BACKGROUND: Type 2 diabetes mellitus (T2DM) is associated with poor glycemic control and reduced exercise adherence, often influenced by low exercise self-efficacy (ESE). Traditional Chinese Medicine (TCM) exercises, such as Sanxiao Jiuzhi Gong (SJG), may improve both physiological and psychological outcomes in T2DM patients. This study aimed to evaluate the effects of SJG on blood glucose levels and ESE when added to standard diabetes care. METHODS: We conducted a randomized controlled trial involving 60 patients with type 2 diabetes, randomly assigned to either the control group (n = 30) or the SJG group (n = 30). The control group received the standard care for diabetes management, including individualized dietary recommendations, psychological support and aerobic exercise. The experimental group, on the other hand, received the same routine care but also underwent a 12-week intervention of the Sanxiao Jiuzhi Gong program (3 times/wk, 45 minutes each time). The primary outcome was change in glycated hemoglobin A1c. Secondary outcomes included fasting blood glucose, 2-hour postprandial blood glucose, and ESE scores. All outcomes were assessed at baseline and after the 12-week intervention. RESULTS: At baseline, no statistically significant differences existed in blood glucose parameters or ESE scores between groups. After 12 weeks, the SJG group demonstrated significantly greater improvements in all glycemic parameters compared to the control group: fasting blood glucose decreased by 3.28 mmol/L versus 1.18 mmol/L (mean difference 2.10 mmol/L, 95% CI 0.35 to 3.84, p < 0.05); 2-hour postprandial blood glucose decreased by 6.05 mmol/L versus 2.03 mmol/L (mean difference 4.01 mmol/L, 95% CI 1.38 to 6.63, p < 0.001); and hemoglobin A1c decreased by 2.73% versus 1.53% (mean difference 1.20%, 95% CI 0.20 to 2.19, p < 0.05). ESE scores increased significantly in the SJG group (2.54 points, p < 0.001) but not in the control group (0.68 points, p = 0.127). CONCLUSION: This study provides evidence that SJG exercise, when added to standard care, significantly improves glycemic control and ESE in patients with type 2 diabetes. Future larger-scale, multicenter trials with longer follow-up periods are warranted to confirm these findings and explore the long-term benefits of SJG.

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