Type 2 Diabetics, MetSyn Patients Get Less Exercise

Actigraphy study shows lower levels of physical activity

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    Contributing Writer, MedPage Today
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Action Points

  • Individuals with type 2 diabetes or metabolic syndrome were significantly less physically active than those with normal glucose metabolism, according to a large cross-sectional study (2,497 participants) from The Netherlands.
  • Note that since the analyses were cross sectional in nature, causal relationships could not be determined, but other evidence suggests that sedentary behavior drives health outcomes in this circumstance.

Individuals with type 2 diabetes or metabolic syndrome were significantly less active than those with normal glucose metabolism, a cross-sectional study reported in Diabetologia confirmed.

Every extra hour of sedentary waking time per week was associated with a 22% increased odds of having a diagnosis of type 2 diabetes, and with a 39% increase in likelihood of the metabolic syndrome, reported a research team led by Julianne van der Berg, a PhD candidate at Maastricht University in The Netherlands.

And unlike most previous studies linking sedentarism with metabolic dysfunction, the study didn't rely on self-reports of physical activity, but instead measured participants' activity levels more objectively with a thigh-worn accelerometer, van der Berg and colleagues noted.

"To date, large-scale studies that have objectively measured sedentary behavior in a population with type 2 diabetes have been scarce. However, given the large amounts of time people spend being sedentary and the high prevalence of type 2 diabetes, such studies are important," van der Berg and colleagues wrote.

"These studies can provide more insights into the associations between sedentary behavior and diabetes, and contribute to the development of strategies to prevent diabetes and its complications and comorbidities," they said.

The study included 2,497 participants from the Maastricht study. They ranged in age from 40 to 75 years. Half of the participants (52%) were men. They wore a waterproof, active PAL3 accelerometer strapped to the thigh 24 hours per day for 8 days. Glucose metabolism was measured with an oral glucose tolerance test. The investigators also measured lipid levels, waist circumference, and blood pressure.

The investigators looked for relationships between total sedentary time as well as patterns of sedentary behavior with type 2 diabetes and the metabolic syndrome, adjusting for body-mass index, high-intensity physical activity, and other potential confounders.

Overall, 1,395 participants (55.9%) had normal glucose metabolism, 388 (15.5%) had impaired glucose metabolism, and 714 (28.6%) had type 2 diabetes. Participants with type 2 diabetes spent the most time in sedentary activities, a mean of 26 minutes more per day than those with normal glucose (P<0.001).

Every additional hour of sedentary time during the study period was associated with a significantly increased risk for type 2 diabetes (odds ratio 1.22; 95% CI 1.13-1.32). Similarly, every extra hour of sedentary time was associated with a higher risk for the metabolic syndrome (OR 1.39; 95% CI 1.27-1.53).

The investigators found no significant associations with patterns of sedentary behavior, such as the number of sedentary breaks, the number of prolonged sedentary bouts, or the average sedentary bout duration.

"As our analyses were cross sectional in nature, causal relationships could not be examined. It may therefore be possible that participants with type 2 diabetes had more sedentary time because of their poorer health," van der Berg and colleagues wrote.

However, when study participants with type 2 diabetes on insulin -- who likely had more severe disease and therefore more sedentary time -- were excluded from the analysis, the results did not change. In addition, previous prospective studies have demonstrated that sedentary behavior predicts markers of insulin resistance, van der Berg and colleagues noted.

"Taken together, these findings support the hypothesis that the direction of the association is predominantly from sedentary behavior to health outcomes, although large-scale prospective studies are warranted to provide better insights into the directions of the associations," the investigators wrote.

"Further, although we adjusted for a broad range of confounding factors, it is possible that some unmeasured factors, for example dietary intake, partly explain the associations. Finally, sedentary behavior was measured during 1 week only, and this may not truly reflect habitual behavior," the researchers said.

"Nevertheless, our findings could have important implications for public health as they suggest that sedentary behavior may play a significant role in the development and prevention of type 2 diabetes, independent of high-intensity physical activity. Consideration should be given to including strategies to reduce the amount of sedentary time in diabetes prevention programs," van der Berg and colleagues concluded.

The study was funded by various governmental agencies, including the European Regional Development Fund and the Dutch Ministry of Economic Affairs, as well as Janssen-Cilag, Novo Nordisk Farma, and Sanofi-Aventis Netherlands.

The researchers disclosed no relevant financial relationships with industry.


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