Changes in glucose metabolism and intestinal flora in patients with type 2 diabetes mellitus after high-intensity intermittent exercise

doi:10.12307/2025.240

Abstract

Abstract: BACKGROUND: Exercise has a regulatory effect on intestinal flora and glucose metabolism, but the effects of high-intensity intermittent exercise on intestinal flora and glucose metabolism in patients with type 2 diabetes mellitus are unclear.
OBJECTIVE: To investigate the effects of high-intensity intermittent exercise on glucose metabolism and intestinal flora in patients with type 2 diabetes mellitus.
METHODS: Eleven patients with type 2 diabetes mellitus were recruited, among which, two were lost to the follow-up and nine were finally enrolled. High-intensity intermittent exercise intervention was conducted 3 times per week for 6 continuous weeks. Fasting blood and fecal samples were collected before and after the intervention. Glucose metabolism indexes were detected in the blood samples, and intestinal flora was detected in the fecal samples. Changes in glucose metabolism indexes and intestinal flora indexes of the patients with type 2 diabetes mellitus before and after the intervention were compared.
RESULTS AND CONCLUSION: After 6 weeks of high-intensity intermittent exercise intervention, fasting blood glucose and glycosylated serum protein levels in patients were significantly reduced (P < 0.05), and fasting insulin, although not significantly changed, was decreased compared with before intervention. Alpha diversity analysis showed that the diversity (Shannon index), richness (Chao index) and coverage (Coverage index) did not change significantly. Venn diagrams showed that the relative abundance of Bacteroidetes, Actinobacteria, Proteobacteria, and Fusobacteria in the intestinal flora of the patients increased, and the relative abundance of Firmicutes decreased, and a significant decrease was seen in Ruminococcus_torques and Ruminococcus_gnavus in the Firmicutes, which were both positively correlated with the abnormalities of the glycemic metabolism-related indicators, as well as with other disease development. All these findings indicate that high-intensity intermittent exercise intervention has an improvement effect on the glycemic metabolism-related indexes of patients with type 2 diabetes mellitus, and the abundance of beneficial flora in the intestinal tract increases, and the abundance of harmful flora decreased, enhancing the stability of the intestinal flora in patients.

Key words: high-intensity intermittent exercise, type 2 diabetes mellitus, intestinal flora, glucose metabolism, intervention

CLC Number:

Yu Hanglin, Tian Haodong, Wen Shiyuan, Huang Li, Liu Haowei, Li Hansen, Wang Peisong, Peng Li. Changes in glucose metabolism and intestinal flora in patients with type 2 diabetes mellitus after high-intensity intermittent exercise [J]. Chinese Journal of Tissue Engineering Research, 2025, 29(2): 286-293.

Figures/Tables 6

2.3 高强度间歇性运动干预对2型糖尿病患者肠道菌群的影响 2.3.1 肠道菌群Alpha多样性分析对高强度间歇运动前后糖尿病患者的肠道菌群OTUs数量进行Alpha多样性分析，其中群落多样性选用Shannon指数、丰富度选用Chao指数、覆盖度选用Coverage指数来表示。在经6周的高强度间歇性运动干预后，2型糖尿病患者的肠道菌群群落多样性shannon指数由3.299 4变为3.034 2，呈下降趋势，经韦尔奇t检验，结果显示变化无显著性差异(P > 0.05)。见图2。 2.3.2 肠道菌群群落丰富度分析在经过6周高强度间歇性运动干预后，2型糖尿病患者的肠道菌群群落丰富度Chao指数由287.12变为276.33，呈下降趋势，经韦尔奇t检验，结果显示变化无显著性差异(P > 0.05)。见图3。 2.3.3 肠道菌群群落覆盖度分析在经过6周高强度间歇性运动干预后，2型糖尿病患者的肠道菌群群落覆盖度coverage指数由0.998 53变为0.998 51，呈下降趋势，经韦尔奇t检验，结果显示变化无显著性差异(P > 0.05)。见图4。 2.3.4 肠道菌群数目分析 Venn图用于统计2型糖尿病患者肠道菌群样本中共有和独有的物种数目，可以直观地表现高强度间歇性运动干预前后样本的物种组成相似性及重叠情况。干预前与干预后重叠部分含有548种OTUs，干预后，9例患者共减少140种菌群，增加77种菌群，菌群总数呈下降趋势。高强度间歇性运动干预前后共有微生物物种排名前5位为OTU854、OTU943、OTU487、OTU497、OTU573，分别属于普氏粪杆菌属(Faecalibacterium_prausnitzii)、长双歧杆菌属(Bifidobacterium_longum)、多利亚氏菌属(uncultured_bacterium_g_Dorea)、布劳提亚氏菌属(unclassified_g_Blautia)、双歧杆菌属(Bifidobacterium_pseudocatenulatum)，经进一步筛选分析，发现大多数样本中含有以上5类OTUs，排除某一OTU只存在单独样本中的偶然性，这些菌群可进一步探究讨论。见图5。 2.3.5 高强度间歇性运动干预前后肠道菌群相对丰度的分析相对丰度排名前5名分别为厚壁菌门(Firmicutes)、放线菌门(Actinobacteria)、拟杆菌门(Bacteroidetes)、变形菌门(Proteobacteria)、梭杆菌门(Fusobacteria)。经6周高强度间歇性运动干预后2型糖尿病患者厚壁菌门(由78.01%变为68.22%)相对丰度减少，放线菌门(由12.79%变为14.36%)相对丰度增加，拟杆菌门(由7.84%变为10.01%)相对丰度增加，变形菌门(由1.03%变为2.09%)相对丰度增加，梭杆菌门(0.06%变为5.01%)相对丰度增加。说明高强度间歇性运动干预后，2型糖尿病患者肠道菌群门类水平相对丰度中，除厚壁菌门的变化呈下降趋势，其他4个门类呈上升趋势。见图6。 2.3.6 高强度间歇性运动干预前后肠道菌群差异显著性分析威尔科克森符号秩检验结果显示，经6周高强度间歇性运动干预后，2型糖尿病患者所有肠道菌群在门水平上的变化均不具有显著性，在属水平上，组内出现扭链瘤胃球菌属(Ruminococcus-torques-group)、活泼瘤胃球菌属(Ruminococcus-ganvus-group)两种菌属干预后显著性降低(P < 0.05)。见图7。 2.4 2型糖尿病患者肠道菌群与糖代谢指标的相关性分析运用相关性Heatmap图分析2型糖尿病患者糖代谢指标与肠道菌群的Spearman相关性系数，图形中的颜色反映糖代谢指标与肠道菌群的相关性，颜色越深则代表数值越大，反之则越小。经高强度间歇性运动干预后，2型糖尿病患者肠道菌群在属级水平上与空腹胰岛素呈显著性相关的菌群为粪便杆菌属(P=-0.49)；002瘤胃球菌(P=0.57)、产粪甾醇真"

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