不同强度运动对2型糖尿病患者糖脂代谢影响的系统综述

Systematic Review on the Effects of Different Exercise Intensities on Glycemic and Lipid Metabolism in Patients with Type 2 Diabetes Mellitus

摘要: 近30多年来，我国糖尿病显著增加，糖尿病人群中2型糖尿病(T2DM)占90%以上 。其发病率和并发症负担持续攀升。运动锻炼在糖尿病患者的综合管理中占重要地位，运动强度差异对糖脂代谢的调控效果成为研究热点。本综述系统梳理了近五年不同强度运动干预T2DM糖脂代谢的研究进展，涵盖运动强度分类、作用机制、临床效果比较、时间生物学影响、联合干预策略及未来研究方向。最新研究表明，中等强度持续训练(MICT)和高强度间歇训练(HIIT)均可显著改善血糖控制，其中HIIT在提升胰岛素敏感性和高密度脂蛋白胆固醇(HDL-C)方面更具优势，而循环抗阻训练(CRT)则对降低甘油三酯(TG)效果显著。最新研究发现，下午进行中高强度运动可使糖化血红蛋白(HbA1c)下降幅度增加30%~50%，且这一效应独立于运动量和强度。分子机制研究表明，不同强度运动通过差异激活AMPK/PGC-1α信号通路调节骨骼肌葡萄糖摄取，其中HIIT可显著增加乳酸生成，通过血脑屏障刺激BDNF表达，进而改善中枢胰岛素敏感性。未来研究应关注运动与新型降糖药的协同效应、基于昼夜节律的时间优化策略以及人工智能辅助的动态处方系统，以实现T2DM管理的精准化和个体化。

Abstract: Over the past three-plus decades, the prevalence of diabetes has increased remarkably in China, with type 2 diabetes mellitus (T2DM) accounting for more than 90% of all diabetic cases. Its incidence rate and the burden of complications have been on a continuous rise. Exercise plays a crucial role in the comprehensive management of diabetic patients, and the regulatory effects of different exercise intensities on glucose and lipid metabolism have become a research focus. This review systematically summarizes the research progress in the past five years regarding the intervention of different-intensity exercise on glucose and lipid metabolism in T2DM patients, covering exercise intensity classification, mechanism of action, comparison of clinical effects, influence of chronobiology, combined intervention strategies, and future research directions. Latest studies have shown that both moderate-intensity continuous training (MICT) and high-intensity interval training (HIIT) can significantly improve blood glucose control. Among them, HIIT has more advantages in enhancing insulin sensitivity and high-density lipoprotein cholesterol (HDL-C), while circuit resistance training (CRT) shows a significant effect in reducing triglycerides (TG). A recent study found that performing moderate-to-high intensity exercise in the afternoon can increase the reduction range of glycated hemoglobin (HbA1c) by 30%~50%, and this effect is independent of exercise volume and intensity. Molecular mechanism studies indicate that different-intensity exercises regulate skeletal muscle glucose uptake by differentially activating the AMPK/PGC-1α signaling pathway. Specifically, HIIT can significantly increase lactic acid production, which crosses the blood-brain barrier to stimulate the expression of brain-derived neurotrophic factor (BDNF), thereby improving central insulin sensitivity. Future research should focus on the synergistic effects of exercise and new hypoglycemic drugs, time optimization strategies based on circadian rhythm, and artificial intelligence-assisted dynamic prescription systems, so as to achieve precise and individualized management of T2DM.