Patterns of Timing and Intensity of Physical Activity and HbA1c Levels in Hispanic/Latino Adults With or at Risk of Type 2 Diabetes

Associations Between Physical Activity Patterns and Cardiovascular Events and Risk Factors: Cross-Sectional and Prospective Studies

Background

Moderate-intensity physical activity (PA) is recommended for health benefits, but optimal PA timing regarding cardiovascular disease (CVD) is debated.

Objectives

The authors assessed the impact of differing PA patterns on CVD risk factors and outcomes.

Methods

Data from 2 surveys (S1 and S2) of the CoLaus-PsyCoLaus study (2,465 and 1,692 participants, respectively; 55.3% [54.3%] females; mean age 61.2 ± 9.7 years [64.4 ± 9.5]), conducted in Lausanne, Switzerland. PA was assessed using a wrist-worn accelerometer, and PA patterns were assessed using K-means clustering.

Results

Morning PA was positively associated with hypertension (multivariable-adjusted OR: 1.36 [95% CI: 1.00-1.84]) in S1, similar trend in S2. No significant association was found between PA clusters and total, HDL-, and LDL-cholesterol or triglycerides. Morning PA was positively associated with hypolipidemic drug treatment: 1.88 (1.07-3.30) in S2. Evenly distributed daily PA was positively associated with diabetes: 1.82 (95% CI: 1.06-3.12) in S2, with a similar trend in S1. In the outcome analysis, the early morning PA cluster (7 am-12 am) and the evenly distributed daily PA cluster led to a higher risk of CVD events (HR: 3.33 [95% CI: 1.08-10.3] and 3.16 [95% CI: 1.04-9.57], respectively).

Conclusions

In a population-based study, we observed a higher risk for cardiovascular events in participants whose daily PA occurred predominantly in the early morning (7 am-12 am) or was evenly distributed throughout the day. No PA pattern was consistently associated with hypertension, blood lipids, or diabetes markers.

Multimodal digital phenotyping of diet, physical activity, and glycemia in Hispanic/Latino adults with or at risk of type 2 diabetes

Digital phenotyping refers to characterizing human bio-behavior through wearables, personal devices, and digital health technologies. Digital phenotyping in populations facing a disproportionate burden of type 2 diabetes (T2D) and health disparities continues to lag compared to other populations. Here, we report our study demonstrating the application of multimodal digital phenotyping, i.e., the simultaneous use of CGM, physical activity monitors, and meal tracking in Hispanic/Latino individuals with or at risk of T2D. For 14 days, 36 Hispanic/Latino adults (28 female, 14 with non-insulin treated T2D) wore a continuous glucose monitor (CGM) and a physical activity monitor (Actigraph) while simultaneously logging meals using the MyFitnessPal app. We model meal events and daily digital biomarkers representing diet, physical activity choices, and corresponding glycemic response. We develop a digital biomarker for meal events that differentiates meal events into normal and elevated categories. We examine the contribution of daily digital biomarkers of elevated meal event count and step count on daily time-in-range 54-140 mg/dL (TIR54-140) and average glucose. After adjusting for step count, a change in elevated meal event count from zero to two decreases TIR54-140 by 4.0% (p = 0.003). An increase in 1000 steps in post-meal step count also reduces the meal event glucose response by 641 min mg/dL (p = 0.0006) and reduces the odds of an elevated meal event by 55% (p < 0.0001). The proposed meal event digital biomarkers may provide an opportunity for non-pharmacologic interventions for Hispanic/Latino adults facing a disproportionate burden of T2D.

Temporal changes in bio-behavioral and glycemic outcomes following a produce prescription program among predominantly Hispanic/Latino adults with or at risk of type 2 diabetes

In the United States (U.S.), consumption of fresh vegetables and fruits is below recommended levels. Enhancing access to nutritious food through food prescriptions has been recognized as a promising approach to combat diet-related illnesses. However, the effectiveness of this strategy at a large scale remains untested, particularly in marginalized communities where food insecurity rates and the prevalence of health conditions such as type 2 diabetes (T2D) are higher compared to the background population. This study evaluated the impact of a produce prescription program for predominantly Hispanic/Latino adults living with or at risk of T2D. A total of 303 participants enrolled in a 3-month observational cohort received 21 medically prescribed portions/week of fresh produce. A subgroup of 189 participants used continuous glucose monitoring (CGM) to assess the relationship between CGM profile changes and HbA1c level changes. For 247 participants completing the study (76% female, 84% Hispanic/Latino, 32% with T2D, age 56·6 ± 11·9 years), there was a reduction in weight (-1·1 [-1·6 to -0·6] lbs., p < 0.001), waist circumference (-0·4 [-1·0 to 0·6] cm, p = 0·007) and systolic blood pressure (SBP) for participants with baseline SBP >120 mmHg (-4·2 [-6·8 to -1·8] mmHg, p = 0·001). For participants with an HbA1c ≥ 7·0% at baseline, HbA1c fell significantly (-0·5 [-0·9 to -0·1] %, p = 0·01). There were also improvements in food security (p < 0·0001), self-reported ratings of sleep, mood, pain (all p < 0·001), and measures of depression (p < 0·0001), anxiety (p = 0·045), and stress (p = 0·002) (DASS-21). There was significant correlation (r = 0·8, p = 0·001) between HbA1c change and the change in average glucose for participants with worsening HbA1c, but not for participants with an improvement in HbA1c. In conclusion, medical prescription of fresh produce is associated with significant improvements in cardio-metabolic and psycho-social risk factors for Hispanic/Latino adults with or at risk of T2D.