A systematic search was conducted in PubMed, Cochrane Library, EmBase, Web of Science, CNKI, and Wanfang Data Knowledge Service Platform to identify relevant studies published from database inception to June 15, 2024, on the effects of exercise on glycemic metabolism in East Asian patients with T2DM. The study type was limited to randomized controlled trials (RCTs), where the intervention group received exercise interventions and the control group did not. Two researchers independently screened the literature based on inclusion and exclusion criteria and extracted relevant data. Publication bias was assessed using Egger's test in Stata 17.0 and funnel plots in RevMan 5.3. Meta-analysis was performed using RevMan 5.3.

A total of 21 RCTs involving 1289 participants (675 in the intervention group and 614 in the control group) were included. Publication bias assessment indicated overall good quality of the included studies. The random-effects model showed that exercise interventions significantly reduced fasting blood glucose (MD=-1.31 mg/L, 95% CI: -1.55 to -1.07, P < 0.001), glycated hemoglobin A1c (HbA1c) (MD=-0.34, 95% CI: -0.45 to -0.22, P < 0.001), homeostatic model assessment of insulin resistance (HOMA-IR) (MD=-0.39, 95% CI: -0.54 to -0.23, P < 0.001), and fasting insulin (MD=-0.71 μIU/mL, 95% CI: -1.18 to -0.24, P=0.003) in the intervention group. Heterogeneity was observed in the effects of different exercise modalities on glycemic metabolism. Aerobic training (MD=-1.49 mg/L, 95% CI: -2.53 to -0.44, P=0.005) and combined training (MD=-1.41 mg/L, 95% CI: -1.87 to -0.95, P < 0.001) were more effective than resistance training in reducing fasting blood glucose. Combined training (MD=-0.47, 95% CI: -0.81 to -0.31, P=0.007) was superior to aerobic and resistance training in reducing HbA1c. Only aerobic training (MD=-0.48, 95% CI: -0.89 to -0.07, P=0.020) and combined training (MD=-0.35, 95% CI: -0.69 to -0.01, P=0.040) significantly reduced HOMA-IR, with aerobic training showing a greater effect than combined training. Subgroup analyses based on age group, exercise duration, session length, frequency, and intensity revealed that aerobic training performed less than 5 times per week for no more than 1 hour per session significantly improved fasting blood glucose in East Asian patients with T2DM.

Exercise interventions can improve glycemic control and reduce insulin resistance in East Asian patients with T2DM. Aerobic exercise and combined exercise are more effective exercise prescriptions for glycemic management in this population.