Diabetes Mellitus (DM), a chronic metabolic disease-causing chronic hyperglycemia. Globally more than 90% cases are of type II diabetes mellitus (T2DM). Around 537 million adults worldwide had diabetes but according to data from Pakistan, female sufferers are marginally higher (26.4%) as compared to men (25.1%). The main causes of DM II are genetic predispositions, including consanguinity, dietary changes, urbanization and sedentary lifestyles. It is reported that postmenopausal status is linked to worsened glycemic control, increased visceral adiposity and and inflammation, and women before menopause generally have improved lipid metabolism and insulin sensitivity. HIIT provides powerful and time-efficient benefits by alternating high-intensity workouts (85-95% HR_Max) with recovery.

Diabetes Mellitus (DM), is linked to impaired protein, lipid and carbohydrate metabolism, as well as impaired insulin secretion or its reduced sensitivity and this number will increase to almost 643 million by 2030 and 783 million by 2045. As estimated by the International Diabetes Federation (2021), the burden of DM type II is especially severe in Pakistan, where 33 million adults are affected by it, ranking Pakistan at number three globally. A study published in January 2025 in BMC Public Health found that the DALY burden of type 2 diabetes in Asian women was approximately 7,122 per 100,000, with behavioral risk factors (air pollution, fasting plasma glucose, and dietary risks) playing a significant role. The Study of Women's Health across the Nation (SWAN) cohort showed that Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) levels rose steadily during menopause this means that insulin resistance gets a lot worse for women during menopause. While another study reported that postmenopausal women have comparatively increased Low Density Lipo-protein (LDL) cholesterol, triglycerides, decreased high-density lipoprotein (HDL) cholesterol, increased C-Reactive Protein (CRP) and Interleukin-6 (IL-6), the markers of cardio-metabolic risk, as compared to premenopausal women. As estradiol deficiency is linked to decreased adiponectin and increased leptin, these hormonal changes also upset the balance of adipokines, exacerbating insulin resistance and inflammatory signaling pathways. After age 45, the odds ratio (OR) of getting T2DM was about 0.13, and the risks stopped rising after age 50-55. The key to managing type 2 diabetes is physical activity. Insulin sensitivity, systemic inflammation, fasting glucose, and HbA1c are all improved by conventional aerobic exercise. High-intensity interval training (HIIT) and other interventions meant to improve insulin sensitivity and inflammatory status. HIIT improves mitochondrial function, decreases inflammation, changes the distribution of body fat, and increases muscle glucose uptake to help manage type 2 diabetes in premenopausal and postmenopausal women. HIIT therefore enhances insulin sensitivity and glycemic control. According to meta-analyses, adults with type 2 diabetes who receive 8-12 weeks of HIIT experience significant decreases in their HbA1c (0.3-0.8%), fasting insulin (~20-30%), and CRP (~15-25%). In another study HIIT protocol were applied on the PCOS women with hormonal imbalances and metabolic issues Running at 100-110% of maximum aerobic velocity (MAV) was part of the training regimen, which was divided into 4-6 sets of 4 laps. For eight weeks, participants trained three times a week. The goal of this intense training program was to improve aerobic capacity and performance. Diabetes is prevalent worldwide; postmenopausal women are more vulnerable because of metabolic and hormonal changes. Previous studies have not much inquired the effect of glycemic control in varying menopausal status, although effectiveness of HIIT is proven for improving in insulin sensitivity and CRP in women and is considered a promising modality, but there is need to determine its effectiveness across women of varied menopausal status with T2DM. The aim of the study is to evaluate the effects of HIIT on glycemic control, Inflammatory markers, and Insulin sensitivity in pre versus postmenopausal women with T2DM and to support culturally appropriate menopause-sensitive exercise recommendations for women with T2DM.High-Intensity Interval Training (HIIT) provides a quick, non-pharmacological method to enhance insulin sensitivity, blood sugar regulation, body composition, and heart health, , this study intends to investigate how HIIT can specifically help manage blood sugar problems associated with hormonal changes associated with menopause.

Inclusion Criteria:

• Female patients aged 40-65 years with physician-diagnosed T2DM.
• Premenopausal (regular menstruation) or postmenopausal (≥12 months amenorrhea) (self-reported).
• Participants who have not engaged in any structured exercise sessions or gym workouts in the past six months.
• Willing to follow supervised HIIT protocol and provide informed consent.

Exclusion Criteria:

• Cardiovascular, orthopedic, or endocrine conditions contraindicating exercise.
• Current use of insulin or hormone replacement therapy.
• Participation in structured exercise programs in the past 6 months.
• Cognitive impairment or psychiatric illness