Date of Graduation

Summer 8-10-2013

Degree Type

Capstone Project

Degree Name

Master of Science in Physician Assistant Studies

Abstract

Background: Type 2 diabetes mellitus is a growing disorder throughout the world. Two of the major treatment modalities are used concurrently to fight inadequate glycemic control is exercise and diabetic medications. Metformin and rosiglitazone are diabetic medications known to improve glycemic control. Metformin lowers exercise capacity in diabetics while rosiglitazone improves exercise capacity. Given the impact of metformin and rosiglitazone on exercise capacity, the overall improvements in glycemic control, when used with a concurrent exercise program, needs to be examined.

Method: An exhaustive search of available medical literature was conducted using Medline-OVID, EBSCO-CINAHL and Web of Science using the keywords: type 2 diabetes mellitus, metformin, rosiglitazone, insulin resistance and exercise. Relevant articles were assessed for quality using GRADE.

Results: The search resulted in two studies that met inclusion criteria to be in this systematic review. The first study was a controlled trial with 32 participants and demonstrated that metformin does not accentuate the insulin sensitivity of exercise alone. The second study was a randomized controlled trial with 100 participants and demonstrated that rosiglitazone plus exercise improved glycemic control more than either treatment alone.

Conclusion: Although the amount and quality of evidence on the subject is lacking, these results have implications for clinical practice when individualizing patient treatment plans. Metformin and exercise do not have additive effects on glycemic control while rosiglitazone and exercise complement each other and do provide additive effects over time on glycemic control. Further research is needed to expand on the interactions between exercise and these diabetic medications on glycemic control, HbA1c and fasting glucose levels.

Keywords: Type 2 diabetes mellitus, metformin, rosiglitazone, exercise, insulin resistance and glycemic control.

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