Abstract
We assessed the prospective association between baseline levels of physical activity (PA) and the incidence of newly developed diabetic retinopathy (DR) in patients with type 2 diabetes. Data from 1,814 patients with type 2 diabetes without DR were obtained from a Japanese diabetes registry at Tenri Hospital, Nara, Japan. To assess the independent correlations between baseline PA levels and newly developed DR, the participants were divided into five categories based on their PA levels. A Cox proportional hazards model with time-varying exposure information was used and adjusted for potential confounders to assess the independent correlations. At baseline, the mean age, BMI, and hemoglobin A1c levels of the patients were 65.5 years, 24.5 kg/m2, and 7.2% (54 mmol/mol), respectively. After 2 years, newly developed DR was confirmed in 184 patients (10.1%). Patients with newly developed DR had longer duration of type 2 diabetes (14.7 versus 11.0 years, p < 0.0001), higher systolic blood pressure (139.2 versus 135.1 mmHg, p = 0.0012), lower estimated glomerular filtration rate (74.0 versus 77.1 mL/min/1.73 m2, p = 0.0382), greater urinary albumin–creatinine ratio (4.00 versus 2.45 mg/mmol, p < 0.0039), and higher HbA1c levels (7.5 versus 7.2%, p = 0.0006) than those without newly developed DR. The multivariable-adjusted hazard ratios for DR development were 0.87 (95% CI, 0.53–1.40; p = 0.557), 0.83 (95% CI, 0.52–1.31; p = 0.421), 0.58 (95% CI, 0.35–0.94; p = 0.027), and 0.63 (95% CI, 0.42–0.94; p = 0.025)for the second, third, fourth, and fifth PA categories, respectively, compared with the reference category of patients with a mean PA of 0 metabolic equivalent of task-hours/week). Higher PA levels are independently associated with a lower incidence of DR in Japanese patients with type 2 diabetes.
Highlights
The prevalence of type 2 diabetes mellitus has significantly increased worldwide, which has in turn increased the burdens on individuals and health-care systems [1]
Studies have shown that increased physical activity (PA) is associated with a substantially reduced risk of cardiovascular events [8,9] and that a low PA level is an independent predictor of all-cause mortality in patients with type 2 diabetes [10,11]
We found significant differences between the two groups in terms of age (p = 0.006), duration of diabetes (p < 0.0001), systolic blood pressure (sBP) (p = 0.0012), resting heart rate (p = 0.0408), estimated glomerular filtration rate (eGFR) (p = 0.0382), UACR (p = 0.0039), and hemoglobin A1c (HbA1c) levels (p = 0.0006)
Summary
The prevalence of type 2 diabetes mellitus has significantly increased worldwide, which has in turn increased the burdens on individuals and health-care systems [1] One such burden is the increased prevalence of chronic complications, such as diabetic retinopathy (DR). Studies have shown that increased physical activity (PA) is associated with a substantially reduced risk of cardiovascular events [8,9] and that a low PA level is an independent predictor of all-cause mortality in patients with type 2 diabetes [10,11]. The Finnish Diabetic Nephropathy (FinnDiane) Study demonstrated a significant association between low PA levels and proliferative DR in patients with type 1 diabetes [17]. Few large-scale prospective studies have evaluated the association between PA and newly developed DR in patients with type 2 diabetes
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