Physical activity is associated with decreased incidence of chronic kidney disease in type 2 diabetes patients: a retrospective cohort study in Taiwan

A Mendelian randomization study: physical activities and chronic kidney disease

Increasing evidence has shown that physical activity is related to a lower risk of chronic kidney disease (CKD), thus indicating a potential target for prevention. However, the causality is not clear; specifically, physical activity may protect against CKD, and CKD may lead to a reduction in physical activity. Our study examined the potential bidirectional relationship between physical activity and CKD by using a genetically informed method. Genome-wide association studies from the UK Biobank baseline data were used for physical activity phenotypes and included 460,376 participants. For kidney function (estimated Glomerular Filtration Rate (eGFR) and CKD, with eGFR < 60 mL/min/1.73 m2), CKDGen Consortium data were used, which included 480,698 CKD participants of European ancestry. Mendelian randomization (MR) analysis was used to determine the causal relationship between physical activities and kidney function. Two-sample MR genetically predicted that heavy DIY (do it yourself) (e.g., weeding, lawn mowing, carpentry, and digging) decreased the risk of CKD (odds ratio [OR] = 0.287, 95% CI = 0.117-0.705, p = 0.0065) and improved the level of eGFR (β = 0.036, 95% CI = 0.005-0.067, p = 0.021). The bidirectional MR showed no reverse causality. It is worth noting that other physical activities, such as walking for pleasure, strenuous sports, light DIY (e.g., pruning and watering the lawn), and other exercises (e.g., swimming, cycling, keeping fit, and bowling), were not significantly correlated with CKD and eGFR. This study used genetic data to provide reliable and robust causal evidence that heavy physical activity (e.g., weeding, lawn mowing, carpentry, and digging) can protect kidney function and further lower the risk of CKD.

Association of aerobic and muscle-strengthening physical activity with chronic kidney disease in participants with hypertension

BACKGROUND

In Korea, chronic kidney disease (CKD) is increasingly prevalent among adults with hypertension, of which approximately 30% of the population is affected. Despite the recognized benefits of adherence to physical activity (PA) recommendations, including aerobic and muscle-strengthening activities (MSA), the impact of such adherence on the prevalence of CKD in individuals with hypertension has not been extensively studied. This study aimed to investigate the association between aerobic PA and MSA levels, and the prevalence of CKD in individuals with hypertension.

METHODS

This study included 5,078 individuals with hypertension using data from the Korean National Health and Nutrition Examination Survey (2019-2021). PA levels were measured as min/week of moderate-to-vigorous PA (MVPA) based on self-reports, and MSA was quantified as the number of days per week. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m². Logistic regression analysis evaluated the association between meeting PA guidelines and CKD after adjusting for potential confounders. Additionally, a joint analysis was conducted to assess the combined effects of MVPA and MSA on CKD.

RESULTS

After adjusting for all covariates, higher MVPA was associated with a lower prevalence of CKD. Compared to the group with inactive, the group with MVPA 1-149 min/week had an odds ratio (OR) of 0.80 (95% confidence interval [CI], 0.61-1.05), the group that met the MVPA 150-299 min/week criteria had an OR of 0.85 (95% CI, 0.62-1.17), and the group that met the MVPA ≥ 300 min/week criteria had an OR of 0.53 (95% CI, 0.37-0.76). MSA alone did not show a significant association with CKD. In the joint analysis, the group that met the MVPA and MSA guidelines had the lowest OR of 0.54 (95% CI, 0.34-0.86), compared to the group that did not meet either.

CONCLUSIONS

MVPA was associated with the prevalence of CKD in participants with hypertension but not in those with MSA alone. However, compared with the group that did not meet both guidelines, the group that met both guidelines showed the lowest prevalence of CKD.

The expert consensus on care and education for patients with diabetic kidney disease in Taiwan

Increasing prevalence of type 2 DM (T2DM) and diabetic kidney disease (DKD) has posed a great impact in Taiwan. However, guidelines focusing on multidisciplinary patient care and patient education remain scarce. By literature review and expert discussion, we propose a consensus on care and education for patients with DKD, including general principles, specifics for different stages of chronic kidney disease (CKD), and special populations. (i.e. young ages, patients with atherosclerotic cardiovascular disease or heart failure, patients after acute kidney injury, and kidney transplant recipients). Generally, we suggest performing multidisciplinary patient care and education in alignment with the government-led Diabetes Shared Care Network to improve the patients' outcomes for all patients with DKD. Also, close monitoring of renal function with early intervention, control of comorbidities in early stages of CKD, and nutrition adjustment in advanced CKD should be emphasized.

Incidence and predictors of chronic kidney disease among patients with diabetes treated at governmental hospitals of Harari Region, eastern Ethiopia, 2022

Background

Chronic kidney disease (CKD) is the leading cause of morbidity and mortality in diabetic patients. However, limited evidence is available about its incidence and predictors in Ethiopia, specifically in the Harari region.

Methods

A retrospective follow-up study was conducted among 520 diabetes patients who followed their treatment at governmental hospitals in the Harari region between 1 September 2012, and 30 May 2022. The risk of developing CKD was calculated with a 95% CI, and the risk was stratified by type of diabetes mellitus. Predictors of CKD were determined using the Gompertz regression model with the baseline Cox model.

Results

Data from 494 patients were included in the final analysis with 26 (5%) excluded. A total of 51 patients (10.32%) developed CKD over the 10-year follow-up period with an incidence rate of 2.16 cases (95% CI 1.64-2.84) per 100 person-years of observation. The risk of CKD was increased by three times (AHR: 3.09, 45 95% CI: 1.56, 6.14) among patients older than 60 years and by more than three times (AHR: 3.53, 95% CI: 1.43, 8.71) among patients with diabetes mellitus for longer than 5 years of stay with the diabetes mellitus. Moreover, the risk of CKD was increased four-fold among patients with high-density lipoprotein cholesterol (HDL-C) levels <40 mg/dL (AHR: 3.84, 95% CI, 1.80-8.18) and those with positive baseline proteinuria (AHR: 3.77, 95% CI: 1.43-8.71).

Conclusion

We found that one in ten diabetic patients had developed CKD within 10 years of the diabetes mellitus diagnosis. Advanced age, longer duration of diabetes, lower baseline HDL-C level, and proteinuria had increased the hazards of developing CKD. We recommend a more focused follow-up of older adult patients with advanced disease status at baseline for optimal control of diabetes mellitus that prevents its furthering to CKD.

Assessing physical inactivity as a risk factor for chronic kidney diseases in Iranian population

OBJECTIVES

Physical inactivity is a major adjustable lifestyle risk factor in renal patients; nevertheless, research on the association of physical activity (PA) with chronic kidney disease (CKD) is unclear.

DESIGN

Cross-sectional.

SETTING

We evaluated the secondary care related to the nephrology specialists.

PARTICIPANTS

We evaluated PA in 3374 Iranian patients with CKD aged ≥18 years. Exclusion criteria were current or prior kidney transplantation, dementia, institutionalisation, expected to start renal replacement therapy or leave the area within study duration, participation in a clinical trial or inability to undergo the informed consent process.

PRIMARY AND SECONDARY OUTCOME

The renal function parameters were measured and compared with PA, assessed by the Baecke questionnaire. Estimated glomerular filtration rate, haematuria and/or albuminuria were used to estimate decreased kidney function and the incidence of CKD. To estimate the relationship between PA and CKD, we used the multinomial adjusted regression models.

RESULTS

In the first model, findings indicate that the patients with the lowest PA score had significantly higher odds of CKD (OR 1.44, 95% CI 1.16 to 1.78; p=0.01), adjustment for age and sex attenuated this relationship (OR 1.25, 95% CI 1.56 to 1.78, p=0.04). Furthermore, adjusting for low-density lipoprotein, high-density lipoprotein, triglyceride, fasting blood glucose, body mass index, waist circumference, waist/hip ratio, coexisting diseases and smoking made this relationship insignificant (OR 1.23, 95% CI 0.97 to 1.55; p=0.076). After adjusting for potential confounders, we found that patients with lower PA have higher odds of CKD stage 2 (OR 1.62, 95% CI 1.13 to 2.32; p=0.008), no association with other CKD stages.

CONCLUSION

These data suggest that physical inactivity contributes to the risk of early CKD, so encouraging patients with CKD to maintain higher PA levels could be used as a simple and useful tool to decrease the risk of disease progression and its related burden.

Epidemiological characteristics of diabetic kidney disease in Taiwan

Diabetic kidney disease (DKD) is a critical microvascular complication of diabetes. With the continuous increase in the prevalence of diabetes since 2000, the prevalence of DKD has also been increasing in past years. The prevalence of DKD among individuals with type 2 diabetes in Taiwan increased from 13.32% in 2000 to 17.92% in 2014. The cumulative incidence of DKD among individuals with type 1 diabetes in Taiwan was higher than 30% during 1999-2012. DKD is the leading cause of end-stage renal disease (ESRD), with a prevalence of approximately 45% in a population on chronic dialysis in Taiwan. Among individuals with type 2 diabetes, the prevalence of ESRD in the receipt of dialysis also increased from 1.32% in 2005 to 1.47% in 2014. Risk factors for DKD development are age, race, family history, hyperglycemia, hypertension, dyslipidemia, dietary patterns, and lifestyles. Prognostic factors that aggravate DKD progression include age, family history, sex, glycemic control, blood pressure (BP), microvascular complications, and atherosclerosis. This review summarizes updated information on the onset and progression of DKD, particularly in the Taiwanese population. Translating these epidemiological features is essential to optimizing the kidney care and improving the prognosis of DKD in Asian populations.

Leisure-time, occupational, and commuting physical activity and the risk of chronic kidney disease in a working population

Physical activity has been linked to a lower risk of chronic kidney disease (CKD); however, evidence on the relationship between domain-specific physical activity and CKD is scarce. This study aimed to examine the risk of CKD in relation to leisure-time, occupational, and commuting physical activities in a large occupational cohort in Japan. Participants were 17,331 workers (20-65 years old) without CKD and were followed-up for a maximum period of 13 years. Incident CKD was defined as an estimated glomerular filtration rate of < 60 mL/min/1.73 m² and/or proteinuria determined using the dipstick test. The Cox proportional hazards models were used to examine the associations. During 147,752 person-years of follow-up, 4013 participants developed CKD. Workers who were standing or walking at work and those who were fairly active at work had adjusted hazard ratios of 0.88 (95% confidence interval 0.86-0.96) and 0.89 (95% confidence interval 0.78-1.02), respectively, for developing CKD than sedentary workers. Leisure-time physical activity and walking for commute were not associated with CKD risk. Our findings suggest that occupational, but not leisure-time and commuting physical activities, is associated with a lower CKD risk.

Impact of self-reported walking habit on slower decline in renal function among the general population in a longitudinal study: the Japan Specific Health Checkups (J-SHC) Study

BACKGROUND

Association between physical activity and decline in renal function among the general population is not fully understood.

METHODS

This is a longitudinal study on subjects who participated in the Japanese nationwide Specific Health Checkup program between 2008 and 2014. The exposure of interest was baseline self-reported walking habit. The outcomes were annual change and incidence of 30% decline in estimated glomerular filtration rate (eGFR). Changes in eGFR were compared using a linear mixed-effects model. Cox proportional hazard models were used to examine the association between self-reported walking habit and 30% decline in eGFR.

RESULTS

Among 332,166 subjects, 168,574 reported walking habit at baseline. The annual changes in eGFR [95% confidence interval (CI)] among subjects with and without baseline self-reported walking habit were - 0.17 (- 0.19 to - 0.16) and - 0.26 (- 0.27 to - 0.24) mL/min/1.73 m²/year, respectively (P for interaction between time and baseline self-reported walking habit, < 0.001). During a median follow-up of 3.3 years, 9166 of 314,489 subjects exhibited 30% decline in eGFR. The incidence of 30% decline in eGFR was significantly lower among subjects with self-reported walking habit after adjustment for potential confounders including time-varying blood pressure, body mass index, lipid profile, and hemoglobin A1c, with hazard ratio (95% CI) of 0.93 (0.89-0.97). Sensitivity analysis restricted to subjects with unchanged self-reported walking habit from baseline or analysis with time-varying self-reported walking habit yielded similar results.

CONCLUSIONS

Self-reported walking habit was associated with significantly slower decline in eGFR. This association appeared to be independent of its effects on metabolic improvement.

Modifiable Lifestyle Factors for Primary Prevention of CKD: A Systematic Review and Meta-Analysis

BACKGROUND

Despite increasing incidence of CKD, no evidence-based lifestyle recommendations for CKD primary prevention apparently exist.

METHODS

To evaluate the consistency of evidence associating modifiable lifestyle factors and CKD incidence, we searched MEDLINE, Embase, CINAHL, and references from eligible studies from database inception through June 2019. We included cohort studies of adults without CKD at baseline that reported lifestyle exposures (diet, physical activity, alcohol consumption, and tobacco smoking). The primary outcome was incident CKD (eGFR<60 ml/min per 1.73 m²). Secondary outcomes included other CKD surrogate measures (RRT, GFR decline, and albuminuria).

RESULTS

We identified 104 studies of 2,755,719 participants with generally a low risk of bias. Higher dietary potassium intake associated with significantly decreased odds of CKD (odds ratio [OR], 0.78; 95% confidence interval [95% CI], 0.65 to 0.94), as did higher vegetable intake (OR, 0.79; 95% CI, 0.70 to 0.90); higher salt intake associated with significantly increased odds of CKD (OR, 1.21; 95% CI, 1.06 to 1.38). Being physically active versus sedentary associated with lower odds of CKD (OR, 0.82; 95% CI, 0.69 to 0.98). Current and former smokers had significantly increased odds of CKD compared with never smokers (OR, 1.18; 95% CI, 1.10 to 1.27). Compared with no consumption, moderate consumption of alcohol associated with reduced risk of CKD (relative risk, 0.86; 95% CI, 0.79 to 0.93). These associations were consistent, but evidence was predominantly of low to very low certainty. Results for secondary outcomes were consistent with the primary finding.

CONCLUSIONS

These findings identify modifiable lifestyle factors that consistently predict the incidence of CKD in the community and may inform both public health recommendations and clinical practice.

Association of physical activity with chronic kidney disease: a systematic review and dose-response meta-analysis

BACKGROUND

The relationship between physical activity (PA) and chronic kidney disease (CKD) risk was inconsistent. We therefore conducted a systematic review and dose-response meta-analysis to comprehensively evaluate the association of PA and CKD.

RESULTS

A total of 14 studies from 13 articles with 353,975 participants were included. By comparing the highest vs. the lowest level of PA, we found that PA was inversely associated with CKD risk (odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.91-0.98). Seven studies from 6 articles were included in dose-response analysis. Restricted cubic splines showed no evidence of a nonlinear dose-response relationship of PA and CKD risk (P_nonlinearity = 0.135). The risk of CKD was reduced by 2% (OR = 0.98, 95% CI = 0.96-1.00) with each 10 metabolic equivalent h/week increment of PA.

CONCLUSIONS

The findings demonstrated that the higher level of PA might have a protective effect against the risk of CKD.

METHODS

Electronic databases PubMed and Embase were searched up to March 11, 2020. Observational studies investigated the relationship between PA and CKD risk with estimated effects (relative risk, hazard ratio, or OR) with 95 % CI among adults were included.

Physical Activity Frequency Among Older Adults With Diabetes or Prediabetes: Associations With Sociodemographics, Comorbidity, and Medical Advice

To examine the differences in physical activity (PA) between older adults with and without diabetes/prediabetes and the correlates of PA frequency and associations between medical advice on PA and/or diet/weight loss and increasing PA among those with diabetes/prediabetes. Multinomial and binary logistic regression models using 2016-2017 National Health Interview Survey data (N = 4,860 aged 65+ years with diabetes/prediabetes). About 44.2% of those with diabetes/prediabetes, compared with 48.1% of a matched sample without, engaged in any PA three plus times a week. The low PA group (PA frequency was zero to two times a week) was more socioeconomically disadvantaged and had more chronic illnesses than the medium (three to four times a week) or high (five plus times a week) PA groups. Any PA and/or diet/weight loss medical advice was associated with two to three times higher odds of increasing PA. Health care providers should consider prescribing PA and/or diet/weight loss for patients with diabetes/prediabetes.

Impact of interval walking training managed through smart mobile devices on albuminuria and leptin/adiponectin ratio in patients with type 2 diabetes

Background

Interval walking training has demonstrated more pronounced positive effects on physical fitness and metabolism in type 2 diabetes (T2D), compared to continuous walking. One of the pathogenic mechanisms of T2D is associated with derangements in leptin/adiponectin axis, which might predispose affected individuals to vascular inflammation and albuminuria. The aim of this study was to investigate the effects of interval walking training delivered through smart mobile devices upon albuminuria and leptin/adiponectin ratio in patients with T2D.

Methods

Patients with T2D aged 35–75 were randomized into control (n = 26) and interval training (IT, n = 14) groups. Patients in IT group had to perform three 60‐min interval walking sessions (3 min intervals of slow and fast walking with the intensity of 40% and 70% of the peak energy expenditure) per week delivered by smartphone application for four months. The adherence to training was monitored remotely. Outcome measures were albuminuria, leptin/adiponectin ratio, obesity indicators, and glycaemic control. Leptin and adiponectin concentration was measured in serum samples by Luminex technology.

Results

In the IT group compared to control group, we observed a statistically significant decrease in albuminuria (p = .002) and leptin/adiponectin ratio (p = .01), as well as a decrease in HbA1c close to statistical significance (p = .09). In IT group, changes in leptin/adiponectin ratio correlated significantly with changes in hip circumference (p = .024).

Conclusion

Interval walking training is beneficial for vascular health in T2D via impact on albuminuria and leptin/adiponectin ratio.

Objectively Measured Physical Activity and Polypharmacy Among Brazilian Community-Dwelling Older Adults

BACKGROUND

Previous observations regarding association between physical activity (PA) and use of medicines among older adults are derived from self-reported PA. This study aimed to evaluate the association between objectively measured PA and polypharmacy among older adults with multimorbidity in Southern Brazil.

METHODS

This study included 875 noninstitutionalized older people, aged ≥60 years. Prescribed medicines used in the 15 days prior to the interview, socioeconomic data, and the presence of comorbidities were self-reported. Accelerometers were used to evaluate PA following the interview.

RESULTS

Prevalence of polypharmacy (≥5 medicines) was 38.3% (95% confidence interval, 35.0-41.5); those belonging to the lowest tertile of PA used more medicines. The authors observed a significant inverse association for polypharmacy between men belonging to the second and third tertiles of PA for objectively measured overall PA and light PA compared with the most inactive tertile. For women, the association between PA and polypharmacy was significant for overall, light, and moderate to vigorous PA only in the third tertile.

CONCLUSIONS

Overall, light and moderate to vigorous PA were inversely associated to polypharmacy and differed by gender. Promotion of PA in older adults may be an effective intervention to reduce the number of medicines used independent of the number of comorbidities.

Habitual physical activity, renal function and chronic kidney disease: a cohort study of nearly 200 000 adults

BACKGROUND

There is limited information on the association between habitual physical activity (PA) and renal function.

OBJECTIVE

To report the longitudinal association between self-reported habitual PA and measures of renal function in a large cohort in Taiwan.

METHODS

A total of 199 421 participants (aged ≥20 years) were selected from a Taiwan cohort between 1996 and 2014. All participants underwent at least two standardised medical examinations between 1996 and 2014. Self-administrated questionnaires were used to collect information on habitual PA. We used a generalised linear mixed model to investigate the associations between habitual PA and yearly change in estimated glomerular filtration rate (eGFR). The Cox proportional hazard regression model was used to investigate the associations between habitual PA and incident chronic kidney disease (CKD).

RESULTS

Participants had a median follow-up duration of 4.2 years (0.2-18.9). The yearly mean (±SD) decrease in eGFR in participants with baseline very low-PA, low-PA, moderate-PA and high-PA was 0.46±1.01, 0.36±0.97, 0.30±0.94 and 0.27±0.91 mL/min/1.73 m², respectively. Relative to the participants with very low-PA, the coefficients of yearly eGFR change were -43.93 (95% CI -79.18 to -8.68), 35.20 (95% CI -2.56 to 72.96) and 53.56 (95% CI 10.42 to 96.70) µL/min/1.73 m², respectively, for the participants with low-PA, moderate-PA and high-PA, after controlling for a wide range of covariates. Relative to the very low-PA participants, those who had low-PA, moderate-PA and high-habitual PA had HRs of 0.93 (95% CI 0.88 to 0.98), 0.94 (95% CI 0.89 to 0.99) and 0.91 (95% CI 0.85 to 0.96) to develop CKD, respectively, after controlling for the covariates.

CONCLUSIONS

A higher level of habitual PA is associated with a smaller decrease in the level of eGFR and a lower risk of developing CKD.

Objectively Measured Physical Activity Reduces the Risk of Mortality among Brazilian Older Adults

OBJECTIVES

Use of objectively measured physical activity (PA) in older adults to assess relationship between PA and risk of all-causes mortality is scarce. This study evaluated the associations of PA based on accelerometry and a questionnaire with the risk of mortality among older adults from a city in Southern Brazil.

DESIGN

A cohort study.

SETTING

Urban area of Pelotas, Southern Brazil.

PARTICIPANTS

A representative sample of older adults (≥60 y) from Pelotas, enrolled in 2014.

MEASUREMENTS

Overall physical activity (mg), light physical activity (LPA), and moderate to vigorous physical activity (MVPA) were estimated by raw accelerometer data. The International Physical Activity Questionnaire estimated leisure time and commuting PA. Hazard ratios (excluding deaths in the first 6 mo) stratified by sex were estimated by Cox regression analysis considering adjustment for confounders.

RESULTS

From the 1451 older adults interviewed in 2014, 145 died (10%) after a follow-up of an average 2.6 years. Men and women in the highest tertile of overall PA had on average a 77% and 92% lower risk of mortality than their less active counterparts (95% confidence interval [CI] = .06-.84 and 95% CI = .01-.65, respectively). The highest tertile of LPA was also related to a lower risk of mortality in individuals of both sexes (74% and 91% lower risk among men and women, respectively). MVPA statistically reduced the risk of mortality only among women (hazard ratio [HR] = .30 and HR = .07 in the second and third tertiles). Self-reported leisure-time PA was statistically associated with a lower risk of mortality only among men. Women in the highest tertiles of commuting PA showed a lower risk of mortality than those in the reference group.

CONCLUSION

Accelerometry-based PA was associated with a lower risk of mortality among Brazilian older adults. Older individuals should practice any type of PA. J Am Geriatr Soc 68:137-146, 2019.

Incidence and predictors of chronic kidney diseases among type 2 diabetes mellitus patients at St. Paul's Hospital, Addis Ababa, Ethiopia

OBJECTIVE

This study aimed to estimate the incidence of chronic kidney disease and its predictors among newly diagnosed type 2 diabetes patients attending St. Paul's Hospital, Addis Ababa, Ethiopia.

RESULTS

The overall incidence of chronic kidney disease was a major public health issue among type 2 diabetes mellitus patients with 2178 (95% CI 12,801, 21,286) cases per 10,000 patient-months. Moreover, 62(14.25%) patients in the sample experienced chronic kidney disease. Old age [adjusted hazard ratio (AHR) = 1.06, 95%CI 1.03, 1.09], no diabetic retinopathy [AHR = 0.13, 95%CI 0.07-0.24], high density lipoprotein cholesterol ≥ 40 mg/dl [AHR = 0.55, 95%CI 0.31, 0.97] and high body mass index [AHR = 1.17, 95%CI 1.1, 1.25] were common factors for chronic kidney diseases.

Ethnic disparity in prevalence of diabetic kidney disease in an Asian primary healthcare cluster

AIMS

Diabetic kidney disease (DKD) incidence is rising in Singapore. While measures to prevent onset and early detection of diabetes as well as optimal diabetes and blood pressure control are important, early detection and treatment of DKD at primary care are crucial to ameliorate its course. This study aimed to evaluate the prevalence of DKD in a primary care cluster in Singapore and identify its risk factors in a multi-ethnic Asian population.

METHODS

A total of 57,594 patients with type 2 diabetes mellitus (T2DM) followed-up at the National Healthcare Group Polyclinics with estimated glomerular filtration rate and at least two urine albumin/creatinine ratio (UACR) were stratified into DKD stages: normoalbuminuria (UACR <30 mg/g), microalbuminuria (MI, UACR 30-299 mg/g), macroalbuminuria (MA, ≥300 mg/g) and renal impairment (RI, estimated glomerular filtration rate eGFR <60 mL/min per 1.73 m(2)). Factors associated with DKD stages were evaluated.

RESULTS

Overall DKD prevalence (T2DM with MI, MA or RI) was high at 52.5%; 32.1% had MI, 5.3% had MA and 15.1% had RI. DKD prevalence within ethnic subpopulations was different: 52.2% of Chinese, 60.4% of Malays and 45.3% of Indians had DKD, respectively. Malays had a 1.42-fold higher DKD prevalence, while Indians had a 0.86-fold lower. Other independent risk factors were age, female gender, duration of diabetes and hypertension, HbA1c and body mass index.

CONCLUSION

The high prevalence of DKD and its interethnic differences suggest need for additional measures to optimize the care of T2DM at primary care to mitigate its progression.

Changes in physical activity among adults with diabetes: a longitudinal cohort study of inactive patients with Type 2 diabetes who become physically active

AIMS

To identify the predictors and clinical effects among inactive patients with diabetes who become physically active, in the setting of a large integrated health system.

METHODS

We studied adults with Type 2 diabetes with at least two clinic visits between December 2011 and November 2012 who reported being inactive at their first visit. The mean (±sd) interval between their first and last visit was 6.2 (±2.3) months. We analysed self-reported moderate-to-vigorous physical activity data collected using a structured intake form during routine clinical care.

RESULTS

The study cohort (N = 6853) had a mean age of 60.2 years; 51.4% were women and 53.6% were non-white. Nearly two-thirds (62.5%, n = 4280) reported remaining physically inactive, while 16.0% reported achieving the recommended moderate-to-vigorous physical activity levels (≥ 150 min/week) by the last visit of the study period. Female gender (odds ratio 0.77, 95% CI 0.67, 0.88), obesity (BMI 30-34.9 kg/m(2) : odds ratio 0.76, 95% CI 0.60, 0.97; BMI ≥ 35 kg/m(2) : odds ratio 0.55, 95% CI 0.42, 0.70), chronic kidney disease (odds ratio 0.78, 95% CI 0.65, 0.94) and depression (odds ratio 0.77, 95% CI 0.62, 0.96) were each independently associated with not achieving the recommended moderate-to-vigorous physical activity level, while physician referral to lifestyle education was a positive predictor (odds ratio 1.40, 95% CI 1.09, 1.85). Controlling for baseline differences, patients achieving the recommended moderate-to-vigorous physical activity target lost 1.0 kg more weight compared with patients remaining inactive (P < 0.001).

CONCLUSIONS

Patients with diabetes in a real-world clinical setting lost weight after becoming physically active; however, nearly two-thirds of patients remained inactive. Novel interventions to address physical inactivity in primary care should address barriers faced by older patients with medically complex disease.