Exercise-Based Interventions in Type 2 Diabetes Mellitus: Effects on Glycemic Control and Metabolic Adaptations

A Narrative Review

Abstract

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycemia, insulin resistance, and progressive β-cell dysfunction, contributing to increased cardiovascular and metabolic complications. Alongside pharmacological treatment, structured physical activity is a fundamental component of contemporary diabetes management, owing to its broad metabolic and functional benefits.

This narrative review aimed to summarize current evidence regarding exercise-based interventions in T2DM, with particular emphasis on their effects on glycemic control, physiological mechanisms, and implications for individualized exercise prescription. A literature review was conducted using peer-reviewed publications published between 2016 and 2026 identified through PubMed/MEDLINE, Scopus, and Google Scholar. The analyzed literature included randomized controlled trials, systematic reviews, meta-analyses, umbrella reviews, mechanistic studies, consensus statements, clinical guidelines, and selected intervention studies related to exercise physiology and diabetes management.

Current evidence indicates that aerobic training, resistance training, high-intensity interval training (HIIT), and combined exercise modalities improve glycemic control, insulin sensitivity, and cardiometabolic outcomes through distinct physiological pathways. Exercise-induced adaptations include enhanced skeletal muscle glucose uptake, improved insulin signaling, increased GLUT4 translocation, and mitochondrial adaptations.

Combined exercise programs appear to provide the most consistent metabolic benefits, whereas HIIT may represent a time-efficient alternative for selected individuals. These findings support individualized exercise prescription as an important strategy for optimizing long-term management of T2DM.