Abstract MP62: Adherence to Guideline-Recommended Physical Activity Nullifies Mortality Risks of Extended Sitting in Adults With Diabetes

Abstract

Introduction: Sedentary lifestyles have been associated with increased mortality for people with diabetes. While most governments and health organizations advocate for adults with diabetes to engage in at least 150 min/week of moderate-to-vigorous physical activity (MVPA), it is unclear whether meeting these guidelines can mitigate the heightened mortality risks associated with prolonged sedentary time in this population. Hypothesis: We hypothesized that adhering to the guideline-recommended 150 min/week of MVPA could mitigate the mortality risk from prolonged sedentary time in U.S. adults with diabetes. Methods: This study included 3,533 nonpregnant adults aged 20 years diagnosed with diabetes from the U.S. National Health and Nutrition Examination Survey (2007-2018). Sitting time and MVPA were assessed using the Global Physical Activity Questionnaire. We analyzed sitting time as both a continuous variable (h/d) and as a categorical variable (<4, 4-<6, 6-8, >8 h/d). The mortality status of the participants were ascertained via linkage to the National Death Index by December 31, 2019. Hazard ratios (HRs) and 95% CIs for associations between sitting time and mortality were estimated using Cox models, adjusted for sociodemographic characteristics, lifestyle factors, and Carlson comorbidity index, stratified by MVPA (inactive [<10 min/week], insufficiently active [10-<150 min/week], active [150 min/week]). The presence of multiplicative effect measure modification was evaluated by contrasting the model incorporating continuous sitting time, categorical MVPA, and their interaction term, and the model excluding the interaction. We accounted for the NHANES complex survey design (sampling weights, clustering, and stratification) in all analyses. Results: Among 3,533 adults diagnosed with diabetes (mean [SE] age: 60.3 [0.3] years; 48.7% females; 60.6% non-Hispanic White), 695 deaths were documented over a median (interquartile range) follow-up of 5.6 (3.1-8.7) years. In the fully adjusted models, sitting time was positively associated with mortality risk among adults with diabetes who were physically inactive or insufficiently active but not among active adults ( P for interaction=0.04). Specifically, the HRs (95% CIs) of mortality for 1h/d increment in sitting time across MVPA levels were 1.08 (1.04, 1.12) in inactive adults, 1.09 (1.01, 1.18) in insufficiently active adults, and 1.01 (0.96, 1.06) in active adults. Results remained unaltered when comparing the most sedentary (>8 h/d) to the least sedentary (<4 h/d) categories: across MVPA levels (from low to high), the HRs (95% CIs) of mortality were 1.83 (1.23, 2.72), 1.84 (0.81, 4.17), and 1.11 (0.73, 1.69), respectively. Conclusions: Our findings show that achieving 150 min/week of MVPA can substantially mitigate the elevated mortality risks associated with extended sitting time among U.S. adults with diabetes.