THE MULTIDIMENSIONAL IMPACT OF HIGH-INTENSITY INTERVAL TRAINING (HIIT) ON GLYCEMIC CONTROL, CARDIORESPIRATORY FITNESS, BODY COMPOSITION, AND METABOLIC AND INFLAMMATORY MARKERS IN PATIENTS WITH TYPE 2 DIABETES: A REVIEW OF EVIDENCE AND CLINICAL IMPLICATION
Abstract
Introduction: Type 2 Diabetes Mellitus (T2DM) is a major global health burden, marked by chronic hyperglycemia and complications. Physical activity is central to management, with High-Intensity Interval Training (HIIT) emerging as a time-efficient, evidence-based approach. This review examines HIIT’s impact on glycemic control, cardiorespiratory fitness, body composition, and inflammation, also addressing safety and feasibility.
Methods: A narrative review was conducted via PubMed using terms such as”Type 2 Diabetes, "“glycemia, "“HbA1c, "“physical activity, " and”HIIT." From forty articles screened, nineteen met inclusion criteria.
Results and Discussion: HIIT effectively improves T2DM outcomes. It lowers HbA1c, fasting and postprandial glucose, and enhances insulin sensitivity and beta-cell function. Compared to moderate-intensity continuous training (MICT), HIIT often yields superior VO₂max improvements. It also reduces BMI, total and visceral fat, and improves lipid profiles. HIIT is associated with lower inflammatory markers. Implementation is feasible and safe, even for older adults, with high adherence and minimal adverse events.
Conclusion: HIIT is a potent non-pharmacological tool in T2DM management, offering benefits across metabolic and cardiovascular domains. Its ability to improve glycemic control, fitness, body composition, and inflammation underscores its clinical relevance. Current evidence supports integrating HIIT into standard care for T2DM patients.
References
Kirwan, J. P., Sacks, J., & Nieuwoudt, S. (2017). The essential role of exercise in the management of type 2 diabetes. Cleveland Clinic Journal of Medicine, 84(7 Suppl 1), S15–S21. https://doi.org/10.3949/ccjm.84.s1.03
Yu, P., Zhu, Z., He, J., Gao, B., Chen, Q., Wu, Y., Zhou, J., Cheng, Y., Ling, J., Zhang, J., Shi, A., Huang, H., Sun, R., Gao, Y., Li, W., Liu, X., Yan, Z. (2023). Effects of high-intensity interval training, moderate-intensity continuous training, and guideline-based physical activity on cardiovascular metabolic markers, cognitive and motor function in elderly sedentary patients with type 2 diabetes (HIIT-DM): A protocol for a randomized controlled trial. Frontiers in Aging Neuroscience, 15, 1211990. https://doi.org/10.3389/fnagi.2023.1211990
Li, M., Li, J., Xu, Y., Gao, J., Cao, Q., Ding, Y., Xin, Z., Lu, M., Li, X., Song, H., Shen, J., Hou, T., He, R., Li, L., Zhao, Z., Xu, M., Lu, J., Wang, T., Wang, S., Lin, H., Zheng, R., Zheng, J., Baker, C. J., Lai, S., Johnson, N. A., Ning, G., Twigg, S. M., Wang, W., Liu, Y., & Bi, Y. (2024). Effect of 5:2 regimens: Energy-restricted diet or low-volume high-intensity interval training combined with resistance exercise on glycemic control and cardiometabolic health in adults with overweight/obesity and type 2 diabetes: A three-arm randomized controlled trial. Diabetes Care, 47(6), 1074–1083. https://doi.org/10.2337/dc24-0241
Quílez Llopiz, P., & Reig García-Galbis, M. (2015). Control glucémico a través del ejercicio físico en pacientes con diabetes mellitus tipo 2; revisión sistemática [Glycemic control through physical exercise in type 2 diabetes: Systematic review]. Nutrición Hospitalaria, 31(4), 1465–1472. https://doi.org/10.3305/nh.2015.31.4.7907
Picard, M., Tauveron, I., Magdasy, S., Benichou, T., Bagheri, R., Ugbolue, U. C., Navel, V., & Dutheil, F. (2021). Effect of exercise training on heart rate variability in type 2 diabetes mellitus patients: A systematic review and meta-analysis. PLoS ONE, 16(5), e0251863. https://doi.org/10.1371/journal.pone.0251863
Hwang, C. L., Lim, J., Yoo, J. K., Kim, H. K., Hwang, M. H., Handberg, E. M., Petersen, J. W., Holmer, B. J., Leey Casella, J. A., Cusi, K., & Christou, D. D. (2019). Effect of all-extremity high-intensity interval training vs. moderate-intensity continuous training on aerobic fitness in middle-aged and older adults with type 2 diabetes: A randomized controlled trial. Experimental Gerontology, 116, 46–53. https://doi.org/10.1016/j.exger.2018.12.013
Qiu, S., Cai, X., Yin, H., Sun, Z., Zügel, M., Steinacker, J. M., & Schumann, U. (2018). Exercise training and endothelial function in patients with type 2 diabetes: A meta-analysis. Cardiovascular Diabetology, 17(1), 64. https://doi.org/10.1186/s12933-018-0711-2
García-Hermoso, A., Ramírez-Vélez, R., Díez, J., González, A., & Izquierdo, M. (2023). Exercise training-induced changes in exerkine concentrations may be relevant to the metabolic control of type 2 diabetes mellitus patients: A systematic review and meta-analysis of randomized controlled trials. Journal of Sport and Health Science, 12(2), 147–157. https://doi.org/10.1016/j.jshs.2022.11.003
Savikj, M., Gabriel, B. M., Alm, P. S., Smith, J., Caidahl, K., Björnholm, M., Fritz, T., Krook, A., Zierath, J. R., & Wallberg-Henriksson, H. (2019). Afternoon exercise is more efficacious than morning exercise at improving blood glucose levels in individuals with type 2 diabetes: A randomised crossover trial. Diabetologia, 62(2), 233–237. https://doi.org/10.1007/s00125-018-4767-z
Mendes, R., Sousa, N., Themudo-Barata, J. L., & Reis, V. M. (2019). High-intensity interval training versus moderate-intensity continuous training in middle-aged and older patients with type 2 diabetes: A randomized controlled crossover trial of the acute effects of treadmill walking on glycemic control. International Journal of Environmental Research and Public Health, 16(21), 4163. https://doi.org/10.3390/ijerph16214163
Kolnes, K. J., Petersen, M. H., Lien-Iversen, T., Højlund, K., & Jensen, J. (2021). Effect of exercise training on fat loss—Energetic perspectives and the role of improved adipose tissue function and body fat distribution. Frontiers in Physiology, 12, 737709. https://doi.org/10.3389/fphys.2021.737709
Gibala, M. J., Little, J. P., Macdonald, M. J., & Hawley, J. A. (2012). Physiological adaptations to low-volume, high-intensity interval training in health and disease. Journal of Physiology, 590(5), 1077–1084. https://doi.org/10.1113/jphysiol.2011.224725
Jin, Y., Wan, K., Liu, C., Cheng, W., & Wang, R. (2024). Mechanisms of exercise intervention in type 2 diabetes: A bibliometric and visualization analysis based on CiteSpace. Frontiers in Endocrinology (Lausanne), 15, 1401342. https://doi.org/10.3389/fendo.2024.1401342
Savikj, M., & Zierath, J. R. (2020). Train like an athlete: Applying exercise interventions to manage type 2 diabetes. Diabetologia, 63(8), 1491–1499. https://doi.org/10.1007/s00125-020-05166-9
Feng, J., Zhang, Q., Chen, B., Chen, J., Wang, W., Hu, Y., Yu, J., & Huang, H. (2024). Effects of high-intensity intermittent exercise on glucose and lipid metabolism in type 2 diabetes patients: A systematic review and meta-analysis. Frontiers in Endocrinology (Lausanne), 15, 1360998. https://doi.org/10.3389/fendo.2024.1360998
de Mello, M. B., Righi, N. C., Schuch, F. B., Signori, L. U., & da Silva, A. M. V. (2022). Effect of high-intensity interval training protocols on VO2max and HbA1c level in people with type 2 diabetes: A systematic review and meta-analysis. Annals of Physical and Rehabilitation Medicine, 65(5), 101586. https://doi.org/10.1016/j.rehab.2021.101586
Poon, E. T., Li, H. Y., Kong, A. P. S., & Little, J. P. (2025). Efficacy of high-intensity interval training in individuals with type 2 diabetes mellitus: An umbrella review of systematic reviews and meta-analyses. Diabetes, Obesity and Metabolism, 27(4), 1719–1734. https://doi.org/10.1111/dom.16220
Liu, J. X., Zhu, L., Li, P. J., Li, N., & Xu, Y. B. (2019). Effectiveness of high-intensity interval training on glycemic control and cardiorespiratory fitness in patients with type 2 diabetes: A systematic review and meta-analysis. Aging Clinical and Experimental Research, 31(5), 575–593. https://doi.org/10.1007/s40520-018-1012-z
Xing, S., Zhang, Y., Chen, Y., Feng, S., Zhang, Y., & Moreira, P. (2025). Comparing the impacts of different exercise interventions on patients with type 2 diabetes mellitus: A literature review and meta-analysis. Frontiers in Endocrinology (Lausanne), 16, 1495131. https://doi.org/10.3389/fendo.2025.1495131
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