Get Off the Diabetes Couch

A sedentary lifestyle may lead to type 2 diabetes and metabolic syndrome.

By identifying factors that lead to type 2 diabetes, we are better able to limit risk factors and prevent onset. Certain factors such as genetics, lifestyle and environment have been linked with type 2 diabetes in past studies; however, the further identification of modifiable risk factors continues to be a valuable tool for prevention. Recent studies have shown that a sedentary lifestyle can increase metabolic syndrome, weight gain, cholesterol, and insulin resistance. It’s thought that such inactivity may also increase the risk of developing diabetes.

This recent cross-sectional study investigated associations between total amount and patterns of sedentary behavior, metabolic syndrome and glucose metabolism. Participants were analyzed from the Maastricht Study, a prospective population-based cohort study of the pathophysiology, etiology and comorbidities of type 2 diabetes. Inclusion criteria mandated that all participants were between the ages of 40-75 and living in the southern Netherlands. They were recruited by means of mass media from municipal registries and diabetes registries.

All participants underwent a fasting 75g oral glucose tolerance test. They were then categorized according to normal glucose metabolism (NGM), impaired fasting glucose (IGM) 110mg/dL-125mg/dL fasting (6.1-6.9 mmol/L) and 2h glucose <140mg/dL (7.8mmol/L), impaired glucose tolerance (fasting <126mg/dL (7.0 mmol/ and 2h 126mg/dL (7.0-11.1 mmol/L), or type 2 diabetes fasting >126mg/dL (7.0 mmol and 2h >198mg/dL (11.1 mmol/L). Impaired fasting glucose and impaired glucose tolerance were lumped together for the purposes of this study. The 2006 World Health Organization’s criteria was used to define glucose metabolism.

The Adult Treatment Panel III guidelines were used to define metabolic syndrome. Presence of metabolic syndrome was determined by measuring triacylglycerol levels, HDL, waist circumference, fasting glucose levels, medication use and blood pressure.

In the current study, sedentary behavior was defined as any action taken while not sleeping that utilized <1.5 metabolic equivalents while sitting or reclining. This was measured using an activPAL3 accelerometer, which has been previously shown to be effective for assessing sedentary behavior and assessing posture. The accelerometer was worn by participants for eight consecutive days, however each participant’s data was included if they provided at least 1 valid day defined as 14 hours of data. On average, each participant provided 6.3 days of valid data. Total sedentary duration was calculated using mean time spent in the sitting or lying position while awake and was differentiated from sleeping by self-report and a computer algorithm. Sedentary breaks were quantified by transitions from sitting or lying to standing or walking. A prolonged sedentary period was defined as >30 minutes.

The Chi squared, Kruskal-Wallis and ANOVA tests were utilized as applicable to compare between the NGM, IGM and type 2 diabetic groups. Linear models were used to calculate adjusted means for amount of sedentary time, breaks and prolonged periods. These were then compared between the three groups. Multinomial logistic regressions were utilized to analyze associations between metabolic syndrome, glucose metabolism and sedentary behavior, the results of which were reported using odds ratios (OR) and 95% confidence intervals (CI). Confounding variables were controlled by adjusting for factors such as age, sex, mobility limitation, BMI, level of education, alcohol consumption and health status.

After excluding participants with failed accelerometers or missing data, 2,497 were analyzed, of which 1,395 (55.9%) had NGM, 338 (15.5%) had IGM and 714 (28.6%) had type 2 diabetes. It was found that 1 additional hour of sedentary time was associated with a 1.22 OR (95% CI: 1.13, 1.32) for developing type 2 diabetes and a 1.39 OR (95% confidence interval (CI) 1.27, 1.53) for developing metabolic syndrome. An additional hour of sedentary activity was associated with a 39% increased chance of metabolic syndrome and a 22% increased chance of type 2 diabetes.

This study took measures to adjust for confounding variables between study groups, but only followed patients for 1 week and could not adjust for the possibility that type 2 diabetes patients may be more sedentary due to poor health. Furthermore, by virtue of the study design, a causal relationship cannot be inferred. Though a longitudinal randomized clinical trial should be conducted to determine causation, this does not discount the findings of the current study, which has made a strong association between sedentary behavior and an increased chance of developing type 2 diabetes.

Practice Pearls:

• Sedentary behavior is associated with an increased risk of type 2 diabetes.
• Sedentary behavior is associated with an increased risk of metabolic syndrome.
• A longitudinal, randomized clinical trial is needed to confirm the findings of this study.

Researched and prepared by Devon Brooks, Doctor of Pharmacy Candidate from LECOM College of Pharmacy, reviewed by Dave Joffe, BSPharm, CDE

 

Van der Berg JD, Stehouwer CD, Bosma H, et al. “Associations of total amount and patterns of sedentary behavior with type 2 diabetes and the metabolic syndrome: The Maastricht Study.” Diabetologia. (2016): 1-10. Diabetologia. Web. 9 Feb. 2016.