New research to be presented at this year's Annual Meeting of the European Association for the Study of Diabetes (EASD) in Vienna, Austria (15-19 September) shows, among people recently diagnosed with type with type 2 diabetes and no previous cardiovascular disease, a clear association exists between a person's self-reported physical activity and their risk of all-cause mortality and major adverse cardiac events (MACE), that include heart attacks and strokes.
The study is by Ms Line Eriksen and Dr Sidsel Domazet, Steno Diabetes Centre Odense, Odense University Hospital, Odense, Denmark, and colleagues.
Multiple studies have shown that physical activity improves insulin sensitivity, blood sugar control and body composition in individuals with type 2 diabetes (T2D) and is associated with reduced cardiovascular risk in the general population.
In this new study, the authors analysed if self-reported physical activity can serve as a prognostic marker of CVD and mortality risk in individuals recently diagnosed with T2D and no previous CVD.
The study used data from the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort, including participants from 2010-2023 diagnosed with T2D within the previous two years. Physical activity was self-reported by 11,355 participants and categorised into sedentary, light, and moderate-to-vigorous physical activity (MVPA).
Primary outcomes were all-cause mortality and MACE including heart attacks, ischaemic stroke, coronary revascularisation, heart failure and CVD death. Statistical modelling, including adjustment for confounders, was used to estimate the risk associated with different levels of physical activity. Participants were followed until first occurrence of either MACE, death, emigration or study end (May 3, 2024). People with previous CVD – a total of 1671 – were excluded.
The researchers found 18% of participants reported being sedentary while 62% and 20% engaged in light physical activity and MVPA, respectively. During a median follow-up time of 8.4 years, 1149 CVD events and 1048 deaths occurred. Higher physical activity levels were inversely associated with both MACE and all-cause mortality.
After adjustment for confounders included age, sex, year of study enrolment, T2D duration, smoking, alcohol consumption, and waist circumference, participants who engaged in light and MVPA had a 23% and 28% lower risk of MACE, and a 27% and 33% lower risk of all-cause mortality, respectively, compared to sedentary participants (see figure 1).
This association was primarily driven by death from cardiovascular disease (CVD). After adjusting for CVD risk factors (LDL or 'bad' cholesterol, glycated haemoglobin [HbA1c, a measure of blood sugar control], systolic blood pressure, kidney blood filtration rate, and a marker called the urine albumin-creatinine ratio) that could potentially mediate the associations, the reduced risks for MVPA remained statistically significant for both MACE (a 30% reduction) and all-cause mortality (a 31% reduction) compared to sedentary participants.
The reduced risks for light physical activity also remained statistically significant for both MACE (a 20% reduction) and all-cause mortality (a 22% reduction).
The authors concluded, "Self-reported physical activity was an independent predictor of all-cause mortality and major adverse cardiac events in individuals recently diagnosed with T2D and no previous cardiovascular disease. These associations persisted even after adjustment for classical CVD risk factors."
They added, "Even light activity reduces the risk of serious cardiac events and all-cause mortality, independently of classical cardiovascular disease risk factors. This highlights the potential health benefits of doing at least some physical activity instead of doing none in terms of preventing cardiovascular disease and premature deaths for individuals recently diagnosed with type 2 diabetes."
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