Potential of Creatine in Glucose Management and Diabetes

Abstract

Creatine is one of the most popular supplements worldwide, and it is frequently used by both athletic and non-athletic populations to improve power, strength, muscle mass and performance. A growing body of evidence has been identified potential therapeutic effects of creatine in a wide variety of clinical conditions, such as cancer, muscle dystrophy and neurodegenerative disorders. Evidence has suggested that creatine supplementation alone, and mainly in combination with exercise training, may improve glucose metabolism in health individuals and insulin-resistant individuals, such as in those with type 2 diabetes mellitus. Creatine itself may stimulate insulin secretion in vitro, improve muscle glycogen stores and ameliorate hyperglycemia in animals. In addition, exercise induces numerous metabolic benefits, including increases in insulin-independent muscle glucose uptake and insulin sensitivity. It has been speculated that creatine supplementation combined with exercise training could result in additional improvements in glucose metabolism when compared with each intervention separately. The possible mechanism underlying the effects of combined exercise and creatine supplementation is an enhanced glucose transport into muscle cell by type 4 glucose transporter (GLUT-4) translocation to sarcolemma. Although preliminary findings from small-scale trials involving patients with type 2 diabetes mellitus are promising, the efficacy of creatine for improving glycemic control is yet to be confirmed. In this review, we aim to explore the possible therapeutic role of creatine supplementation on glucose management and as a potential anti-diabetic intervention, summarizing the current knowledge and highlighting the research gaps.

Keywords: dietary supplements; exercise; glycemic control; skeletal muscle; type 2 diabetes mellitus.

Figure 1

Possible creatine-related mechanisms on glycemic control. Potential mechanisms underpinning the role of creatine on glucose metabolism involve: (1) increased beta-cell insulin secretion; (2) improved water retention and osmosensing genes and (3) increased glucose uptake via type 4 glucose transporter (GLUT-4) content and activity. Additionally, (4) creatine supplementation could enhance the known benefits of exercise on glucose uptake/insulin sensitivity. There are currently insufficient clinical data to support all of these mechanisms. Note: Cr: creatine; CreaT: creatine transporter; IR: insulin receptor; GLUT-4: glucose transporter; PKBa/Akt1: protein kinase Bα; AMPK: Adenosine Monophosphate-activated protein kinase.