Creatine supplementation in type 2 diabetes: A critical appraisal of the evidence gap

Abstract

Creatine supplementation has long been proposed as a potentially beneficial adjunct to exercise for improving metabolic health, owing to its well-described effects on skeletal muscle energetics and glucose transport. In individuals with type 2 diabetes (T2D), mechanistic and preclinical studies suggest that creatine may enhance exercise-induced GLUT4 translocation, muscle glycogen storage, and insulin sensitivity. However, despite this biological plausibility, the available clinical evidence remains limited and inconsistent, precluding firm conclusions regarding its therapeutic value in T2D. This commentary critically examines the persistent translational gap between mechanistic promise and clinical outcomes, with particular emphasis on the methodological limitations of existing trials, safety considerations in a metabolically vulnerable population, and the need for contemporary, high-quality evidence. We argue that future research must move beyond short-term surrogate endpoints and incorporate longer follow-up, rigorous clinical outcomes, and integration with standard-of-care pharmacological therapies.