Effects of resistance exercise combined with metformin on glycemic stability and sleep quality in elderly patients with type 2 diabetes mellitus with sleep disorders

Sleep disorders in elderly type 2 diabetes mellitus (T2DM) patients worsen metabolic dysfunction. This study assessed resistance exercise plus metformin on glycemic stability and sleep quality in 180 elderly T2DM patients with sleep disturbances, divided into metformin alone (control) or metformin plus resistance exercise (intervention) for 12 weeks. Primary outcomes [fasting blood glucose (FBG), 2-hour postprandial glucose (2hPG), glycosylated hemoglobin (HbA1c), pittsburgh sleep quality index (PSQI) scores, electroencephalogram (EEG)-measured sleep architecture] and secondary outcomes [fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), melatonin levels] were evaluated at baseline, 6 and 12 weeks. Baseline characteristics were similar (P>0.05). The intervention group showed greater reductions in FBG, 2hPG and HbA1c (P<0.05), along with significant PSQI score improvements (P<0.05) and better sleep architecture (P<0.05). Fasting insulin and HOMA-IR decreased in both groups but were lower in the intervention group (P<0.05). Melatonin increased only in the intervention group (P<0.05). No major adverse effects were observed. Resistance exercise combined with metformin enhances glycemic control and sleep quality in elderly T2DM patients, supporting nonpharmacologic interventions as valuable adjuncts in diabetes management.