24-hour movement behaviors and cardiometabolic health in adults with type 2 diabetes: a comparative cross-sectional and longitudinal analysis

Introduction

Meeting the recommended guidelines for physical activity (PA), sedentary behavior (SB) and sleep, collectively referred to as 24-hour movement behaviors (24h-MBs), is crucial for type 2 diabetes mellitus (T2DM) management and is associated with favourable health outcomes. However, it is suggested that adults with T2DM spend more time in SB and less time in PA compared to adults without diabetes.

Objectives

This study aims to compare 24h-MBs between adults with and without T2DM (i.e. controls with similar characteristics except for having T2DM), investigate how this is associated with cardiometabolic health, and assess changes in 24h-MBs after two years of follow-up (FU) in adults with T2DM.

Design

Cross-sectional and longitudinal study

Setting

Community-dwelling adults with T2DM and controls in Belgium.

Primary outcome measures

This study took place between September 2021 and December 2023. The 24hMBs were measured using accelerometers (Actigraph wGT3X+); cardiometabolic variables (adiposity, blood pressure and advanced glycation endproducts) were collected in both groups. In adults with T2DM, fasting blood samples were collected at baseline and second FU. Compositional data analysis was used to explore group differences in 24h-MBs using MANOVA, and regression models analysed associations with cardiometabolic health. Changes in 24h-MBs over time in adults with T2DM were assessed using a linear mixed model.

Results

Fifty-two adults with T2DM (mean age 63.2 standard deviation (SD) 10.6) and 74 controls (mean age 62.7SD 9.4) were included in the cross-sectional analysis. The 24h-MBs of adults with T2DM differed significantly from the controls (p=0.026). Adults with T2DM spent significantly less time in light (-34.7 min/day) and moderate-to-vigorous PA (MVPA) (-24.1 min/day) compared to controls. In adults with T2DM, reallocating 30 minutes from any behavior to MVPA was associated with a significant increase in HDL-cholesterol (sleep: 5.05 mg/dl [2.45; 7.80], ES=0.53; SB: 4.53 mg/dl [1.93; 7.27], ES=0.47; LPA: 5.29 mg/dl [2.07; 8.73], ES=0.55) whereas in the control group significant decreases in waist circumference where found when reallocating 30 minutes from SB to sleep (2.42 cm [0.86-3.97], ES=0.34). Thirty-seven (mean age 65.0 SD 9.5) and 22 (mean age 67.0 SD 7.7) adults with T2DM provided valid data after one and two years of follow up, respectively. No significant changes in 24h-MBs were found after one (p=0.93) or two-year (p=0.79) FU among adults with T2DM .

Conclusion

Adults with T2DM have a less favorable 24h-MB composition compared to adults without T2DM indicating the need for additional effort to achieve and maintain the guidelines. Despite the limited associations found, time reallocations from other behaviors to MVPA theoretically suggest the biggest health benefits.

Trial registration

NCT04993482 (ClinicalTrials.gov)

Strengths and limitations of this study

• This study uses objectively collected sleep, sedentary behavior and physical activity data, which limited the risk of recall- and social desirability bias.

• This study includes longitudinal data which provides valuable insights into behavioral changes over time.

• Participants could choose whether the data collection took place at the Ghent University Hospital or at the participant’s home. The location could potentially influence certain measurements, such as BP.

• Since no blood samples were taken in the control group, it is possible that these individuals have prediabetes.