Effects of resistance training on glycaemic control in adults with type 2 diabetes mellitus

A narrative review of mechanisms, clinical evidence, and practical application

Abstract

Background. Skeletal muscle is the main site of insulin-mediated glucose disposal, and its loss aggravates insulin resistance in type 2 diabetes mellitus (T2DM).

Aim. To synthesise evidence on the mechanisms, efficacy, comparative and combined effects, training parameters, safety and prescription of resistance training for glycaemic control in adults with T2DM.

Material and methods. A narrative review with a structured search of PubMed/MEDLINE, Scopus and the Cochrane Library (2007-2026), prioritising randomised trials, systematic reviews, meta-analyses and guidelines.

Results. Resistance training improves glycaemic control by increasing or preserving muscle mass, muscle glucose uptake and insulin sensitivity. Meta-analyses report average HbA1c reductions of 0.3-0.6 percentage points, comparable to aerobic training, though findings vary; combined training generally provides the greatest benefit. Evidence on dose is inconsistent; intensity relates to benefit more than volume. Strength gains are consistent; lean-mass effects less so. In one randomised trial, adverse events were mainly musculoskeletal and more frequent than in controls.

Conclusions. Resistance training is effective, generally safe and guideline-endorsed. It should be undertaken 2-3 days per week, individualised, progressed gradually and, where feasible, combined with aerobic exercise. Implementation requires clinician endorsement, referral pathways and attention to adherence in older and higher-risk adults.