Effects of Tai Chi in diabetes patients: Insights from recent research

Table 1 Randomized controlled trials investigating the effects of Tai Chi on glycemic control, insulin resistance, and cognitive function in patients with type 2 diabetes

Ref.	Country	Study design	Study period (follow-up period)	Subjects (baseline characteristics)	Study outcomes	Intervention/Control	Results
Chan et al[6], 2018	China	Three-arm, randomized, controlled, parallel-group trial	12 wk (9 month)	246 patients with T2D. Tai Chi group (32 men and 50 women): Age: 64.70 ± 7.59 years, BMI: 26, 38 ± 4.26 kg/m2, HbA1c: 6.66% ± 1.17%	Primary outcome: Blood pressure Secondary outcomes: BMI, waist circumference, aerobic endurance, fasting blood glucose, HbA1c, TC, TG, HDL-C, LDL-C, perceived stress, quality of life, exercise self-efficacy	Tai Chi/brisk walking/usual physical activity	Blood pressure↓1. Fasting blood glucose↓, HbA1c↓, perceived stress↓. Exercise self-efficacy↑2
				Walking group (42 men and 40 women): Age: 63.22 ± 11.11 years, BMI: 25.90 ± 4.39 kg/m2, HbA1c: 7.10% ± 1.61%
				Control group (38 men and 44 women): Age: 65.13 ± 10.22 years, BMI: 25.72 ± 4.04 kg/m2, HbA1c: 6.87 %± 1.25%
Li et al[7], 2020	China	Three-arm, randomized, controlled, parallel-group trial	12 wk	87 patients with T2D. Tai Chi group (12 men and 12 women): Age: 61.71 ± 6.91 years, BMI: 24.04 ± 2.98 kg/m2, HbA1c: 8.20% ± 2.46%	Primary outcome: Fasting blood glucose, HbA1c, C-peptide	Tai Chi/Qigong/stretching exercise	Fasting blood glucose→3, HbA1c↑, C-peptide↓
				Qigong group (21 men and 13 women): Age: 59.71 ± 6.67 years, BMI: 25.21 ± 2.71 kg/m2, HbA1c: 7.99% ± 1.66%
				Control group (14 men and 15 women): Age: 58.66 ± 10.89 years, BMI: 25.69 ± 2.57 kg/m2, HbA1c: 7.63% ± 1.74%
Chen et al[9], 2023	China	Three-arm, randomized, controlled, parallel-group trial	24 wk (36 wk)	328 patients with T2D. Tai Chi group (49 men and 58 women): Age: 67.56 ± 4.99 years, BMI: 24.32 ± 3.03 kg/m2, HbA1c: 7.04% ± 1.20%	Primary outcome: MoCA assessment at 36 wk. Secondary outcomes: MoCA assessment at 24 wk, cognitive subdomain tests, fasting blood glucose, HbA1c, AGE, sRAGE, HOMA-IR	AE + RT/usual care	MoCA score at 36 wk↑ vs fitness walking group: (at 24 wk). Fasting blood glucose→, HbA1c→, HOMA-IR→, AGE: sRAGE ratio→. (at 36 wk) Fasting blood glucose↓, HbA1c→, HOMA-IR→, AGE: sRAGE ratio↓ vs control group: (at 24 wk) Fasting blood glucose→, HbA1c→, HOMA-IR→, AGE: sRAGE ratio→. (at 36 wk) Fasting blood glucose↓, HbA1c→, HOMA-IR→, AGE: SRAGE ratio↓
				Fitness walking group (61 men and 49 women): Age: 67.46 ± 4.73 years, BMI: 23.86 ± 2.90 kg/m2, HbA1c: 6.84% ± 1.41%
				Control group (51 men and 60 women): Age: 67.62 ± 5.35 years, BMI: 23.98 ± 3.40 kg/m2, HbA1c: 7.14% ± 1.48%

¹Decreased.

²Increased/improved.

³Unchanged.

BMI: Body mass index; HbA1c: Hemoglobin A1c; TC: Total cholesterol; TG: Triglycerides; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; MoCA: The Montreal Cognitive Assessment; AGE: Advanced glycation end products; sRAGE: Soluble receptor of advanced glycation end products; T2D: Type 2 diabetes; HOMA-IR: Homeostasis model assessment-insulin resistance.

Table 2 Systematic reviews and meta-analyses reporting the effects of Tai Chi on glycemic control, metabolic parameters, physical function, and the quality of life in patients with type 2 diabetes

Ref.	Subjects	Interventions (Tai Chi style)	Comparators	Outcomes	Results
Zhou et al[10], 2019	1235 patients with T2D. Age: 35.6–69.5 years, sex: No description, BMI: No description, HbA1c: 6.9%–11.9%	Time: 15–120 min/session, Number of sessions: 2–14 sessions/wk, Duration of the intervention: 4–24 wk, (Simplified style, Chen style, Yang style, Sun and Yang style, Lin style, Da-yuan-jiang-tang style)	Usual care, usual exercise, or sham exercise	BMI, fasting blood glucose, HbA1c, insulin, HOMA-IR, TC, blood pressure, QoL (SF-36), balance (single-leg stance test)	BMI↓1, fasting blood glucose↓, HbA1c↓, HOMA-IR↓, insulin→3, TC↓, Systolic blood pressure↓, diastolic blood pressure↓, QOL↑2
Xia et al[11], 2019	774 patients with T2D. Age: No description, sex: No description, BMI: No description, HbA1c: No description	Time: 30–60 min/session, Number of sessions: 2–14 sessions/wk, Duration of the intervention: 8–24 wk, (Simplified style, Chen style, Yang style, Sun and Yang style, Lin style, Da-yuan-jiang-tang style, Tai Chi Ball, Unknown style)	Usual care, wait list, dancing, walking or running, conventional exercise, sham exercise, no intervention	BMI, fasting blood glucose, HbA1c, TC, TG, HDL-C, LDL-C	BMI↓, fasting blood glucose↓, HbA1c↓, TC↓, TG↓, HDL-C→, LDL-C→
Palermi et al[12], 2020	144 patients with T2D. Age: 62.73–66.05 years (mean), sex: No description, BMI: No description, HbA1c: No description	Time: 55–120 min/session Number of sessions: 2–3 sessions/wk, Duration of the intervention: 12–16 wk, (Yang and Sun style)	Usual care, sham exercise, no intervention	Balance function measured by single-leg stance test, tandem walk test, Balance Index, and Berg Balance Scale	Balance function↑
Qin et al[13], 2020	1418 patients with T2D. Age: 47–70 years, sex: No description, BMI: No description, HbA1c: No description	Time: 30–120 min/session, Number of sessions: 1–7 sessions/wk, Duration of the intervention: 12–24 wk	Usual care, wait-list, walking, brisk walking, aerobic exercise, dancing, Baduanjin, sham exercise, no intervention	BMI, waist-to-hip ratio, QOL measured by SF-36 or DSQOL	BMI↓, QOL↑
Guo et al[14], 2021	1549 patients with T2D, Age: 46.1–70.4 years (mean), sex: No description, BMI: No description, HbA1c: No description	Time: No description, Number of sessions: No description, Duration of the intervention: No description (Simplified style, Yang and Sun style, Yang style, Chen style)	Usual care, walking, brisk walking, dancing, aerobic exercise, sham exercise	BMI, fasting blood glucose, HbA1c, insulin, HOMA-IR, TC, TG, HDL-C, LDL-C, blood pressure	BMI↓, fasting blood glucose↓ (→ vs aerobic exercise), HbA1c↓, insulin↓, HOMA-IR↓, TC↓ (→ vs aerobic exercise), TG↓ (→ vs aerobic exercise), HDL-C↓, LDL-C↓ (→ vs aerobic exercise), blood pressure↓

¹Decreased.

²Increased/improved.

³Unchanged.

BMI: Body mass index; HbA1c: Hemoglobin A1c; TC: Total cholesterol; TG: Triglycerides; HDL-C: High-density lipoprotein cholesterol; LDL-C: Low-density lipoprotein cholesterol; QOL: Quality of life; SF-36: Medical Outcomes Study Short Form-36; DSQOL: Diabetes-specific quality of life; T2D: Type 2 diabetes; HOMA-IR: Homeostasis model assessment-insulin resistance.