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Association of Longitudinal Activity Measures and Diabetes Risk: An Analysis From the National Institutes of Health All of Us Research Program - PubMed

  • ️Sun Jan 01 2023

. 2023 Apr 13;108(5):1101-1109.

doi: 10.1210/clinem/dgac695.

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Association of Longitudinal Activity Measures and Diabetes Risk: An Analysis From the National Institutes of Health All of Us Research Program

Andrew S Perry et al. J Clin Endocrinol Metab. 2023.

Abstract

Context: Prior studies of the relationship between physical activity and incident type 2 diabetes mellitus (T2DM) relied primarily on questionnaires at a single time point.

Objective: We sought to investigate the relationship between physical activity and incident T2DM with an innovative approach using data from commercial wearable devices linked to electronic health records in a real-world population.

Methods: Using All of Us participants' accelerometer data from their personal Fitbit devices, we used a time-varying Cox proportional hazards models with repeated measures of physical activity for the outcome of incident T2DM. We evaluated for effect modification with age, sex, body mass index (BMI), and sedentary time using multiplicative interaction terms.

Results: From 5677 participants in the All of Us Research Program (median age 51 years; 74% female; 89% White), there were 97 (2%) cases of incident T2DM over a median follow-up period of 3.8 years between 2010 to 2021. In models adjusted for age, sex, and race, the hazard of incident diabetes was reduced by 44% (95% CI, 15%-63%; P = 0.01) when comparing those with an average daily step count of 10 700 to those with 6000. Similar benefits were seen comparing groups based on average duration of various intensities of activity (eg, lightly active, fairly active, very active). There was no evidence for effect modification by age, sex, BMI, or sedentary time.

Conclusion: Greater time in any type of physical activity intensity was associated with lower risk of T2DM irrespective of age, sex, BMI, or sedentary time.

Keywords: activity monitoring; diabetes; physical activity; risk factors.

© The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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Figures

Figure 1.
Figure 1.

Inclusion flow diagram. Exclusion factors were a combination of patient level and Fitbit level factors. Exclusions of Fitbit data often resulted in exclusion of participants, such as removing days with less than 10 hours of wear time resulted in the exclusion of 24 individuals. Participants need to have one month of Fitbit data available in the first 6 months of observation and another month afterwards to be included. Abbreviation: EHR, electronic health record.

Figure 2.
Figure 2.

Discontinuous months of monitoring were rare. Histogram of the number of months without Fitbit monitoring between months with Fitbit monitoring. Most months of monitoring were continuous.

Figure 3.
Figure 3.

Mean step count decreased over study period. Trend of mean step count as a function of time to event (incident diabetes or censoring). The x-axis is grouped into ranges of time (ie, [3,5) = a range of 3-5 years prior to event/censoring, which is inclusive of 3.00 and noninclusive of 5.00). Error bars indicate interquartile range. Mean steps is reported in thousands.

Figure 4.
Figure 4.

Greater amounts of physical activity are associated with lower risk for incident type 2 diabetes mellitus. Spline curves demonstrating the hazard ratio and 95% CI for incident type 2 diabetes mellitus as a function of measures of physical activity (left figures). Spline curves demonstrated the cumulative incidence and 95% CI for type 2 diabetes mellitus as a function of measures of physical activity (right figures). (A) daily steps (B) lightly active minutes (C) fairly active minutes (D) very active minutes (E) sedentary minutes. Data come from Cox regression models adjusted for age, sex, and race. Avg. = average.

Figure 5.
Figure 5.

Greater amounts of physical activity are associated with lower risk for incident type 2 diabetes mellitus. Spline curves demonstrating the hazard ratio and 95% CI for incident type 2 diabetes mellitus as a function of measures of physical activity (left figures). Spline curves demonstrated the cumulative incidence and 95% CI for type 2 diabetes mellitus as a function of measures of physical activity (right figures). (A) daily steps (B) lightly active minutes (C) fairly active minutes (D) very active minutes (E) sedentary minutes. Data come from Cox regression models adjusted for age, sex, race, and body mass index.

Figure 6.
Figure 6.

Spline curves demonstrating the hazard ratio for incident type 2 diabetes mellitus as a function of measures of physical activity with separate curves for the 25th, 50th, and 75th percentile of sedentary function. These plots indicate no significant interaction between sedentary time and measures of physical activity on the outcome of incident type 2 diabetes mellitus, which was corroborated in Cox model analyses.

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