Design: Systematic review and network meta-analysis of randomised trials
Population: 27 trials, 965 adults with type 2 diabetes
Primary outcome: Cardiometabolic risk factors including HbA1c, lipids and blood pressure
Effect: Both sequences improved HbA1c and lipids vs control; direct comparison between orders not significant, low certainty

A network meta-analysis pooled 27 randomised trials (965 people with type 2 diabetes) of concurrent training, comparing aerobic followed by resistance exercise with the reverse order.

Both sequences improved body fat, HbA1c, fasting glucose, total cholesterol, triglycerides and LDL cholesterol compared with control. Resistance-first ranked highest on most glycaemic and lipid outcomes and aerobic-first on blood pressure, but those rankings were unadjusted, the direct comparisons were not significant and the certainty of evidence was rated low.

The useful conclusion is the simple one: combined training works, and the order is not worth arguing over with a patient. Whichever sequence a patient will actually keep doing is the right one.

Recommend combined aerobic and resistance exercise for adults with type 2 diabetes who can manage both.
Let the patient choose the order within a session; there is no reliable advantage either way.
Prioritise regularity and total weekly volume over sequence.
Check for hypoglycaemia risk around exercise in patients on insulin or sulfonylureas.

Why it matters

Removes one more barrier to an exercise prescription that patients find hard to start.

The statistics, in plain English

A ranking (SUCRA) says which option came out on top most often across simulations; it does not say the difference was meaningful. Here the head-to-head comparisons were not statistically significant, so the rankings cannot be read as one order being better.