24-hour movement behaviors and cardiometabolic health in people with type 2 diabetes: a comparative analysis

Background: Type 2 diabetes (T2D) is a prevalent condition associated with cardiometabolic risk in which an unhealthy lifestyle (e.g. low physical activity (PA), high sedentary behavior (SB), insufficient sleep i.e., 24h-movement behaviors (24h-MBs)) plays an important role in disease management. However, it remains unclear whether 24h-MBs are associated with cardiometabolic health in people with T2D (PwT2D) and whether this association differs from that of healthy peers.

Purpose: To compare 24h-MB compositions and associations with cardiometabolic variables between PwT2D and healthy controls.

Methods: Cardiometabolic variables (i.e. Body Mass Index, waist-to-hip ratio, systolic- and diastolic blood pressure, advanced glycation end products) and accelerometer-derived 24-h MBs were collected in 75 healthy controls and 52 PwT2D. Blood parameters (i.e. HbA1c, cholesterol, triglycerides, glucose) were exclusively measured in PwT2D. A MANOVA, using compositional data analysis, was used to explore the differences in compositions between groups. Linear regression models analysed the associations between cardiometabolic variables and 24h-MB composition as the independent variable.

Results: Significant differences (p<0.01) in 24h-MB compositions were observed between both groups with PwT2D spending less time in LPA (-34.13 min) and MVPA (-20.45 min) and more time in SB (+52.38 min) compared to healthy controls while sleep time did not differ. The composition of PwT2D was significantly associated with HDL-cholesterol (p<0.05), reallocating 20 minutes proportional from the other behaviors into MVPA was associated with a 3.53 mg/dl increase in HDL cholesterol. Preliminary results in a subsample of PwT2D (n=36) showed significant changes in 24h-MB compositions (more SB and less PA) after one year follow up.

Conclusions: These findings underscore the importance of considering 24h-MBs in PwT2D. Further longitudinal research is necessary to explore the potential benefits of optimizing 24h-MB compositions on cardiometabolic health.

Practical implications: These findings could be a first step towards an integrated approach in T2D management.

Funding: Research Foundation Flanders