Using continuous glucose monitoring to prescribe an exercise time: a randomised controlled trial in adults with type 2 diabetes
Open accessAbstract
PURPOSE: Growing evidence suggests the exercise timing, time-of-day it is performed, is important for maximizing glycemic benefits in type 2 diabetes (T2D). This randomized controlled trial investigated the impact of utilizing continuous glucose monitoring to personalise exercise timing on peak hyperglycaemia and cardiometabolic health in people with T2D. METHODS: ) were randomized to eight weeks: i) waitlist control (CTL, eight week CTL then re-randomized to interventions), ii) 22-min daily exercise beginning ∼ 30 min before peak hyperglycemia (ExPeak) or iii) 22-min daily exercise ∼ 90 min after peak hyperglycemia (NonPeak). Time of peak hyperglycemia was pre-determined for each participant using the median of a 14-d habitual continuous glucose monitoring (CGM) period. Glycemic control (HbA1c [primary outcome], CGM), vascular function (flow-mediated dilation [FMD]), arterial stiffness, blood pressure) and body composition were assessed. Linear mixed models compared changes across time between groups. RESULTS: There was no intervention effect for HbA1c, however there was a significant interaction for changes in 24-h peak glucose and %FMD between groups. Compared to CTL, both intervention groups significantly lowered peak glucose (ExPeak: 95 %CI: -2.0 to -0.3 mmol/L, NonPeak: CI: -2.3 to -0.6 mmol/L) and %FMD increased (ExPeak: 95 %CI: 0.6 to 1.5 %, NonPeak: 95 %CI: 0.0 to 1.1 %). Adherence to interventions was high for both intervention groups (>90 %). CONCLUSION: Prescribing exercise to target peak hyperglycemia did not improve HbA1c; however cardiometabolic health outcomes improved in both groups prescribed an exercise time compared to control. Personalizing exercise prescription by prescribing a time to exercise may be a novel approach to improve health outcomes and physical activity participation.
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Over time, repeated goal attainment and visible progress may strengthen patients' sense of mastery and self-efficacy, thereby facilitating a shift from externally prompted behavior to proactive self-management.
“Over time, repeated goal attainment and visible progress may strengthen patients' sense of mastery and self-efficacy, thereby facilitating a shift from externally prompted behavior to proactive self-management (14, 17, 20, 25, 26).”
From Behavior change pathways by which digital wearable devices support exercise self-management in type 2 diabetes: a scoping review with machine learning–assisted text mining (2026) · cites this paper as [26]
The Discussion (section 4; page not provided) says visual feedback from an unblinded glucose monitor may improve self-efficacy, motivation, and adherence over time. It does not describe repeated goal attainment, a growing sense of mastery, or a shift from externally prompted behavior to proactive self-management; it says whether this approach empowers patients to improve self-management needs further study. (LLM, conf=0.84)
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Sun, W., Xie, D., Hou, W., Zhang, M., Wang, C., Wang, Z., Yang, H., Xu, G., & Dai, H. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1871682
- Authors
- Chang, C. R., Roach, L. A., Russell, B. M., & Francois, M. E.
- Affiliations
- University of Wollongong (AU)
- Venue
- Diabetes Research and Clinical Practice
- Publisher
- Elsevier BV
- Published
- 2025-04
- Volume
- 222
- Pages
- 112072
- ISSN
- 0168-8227 (ISSN-L)
- OpenAlex
- W4408012441
- Cited by
- 11
- References
- 45
- Citations by year
- 2026: 10 · 2025: 1
- FWCI
- 7.47
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diabetes Research and Clinical Practice (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- NSW Health
- University of Wollongong
- National Health and Medical Research Council (APP1177234)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- type 2 diabetes, exercise timing, continuous glucose monitoring, individualized exercise prescription, glycemic control, HbA1c, flow-mediated dilation, vascular function, arterial stiffness, blood pressure, cardiometabolic health, body composition
- MeSH terms
- Glycemic Control, Continuous Glucose Monitoring, Aged, Blood Glucose, Diabetes Mellitus, Type 2, Female, Glycated Hemoglobin, Humans, Hyperglycemia, Male, Middle Aged, Blood Glucose Self-Monitoring, Exercise
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