Multiparameter MRI assessment of metformin and exercise effects on skeletal muscle in prediabetes: a randomized controlled trial
Abstract
Background: The metabolic effects of combined metformin and aerobic exercise on skeletal muscle in prediabetes remain unclear. We evaluated individual and combined effects on skeletal muscle metabolism using multiparameter magnetic resonance imaging (MRI) and assessed prediabetes remission.
Materials and methods: In this 12-week randomized controlled trial, forty-two prediabetic adults aged 48.4 ± 13.1 years mean ± standard deviation) were randomized into control (n = 10), metformin (n = 10), exercise (n = 11), and combined therapy (n = 11) groups. Multiparameter MRI measured T2, apparent diffusion coefficient (ADC), fractional anisotropy (FA), intermuscular adipose tissue (IMAT), intramyocellular lipids, visceral adipose tissue (VAT), and muscle cross-sectional areas (MSCAs). Blood biomarkers were assessed by standard protocols. Analyses included ANOVA, Fisher's exact test, and correlation analysis.
Results: Normoglycemia occurred in 90% of the combined group, 80% of the exercise, 20% of the metformin, and 10% of the controls. Exercise alone significantly decreased IMAT%, T2, and ADC, and increased FA, whereas metformin alone had no significant effects. Combination therapy did not further improve blood biomarkers or change MRI parameters versus exercise, but uniquely reduced VAT and increased MSCAs. IMAT% reduction was borderline greater in subjects with high baseline IMAT after combination therapy (p = 0.051). MRI parameters, particularly IMAT%, T2, and FA, correlated with…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 11 participants or records.
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