treatment of type 2 diabetes and can improve insulin sensitivity. However, previous evidence suggests that exercise at different times of the day in people with type 2 diabetes may have opposing outcomes on glycaemia. Metformin is the most commonly prescribed initial pharmacological intervention in type 2 diabetes, and may alter adaptions to exercise. It is unknown if there is an interaction between metformin and diurnal exercise outcomes. We aimed to investigate glycaemic outcomes of moderate intensity morning\n vs<\/jats:italic>\n . evening exercise in people with type 2 diabetes being prescribed metformin monotherapy. In this study, nine males and nine females with type 2 diabetes undergoing metformin monotherapy (age 61\u00a0\u00b1\u00a08.2\u00a0years, mean\u00a0\u00b1\u00a0SD) completed a 16\u2010week crossover trial including 2\u2010week baseline recording, 6\u00a0weeks randomly assigned to a morning exercise (07.00\u201310.00\u00a0h) or evening exercise (16.00\u201319.00\u00a0h) and a 2\u2010week wash\u2010out period. Exercise arms consisted of 30\u00a0min of walking at 70% of estimated max heart rate every other day. Glucose levels were measured with continuous glucose monitors and activity measured by wrist\u2010worn monitors. Food\u2010intake was recorded by 4\u2010day food diaries during baseline, first and last 2\u00a0weeks of each exercise arm. There was no difference in exercise intensity, total caloric intake or total physical activity between morning and evening arms. As primary outcomes, acute (24\u00a0h) glucose area under the curve (AUC), was lower (\n P<\/jats:italic>\n \u00a0=\u00a00.02) after acute morning exercise (180.6\u00a0\u00b1\u00a068.4\u00a0mmol\/l) compared to baseline (210.3\u00a0\u00b1\u00a076.7\u00a0mmol\/l); and there were no differences identified for glucose (mmol\/l) between baseline, morning and evening exercise at any specific time point when data were analysed with two\u2010way ANOVA. As secondary outcomes, acute glucose AUC was significantly lower (\n P<\/jats:italic>\n \u00a0=\u00a00.01) in participants taking metformin before breakfast (152.5\u00a0\u00b1\u00a029.95\u00a0mmol\/l) compared with participants taking metformin after breakfast (227.2\u00a0\u00b1\u00a061.51\u00a0mmol\/l) only during the morning exercise arm; and during weeks 5\u20136 of the exercise protocol, glucose AUC was significantly lower (\n P<\/jats:italic>\n \u00a0=\u00a00.04) for participants taking metformin before breakfast (168.8\u00a0\u00b1\u00a015.8\u00a0mmol\/l), rather than after breakfast (224.5\u00a0\u00b1\u00a052.0\u00a0mmol\/l), only during morning exercise. Our data reveal morning moderate exercise acutely lowers glucose levels in people with type 2 diabetes being prescribed metformin. This difference appears to be driven by individuals that consumed metformin prior to breakfast rather than after breakfast. This beneficial effect upon glucose levels of combined morning exercise and pre\u2010breakfast metformin persisted through the final 2\u00a0weeks of the trial. Our findings suggest that morning moderate intensity exercise combined with pre\u2010breakfast metformin intake may benefit the management of glycaemia in people with type 2 diabetes.\n \n \n image<\/jats:alt-text>\n <\/jats:graphic>\n <\/jats:boxed-text>\n <\/jats:p>\n <\/jats:sec>\n \n Key points<\/jats:title>\n \n \n \n Morning moderate exercise acutely lowers glucose levels in people with type 2 diabetes being prescribed metformin.<\/jats:p>\n <\/jats:list-item>\n \n This difference appears to be driven by individuals that consumed metformin prior to breakfast rather than after breakfast.<\/jats:p>\n <\/jats:list-item>\n \n Morning exercise combined with pre\u2010breakfast metformin persistently reduced glucose compared to morning exercise combined with post\u2010breakfast metformin through the final week (week 6) of the intervention.<\/jats:p>\n <\/jats:list-item>\n \n Our study suggests it may be possible to make simple changes to the time that people with type 2 diabetes take metformin and perform exercise to improve their blood glucose.<\/jats:p>\n <\/jats:list-item>\n <\/jats:list>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1113\/jp285722","type":"journal-article","created":{"date-parts":[[2024,3,24]],"date-time":"2024-03-24T11:40:33Z","timestamp":1711280433000},"page":"6491-6506","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Morning exercise and pre\u2010breakfast metformin interact to reduce glycaemia in people with type 2 diabetes: a randomized crossover trial"],"prefix":"10.1113","volume":"602","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8975-8798","authenticated-orcid":false,"given":"Brenda J. Pe\u00f1a","family":"Carrillo","sequence":"first","affiliation":[{"name":"Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences & Nutrition University of Aberdeen Aberdeen UK"},{"name":"The Rowett Institute, School of Medicine, Medical Sciences & Nutrition University of Aberdeen Aberdeen UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3912-6287","authenticated-orcid":false,"given":"Emily","family":"Cope","sequence":"additional","affiliation":[{"name":"Aberdeen Cardiovascular and Diabetes Centre, School of Medicine, Medical Sciences & Nutrition University of Aberdeen Aberdeen UK"},{"name":"The Rowett Institute, School of Medicine, Medical Sciences & Nutrition University of Aberdeen Aberdeen UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5084-180X","authenticated-orcid":false,"given":"Sati","family":"Gurel","sequence":"additional","affiliation":[{"name":"The 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