Association of Longitudinal Activity Measures and Diabetes Risk: An Analysis From the National Institutes of Health All of Us Research Program

Abstract

Aims Prior studies of the relationship between physical activity and incident type 2 diabetes mellitus (T2DM) relied primarily on questionnaires at a single time point. We sought to investigate the relationship between physical activity and incident T2DM with an innovative approach using data from commercial wearable devices linked to electronic health records in a real-world population. Methods Using All of Us participants’ accelerometer data from their personal Fitbit devices, we used a time-varying Cox proportional hazards models with repeated measures of physical activity for the outcome of incident T2DM. We evaluated for effect modification with age, sex, BMI, and sedentary time using multiplicative interaction terms. Results From 5,677 participants in the All of Us Research Program (median age 51 years; 74% female; 89% White), there were 97 (2%) cases of incident T2DM over a median follow-up of 3.8 years between 2010-2021. In models adjusted for age, sex and race, the hazard of incident diabetes was reduced by 44% (95% CI 15-63%, P = 0.01) when comparing those with an average daily step count of 10,700 to those with 6,000. Similar benefits were seen comparing groups based on average duration of various intensities of activity (e.g., lightly active, fairly active, very active). There was no evidence for effect modification by age, sex, body mass index (BMI) or sedentary time. Conclusions Greater time in any type of physical activity intensity was associated with lower risk of T2DM irrespective of age, sex, BMI or sedentary time.

Obesity, diabetes mellitus, and cardiometabolic risk: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2023

“…Evidence supports that 5000 steps or more per day may reduce mortality compared to 2700 steps per day [ 127 ]. Among those who engage in over 10,000 steps per day, the risk of incident type 2 diabetes mellitus (T2DM) is substantially reduced [ 128 ]. The health benefits of increasing steps per day appear to be linear up to 10,000 steps per day, with each 2000-step increment above inactivity associated with 6% lower risk of progression toward T2DM [ 129 ].…”

Novel Prediction Equations for Absolute Risk Assessment of Total Cardiovascular Disease Incorporating Cardiovascular-Kidney-Metabolic Health: A Scientific Statement From the American Heart Association

“…52 Another systematic review compared types of datasets and demonstrated better predictive utility of EMR data compared with administrative data, but noted that most studies failed to include socioeconomic predictors or metrics of model calibration, and did not consider clinical implications. 53 With the growth of available data sources for research (eg, All of Us, UK Biobank), [54][55][56] EMR data for these applications will only continue to grow. The Work Group considered all available data sources and reviewed the advantages and challenges of each and judged that the inclusion of EMR data in the derivation and validation datasets would be highly innovative, and would, on balance, enhance the predictive utility and generalizability of newly developed risk prediction equations.…”

Physical Activity Over the Lifecourse and Cardiovascular Disease

“…85 An analysis from the All of Us Research Program utilizing longitudinal measures of physical activity from commercial wearable devices reported an association between higher levels of physical activity and a lower risk of incident diabetes. 108 Analyses from CARDIA have suggested that physical activity in young adulthood with maintenance into middle adulthood may reduce incident hypertension and prevent premature cardiovascular events in middle-aged adults. 109 Reduction in heart failure risk with physical activity may be most effective in persons without established atherosclerotic disease.…”