Creatine Supplementation Combined with Exercise in the Prevention of Type 2 Diabetes: Effects on Insulin Resistance and Sarcopenia

Type 2 diabetes (T2D) is a chronic metabolic disorder marked by insulin resistance and impaired glucose metabolism, with skeletal muscle being a major site of systemic glucose disposal. This review examines the bidirectional relationship between T2D and sarcopenia, and synthesizes current evidence on how skeletal muscle deterioration and insulin resistance interact to disrupt glucose homeostasis. We summarize molecular mechanisms by which physical exercise enhances glucose uptake via insulin-dependent and insulin-independent pathways, and review the ergogenic and metabolic effects of creatine monohydrate (CrM). We also evaluate studies combining CrM supplementation with resistance or aerobic training and their effects on glycaemic control, muscle mass and function. Overall, combined exercise and creatine supplementation show potential to improve glucose regulation and attenuate muscle loss in older adults and people with T2D. Available data indicate that CrM is well tolerated in healthy and clinical populations when used at recommended doses, with no consistent evidence of adverse renal or hepatic effects. Further large randomized trials are needed to define optimal dosing, training modalities and long-term benefits for metabolic outcomes.