Comparative Effectiveness of Various Combined Interventions for Type 2 Diabetes and Obesity: A Systematic Review and Network Meta-Analysis

Donglei Lu^*sijie tan

• Tianjin University of Sport, Tianjin, China

Background This study conducts a Bayesian network meta-analysis to evaluate the long-term effects of various combined interventions on inflammatory markers and metabolic health in overweight or obese individuals with T2DM. Methods We included randomized controlled trials (RCTs) from January 2000 to April 2023 that examined the effects of aerobic training (AT), resistance training (RT), combined aerobic and resistance training (ART), physical-mental training (PMT), whole-body vibration training (WBT), and acupuncture (ACT) on BMI, lipid profiles, fasting blood glucose (FBG), HbA1c, HOMA-IR, IL-6, and TNF-α. A comprehensive literature search was performed in PubMed, Web of Science, CNKI, MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials. Data extraction and quality assessment were independently conducted by two researchers, and Bayesian network metaanalysis was performed using R software. Results A total of 128 RCTs were included. ART showed the most significant improvements in BMI, IL-6, and TNF-α levels. PMT was the most effective in improving lipid profiles (TG, TC, HDL-C, LDL-C) and insulin sensitivity markers (HbA1c, HOMA-IR). The SUCRA rankings indicated ART and PMT as the most beneficial interventions. Meta-regression analysis highlighted that VO2max improvements were closely associated with reductions in BMI and HbA1c. Conclusion ART and PMT demonstrated comprehensive benefits across multiple metabolic and inflammatory outcomes. ART effectively reduced BMI, improved glycemic control, and decreased inflammatory markers through mechanisms involving AMPK and mTOR pathways. PMT improved lipid metabolism and insulin sensitivity by reducing stress hormone levels and modulating endocrine and nervous system functions. A precise exercise prescription combining ART, PMT, AT, RT, and ACT is recommended to optimize metabolic health in T2DM patients. Future research should focus on individualized intervention strategies to enhance clinical outcomes.1. Exercise can be an effective way to reduce metabolic and inflammatory markers in overweight or obese individuals with T2DM.2. Different types of exercise, including ART and PMT, have been found to be effective in improving multiple health indicators.3. ART and PMT were identified as the most beneficial interventions, with ART significantly reducing BMI, IL-6, and TNF-α levels, and PMT improving lipid profiles and insulin sensitivity.