Gut Microbiota in Exercise-Regulated Development, Progression, and Management of Type 2 Diabetes Mellitus: A Review of the Role and Mechanisms.

Imbalance of the gut microbiota is considered a possible factor in the rapid progression of insulin resistance in type 2 diabetes mellitus (T2DM). Dysbiosis of the gut microbiota can alter intestinal barrier function and host metabolism, as well as signaling pathways in T2DM patients, which are directly or indirectly associated with insulin resistance. Additionally, symbiotic fungi and opportunistic bacteria can stimulate the local immune system, increasing intestinal permeability and leading to gut leakage. This, in turn, activates systemic inflammation and contributes to insulin resistance. Exercise is known to play a crucial role in disease prevention and blood glucose control, as well as in managing diabetes-related organ complications. Aerobic exercise, in particular, is commonly used to prevent and control diabetes by enhancing skeletal muscle responsiveness to insulin through the upregulation of enzymes involved in cellular glucose utilization. Various forms of exercise can also alter the composition and function of the gut microbiota. This paper focuses on the relationship between the gut microbiota and T2DM, the impact of exercise on gut microbiota, and the role of the gut microbiota in exercise-induced improvement of T2DM, aiming to review the role and mechanisms of the gut microbiota in exercise-regulated development, progression, and management of T2DM.