Cold therapy for type 2 diabetes mellitus and insulin resistance
Evidence review
Overview
Interest in cold for type 2 diabetes stems mainly from small Dutch studies of mild cold acclimation in cold rooms (ambient air at 57-63 F for several hours a day), not from cold-water immersion. A 10-day study in 8 patients reported an approximately 43% increase in peripheral insulin sensitivity, but a follow-up in 9 patients without shivering found no improvement, and a 2026 randomized crossover study using a water-perfused suit found that one mild-cold session with shivering lowered 24-hour glucose in type 2 diabetes but not prediabetes. A non-randomized study of 30 whole-body cryotherapy sessions (-184 F, 3 min) in postmenopausal women with type 2 diabetes reported lower fasting glucose and HbA1c, without effect sizes in the abstract. In healthy adults, 16 daily 10-minute immersions at 57 F temporarily reduced insulin sensitivity and glucose tolerance, and foot contrast baths did not increase skin blood flow in patients with type 2 diabetes.
Key findings
- 10 days of mild cold acclimation (57-59 F, cold-room air) increased peripheral insulin sensitivity by about 43% in 8 patients with T2D (Hanssen 2015).
- Repeat study, 9 patients with T2D, 10 days at 61-63 F air with overt shivering prevented: no improvement in insulin sensitivity or postprandial glucose (Remie 2021).
- Randomized crossover, 12 T2D + 12 prediabetes, water-perfused suit: single mild-cold session with shivering raised time in normal glucose range by 8.8 +/- 10.3% (p=0.013) in T2D only; moderate cold had no significant effect (Hashim 2026).
- 30 whole-body cryotherapy sessions (-184 F, 3 min) in postmenopausal women with T2D: fasting glucose and HbA1c fell significantly (magnitudes not stated in abstract; Wiecek 2023).
- Healthy adults (n=12): 16 daily 10-min immersions at 57 F temporarily decreased Matsuda insulin sensitivity and glucose tolerance; values returned to baseline after 1 week (Solianik 2025).
- Foot contrast baths in T2D (n=14 vs 14 controls): no blood-flow gain over warm whirlpool and over 50% smaller response than controls (Petrofsky 2006, 2007).
- 2026 scoping review: only 6 human studies met criteria and only 2 used full-body cold-water exposure; application as therapy for insulin resistance called premature (Gaydos 2026).
Every study we reviewed
2 found benefit · 2 found no effect · 5 mixed results · 1 found harm
Each study was checked on PubMed. The colored edge shows the direction of the result. The research library lists 32 studies on type 2 diabetes, across all heat and cold therapies, including case reports and older work not graded here.
Short-term cold acclimation improves insulin sensitivity in patients with type 2 diabetes mellitus.
Hanssen MJ et al. Nat Med. 2015. PubMed 26147760 · DOI · Free full text
- Who
- patients with type 2 diabetes
- What
- COLD-ROOM AIR acclimation (not water immersion)
- Protocol
- 57-59 (ambient air) °F · 1.4
- Measured
- peripheral insulin sensitivity (clamp), muscle GLUT4
- Result
- Peripheral insulin sensitivity increased by approximately 43%; basal skeletal muscle GLUT4 translocation increased.
- Limitations
- uncontrolled, n=8, cold air not water; shivering likely contributed (per Remie 2021)
Metabolic responses to mild cold acclimation in type 2 diabetes patients.
Remie CME et al. Nat Commun. 2021. PubMed 33750795 · DOI · Free full text
- Who
- patients with type 2 diabetes
- What
- COLD-ROOM AIR acclimation with overt shivering prevented (not water immersion)
- Protocol
- 61-63 (ambient air) °F · 120 (day 1), 240 (day 2), 360 (days 3-10) min · 7/wk · 1.4
- Measured
- insulin sensitivity, postprandial glucose and lipids, liver fat
- Result
- No improvement in insulin sensitivity, postprandial glucose or lipid metabolism, or intrahepatic lipid; only mild effects on fasted fat oxidation, postprandial energy expenditure and aortic augmentation index.
- Limitations
- single-arm, n=9, cold air not water
Acute mild cold exposure with shivering reduces 24 h glucose levels in individuals with type 2 diabetes but not prediabetes.
Hashim D et al. Diabetologia. 2026. PubMed 42474505 · DOI · Free full text
- Who
- sedentary adults aged 40-75, BMI 27-35, with type 2 diabetes (n=12) or prediabetes (n=12)
- What
- WATER-PERFUSED SUIT (not immersion): one mild-cold (59 F) and one moderate-cold (39 F) session in randomized order
- Protocol
- 59 (mild) and 39 (moderate) suit water °F
- Measured
- 24-h continuous glucose monitoring
- Result
- In T2D, mild cold reduced mean 24-h glucose and increased time in normal range (+8.8 +/- 10.3%, p=0.013) while reducing time in hyperglycemia (-10.9 +/- 12.9%, p=0.014); moderate cold had no significant effect. No change in prediabetes.
- Limitations
- acute single-session effect only; small; investigators unblinded; suit cooling not immersion
Daily brief whole-body immersion in 14 °C water temporarily decreases glucose tolerance and insulin sensitivity.
Solianik R et al. J Therm Biol. 2025. PubMed 40048836 · DOI
- Who
- young, non-obese healthy adults
- What
- whole-body cold-water immersion
- Protocol
- 57 °F · 10 min · 7/wk · 2.3
- Measured
- oral glucose tolerance, Matsuda insulin sensitivity index, resting energy expenditure
- Result
- Daily immersion did not change catecholamines, resting energy expenditure or substrate oxidation, but significantly decreased glucose tolerance and insulin sensitivity 24 h after the intervention; values returned to baseline after 1 week.
- Limitations
- healthy volunteers; small; uncontrolled; transient effect
Short-term Cold Acclimation Recruits Brown Adipose Tissue in Obese Humans.
Hanssen MJ et al. Diabetes. 2016. PubMed 26718499 · DOI · Free full text
- Who
- metabolically healthy obese men
- What
- COLD-ROOM AIR acclimation (not water immersion), 10 days
- Protocol
- 1.4
- Measured
- brown adipose tissue glucose uptake (FDG-PET/CT), muscle GLUT4
- Result
- Cold-induced BAT glucose uptake increased; muscle glucose uptake tended to increase; white adipose glucose uptake unchanged.
- Limitations
- mechanistic surrogate outcomes; no clinical metabolic endpoint; uncontrolled
Altered brown fat thermoregulation and enhanced cold-induced thermogenesis in young, healthy, winter-swimming men.
Søberg S et al. Cell Rep Med. 2021. PubMed 34755128 · DOI · Free full text
- Who
- young healthy men who winter-swim 2-3 times/week vs controls
- What
- habitual winter swimming combined with sauna (observational)
- Protocol
- 2-3/wk
- Measured
- brown fat activity, cold-induced thermogenesis
- Result
- Winter swimmers showed lower core temperature, absent BAT activity at thermal comfort, and greater cold-induced thermogenesis; BAT glucose uptake on cold exposure similar to controls.
- Limitations
- cross-sectional; healthy young men; cold confounded with sauna; no glycemic outcome in patients
Cold water exposure therapy and effects on insulin: a scoping review.
Gaydos J et al. J Osteopath Med. 2026. PubMed 42789774 · DOI · Free full text
- Who
- human studies of cold-water exposure with insulin/glucose outcomes (6 studies)
- What
- cold-water exposure, cold suits or partial immersion
- Measured
- insulin sensitivity and glucose metabolism
- Result
- Four of six studies reported improved insulin sensitivity or glucose utilization, but one suggested increased insulin resistance; authors state extrapolation to adjunct therapy for insulin resistance is premature.
- Limitations
- scoping review; mostly acute, healthy-volunteer studies; heterogeneous methods
Whole-Body Cryotherapy Improves Asprosin Secretion and Insulin Sensitivity in Postmenopausal Women-Perspectives in the Management of Type 2 Diabetes.
Wiecek M et al. Biomolecules. 2023. PubMed 38002284 · DOI · Free full text
- Who
- Postmenopausal women with T2D vs postmenopausal women without T2D
- What
- Whole-body cryotherapy chamber, -184 F (-120 C), 3 min; 30 sessions in six series of five with 2-day breaks
- Protocol
- -184 (chamber air) °F · 3 min · 5/wk · about 6
- Measured
- Fasting glucose, HbA1c, insulin, HOMA-IR, QUICKI, asprosin, CRP
- Result
- In the T2D group fasting glucose and HbA1c fell significantly after 30 sessions and 2 weeks later; insulin, HOMA-IR and CRP fell and QUICKI rose at 2 weeks. Effect sizes and sample size not given in abstract.
- Limitations
- Non-randomized; comparison group without diabetes rather than untreated patients; women only; sample size and effect sizes not stated in abstract.
Effects of contrast baths on skin blood flow on the dorsal and plantar foot in people with type 2 diabetes and age-matched controls.
Petrofsky J et al. Physiother Theory Pract. 2007. PubMed 17687732 · DOI
- Who
- Adults with T2D (n=14) and age-matched controls (n=14)
- What
- Foot contrast bath (alternating warm and cold water), 16 min, 3:1 or 6:2 min warm:cold, vs continuous warm whirlpool
- Protocol
- 16 min · single session/wk
- Measured
- Skin blood flow of the dorsal and plantar foot
- Result
- In controls, 3:1 contrast baths raised foot blood flow more than continuous warm water (p<0.01); in T2D, blood flow did not differ between contrast bath and warm whirlpool and was lower than in controls.
- Limitations
- Local limb immersion, not whole-body cold; single session; blood flow surrogate only.
The influence of alterations in room temperature on skin blood flow during contrast baths in patients with diabetes.
Petrofsky JS et al. Med Sci Monit. 2006. PubMed 16810134
- Who
- Adults with T2D (n=14) and age-matched controls (n=14)
- What
- Foot contrast bath (3 min warm, 1 min cold) for 16 min at room temperatures of 66 F (19 C) and 90 F (32 C)
- Protocol
- 16 min · single session/wk
- Measured
- Skin blood flow of the foot
- Result
- Blood flow response in T2D was more than 50% lower than in controls at both room temperatures; a warm room increased the response in both groups.
- Limitations
- Local limb immersion; single session; surrogate endpoint.
Protocols used in the studies
Patient studies used 10 days of mild cold-room air at 57-63 F for up to 6 hours per day, single 2-3 hour exposures in a water-perfused suit at 39-59 F, or 30 whole-body cryotherapy chamber sessions at -184 F (-120 C) for 3 min over about 6 weeks. Foot contrast-bath studies used 16-min alternating warm and cold foot immersion. The only repeated whole-body water immersion trial used 57 F water for 10 minutes daily for 16 days in healthy adults. No published trial has applied cold plunge or cold-water swimming to patients with type 2 diabetes.
What is still unknown
Whether repeated cold-water immersion or whole-body cryotherapy improves HbA1c in randomized controlled trials of type 2 diabetes; dose needed (shivering vs non-shivering); durability beyond the treatment period; safety in patients with neuropathy, peripheral vascular disease or coronary disease. Whole-body cryotherapy trials in obesity and metabolic syndrome are summarized in those entries.
Safety
Cautions for cold therapy in this condition
- Brief daily immersion at 57 F transiently reduced insulin sensitivity and glucose tolerance in healthy adults (Solianik 2025, PMID 40048836).
- Patients with type 2 diabetes show abnormal microvascular responses to cold: after 60-second finger immersion in 39 F water, rewarming time was longer than in controls and correlated with diabetes duration (r=0.513) and HbA1c (r=0.446) (Zeng 2016, PMID 27211911); foot blood-flow responses to contrast baths were over 50% smaller than in controls (PMID 16810134). Cold injury risk is a concern with peripheral neuropathy or vascular disease.
- Coronary artery disease is common in type 2 diabetes; cold immersion raises blood pressure and heart rate acutely (Radtke 2016, PMID 26152773). See general cold safety entry.
For clinicians
Suggested rationale
Cold exposure is an investigational metabolic intervention in type 2 diabetes: short-term cold-room acclimation improved insulin sensitivity in a small uncontrolled study (Hanssen 2015) but not without shivering (Remie 2021), and a non-randomized whole-body cryotherapy study reported lower fasting glucose and HbA1c (Wiecek 2023). Cold-water immersion has not been tested in patients, and current evidence does not support cold plunge as a diabetes therapy.
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