The Efficacy And Potential Mechanism Of Aerobic Exercise On Type 2 Diabetes Mellitus Based On Evidence Medicine And Bioinformatics

Objective: Through the methods of bibliometrics and visual analysis,this paper combs the research status,research hotspots and frontier dynamics of aerobic exercise intervention in T2 DM.To systematically evaluate the clinical efficacy of aerobic exercise intervention in T2 DM.Through text mining and bioinformatics methods,the effective targets,signaling pathways and mi RNA-m RNA regulatory networks of aerobic exercise intervention in T2 DM were screened to predict the potential mechanism of aerobic exercise intervention in T2 DM.Methods: 1.In this part,the literature about aerobic exercise intervention for T2 DM in the last 20 years was retrieved,and the literature was imported into VOSviewer 1.6.17 and Cite Space V software.The annual publication,authors,countries/regions,institutions,discipline,literature cocitation and keywords of the literature were analysed by bibliometrics and visualization.2.Databases at home and abroad were searched to collect RCTs of aerobic exercise intervention in T2 DM.After quality evaluation and data extraction of clinical research meeting the inclusion criteria,the clinical efficacy of aerobic exercise intervention in T2 DM was evaluated by using Revman 5.3 and Stata 17.0 for statistical analysis.3.We searched domestic and foreign databases,screened the related targets of aerobic exercise intervention in T2 DM,and intersected them with the Gene Cards database and Dis Ge NET database to obtain effective human targets.Then,effective human targets were uploaded to the STRING database to build a PPI network and screen core targets.GO and KEGG functional enrichment analyses were carried out using the DAVID database.Finally,the upstream mi RNAs of the above core targets were predicted,and the mi RNA-m RNA regulatory network was constructed to explore the potential mechanism of aerobic exercise intervention in T2 DM.Results: 1.A total of 833 Chinese studies and 4039 English studies were included.The annual publication of aerobic exercise intervention in T2 DM at home and abroad is on the rise,but the annual number of articles in China is less than one-fifth of the number of foreign articles.Domestic teams represented by Liu Xia,Sun Peng,Xiao Guoqiang and Chen Xianghe have a high number of articles,while foreign teams represented by Khunti,Kamlesh,Riddell,Michael C,Blair,Steven N,Sigal and Ronald J have a high number of articles.The publishing institutions are mainly universities,such as the University of Copenhagen and the University of Sydney abroad and Yangzhou University and Shanghai University of Sport in China.In addition,there are some hospitals and research institutions.In terms of published countries,the United States has the largest number of articles,far higher than other countries,and China and Japan are some of the few but highly productive Asian countries.High-frequency keywords at home and abroad mainly include type 2diabetes,aerobic exercise,Baduanjin,insulin resistance,oxidative stress,depression,and hypertension.The emerging keywords at home and abroad mainly include quality of life,glucose and lipid metabolism,autophagy and inflammation.2.A total of 103 RCTs were included,of which 44 were in English and 59 in Chinese.The results of the meta-analysis showed that aerobic exercise decreased the FBG in patients with T2DM(MD=-1.01,95%CI-1.18～-0.85,P<0.05),2h PG(MD=-1.50,95%CI-1.91～-1.08,P<0.05),Hb A1c(MD=-0.68,95%CI-0.82～-0.54,P<0.05),TC(MD=-0.56,95%CI-0.68～-0.44,P<0.05),TG(MD=-0.36,95%CI-0.44～-0.29,P<0.05),LDL(MD=-0.37 95%CI-0.44～-0.29,P<0.05),SBP(MD=-6.18,95%CI-7.76～-4.59,P<0.05),DBP(MD=-3.18,95%CI-4.17～-2.19,P<0.05),INS(SMD=-0.85,95%CI-1.06～-0.63,P<0.05),HOMA-IR(MD=-1.07,95%CI-1.42～-0.73,P<0.05),BMI(MD=-1.32,95%CI-1.67～-0.96,P<0.05)and WC(MD=-2.28,95%CI-4.31～-0.25,P<0.05),and increase the HDL(MD=0.12,95%CI 0.09～0.14,P<0.05),SF-36 PCS(MD=5.67,95%CI 3.81～7.52,P<0.05),SF-36 MCS(MD=10.00,95%CI 8.48～11.52,P<0.05),and the difference was statistically significant.The results of network meta-analysis showed that tennis(SUCRA=97.7),football(SUCRA=90.7),Baduanjin(SUCRA=89.1),Yijinjing(SUCRA=87.6)and Taiji Softball(SUCRA=82.4)were the best interventions for aerobic exercise in improving blood glucose,blood lipid,blood pressure,insulin resistance and obesity in patients with T2 DM.3.A total of 240 targets were obtained by text mining,intersection with Dis Ge NET database and Gene Cards,and 191 effective human targets were obtained.Using betweenness,closeness,degree,EPC,the top 20 targets of MCC,and then the top 20 targets of the five algorithms were used to obtain 10 core targets: AKT1,IL1 B,IL6,TNF,VEGFA,IGF1,CASP3,TP53,PPARG,and STAT3.The targets of aerobic exercise intervention in T2 DM were collectively enriched in 1094 GO entries and 160 signaling pathways(P<0.05).These BP terms mainly included positive regulation of gene expression,aging,negative regulation of apoptotic process,negative regulation of gene expression,positive regulation of transcription from RNA polymerase II promoter,inflammatory response,cellular response to lipopolysaccharide,glucose homeostasis,positive regulation of apoptotic process,cellular response to hypoxia,positive regulation of protein phosphorylation,cellular response to tumor necrosis factor and positive regulation of nitric oxide biosynthetic process Signaling pathways mainly included Lipid and atherosclerosis,AGE-RAGE signaling pathway in diabetic complications,Insulin resistance,Adipocytokine signaling pathway,HIF-1 signaling pathway,TNF signaling pathway,AMPK signaling pathway,Fox O signaling pathway,Type II diabetes mellitus and Insulin signaling pathway.Conclusion: 1.The aerobic exercise intervention in T2 DM research has gradually gained more recognition and attention.The research hotspots mainly include the study of the exercise mode of aerobic exercise intervention in T2 DM,the possible mechanism of aerobic exercise intervention in T2 DM and T2DM-related complications.Research on predicting quality of life and exercise intervention mechanisms in T2 DM patients may become a research hotspot in the future.2.Aerobic exercise can effectively improve blood glucose,blood lipid,blood pressure,insulin level,insulin resistance degree,obesity and quality of life in patients with T2 DM.There are advantages and disadvantages in improving blood sugar,blood lipid,blood pressure,insulin resistance and obesity in patients with T2 DM,and tennis,football,Baduanjin,Yijinjing and Taiji Softball are more advantageous respectively.3.Aerobic exercise intervention in T2 DM has multitarget and multipathway characteristics,mainly through the regulation of glucose and lipid metabolism,cell apoptosis,the inflammatory response,oxidative stress and other mechanisms.