Association between Walking Pace and Diabetes: Findings from the Chilean National Health Survey 2016-2017

Possible sarcopenia and risk of new-onset type 2 diabetes mellitus in older adults in China: a 7-year longitudinal cohort study

BACKGROUND

Previous studies have shown that type 2 diabetes mellitus (T2DM) can cause sarcopenia; however, these conditions may have a bidirectional association. This study aimed to explore the longitudinal association between possible sarcopenia and new-onset T2DM.

METHODS

We conducted a population-based cohort study using nationally representative data from the China Health and Retirement Longitudinal Study (CHARLS). This study included participants aged ≥ 60 years who were free of diabetes during the baseline survey of CHARLS (2011 to 2012) and were followed up until 2018. Possible sarcopenia status was defined according to the Asian Working Group for Sarcopenia 2019 criteria. Cox proportional hazards regression models were used to evaluate the effect of possible sarcopenia on new-onset T2DM.

RESULTS

In total, 3,707 individuals were enrolled in this study, with a median age of 66 years; the prevalence of possible sarcopenia was 45.1%. During the 7-year follow-up, 575 cases (15.5%) of incident diabetes were identified. Participants with possible sarcopenia were more likely to have new-onset T2DM than those without possible sarcopenia (hazard ratio: 1.27, 95% confidence interval: 1.07-1.50; p = 0.006). In subgroup analysis, we found a significant association between possible sarcopenia and T2DM in individuals aged < 75 years or with a BMI < 24 kg/m². However, this association was not significant in individuals aged ≥ 75 years or with a BMI ≥ 24 kg/m².

CONCLUSIONS

Possible sarcopenia is associated with an increased risk of new-onset T2DM in older adults, especially in individuals who are not overweight and aged 75 years or younger.

Effectiveness of a real-life program (DIAfit) to promote physical activity in patients with type 2 diabetes: a pragmatic cluster randomized clinical trial

Introduction

The aim of this study was to evaluate the effectiveness of a real-life clinical physical activity program (DIAfit) on improving physical fitness, body composition, and cardiometabolic health in an unselected population with type 2 diabetes mellitus, and to compare the effects of two variants a different exercise frequencies on the same outcomes.

Research design and methods

This was a cluster randomized-controlled assessor-blind trial conducted in 11 clinical centres in Switzerland. All participants in the clinical program with type 2 diabetes were eligible and were randomized to either standard (3 sessions/week for 12 weeks) or alternative (1 session/week for the first four weeks, then 2 sessions/week for the rest of 16 weeks) physical activity program each consisting of 36 sessions of combined aerobic and resistance exercise. Allocation was concealed by a central office unrelated to the study. The primary outcome was aerobic fitness. Secondary outcome measures included: body composition, BMI, HbA_1c, muscle strength, walking speed, balance, flexibility, blood pressure, lipid profile.

Results

All 185 patients with type 2 diabetes (mean age 59.7 +-10.2 years, 48% women) agreed to participate and were randomized in two groups: a standard group (n=88) and an alternative group (n=97)). There was an 11% increase in aerobic fitness after the program (12.5 Watts; 95% CI 6.76 to 18.25; p<0.001). Significant improvements in physical fitness, body composition, and cardiometabolic parameters were observed at the end of the DIAfit program (improvements between 2-29%) except for lean body mass, triglycerides and cholesterol. No differences were observed between both programs, except for a larger weight reduction of -0.97kg (95% CI -0.04 to -1.91; p=0.04) in the standard program.

Conclusions

Both frequency variants of the nation-wide DIAfit program had beneficial effects on physical fitness, HbA_1c, body composition, and blood pressure in type 2 diabetes patients and differences were negligible.

Clinical trial registration

clinicaltrials.gov, identifier NCT01289587.

Brisk Walking Pace Is Associated with Better Cardiometabolic Health in Adults: Findings from the Chilean National Health Survey 2016-2017

BACKGROUND

Although the importance of walking for promoting a better cardiometabolic health is widely known (this includes both cardiovascular and metabolic/endocrine systems), there is little knowledge regarding its appropriate pace to provide adults with more cardiometabolic benefits.

AIM

To analyze the associations between different walking pace categories and cardiometabolic health markers in the adult Chilean population.

METHODS

Cross-sectional study. A total of 5520 participants aged 15 to 90 years old from the Chilean National Health Survey (CNHS) 2016-2017 were included. Walking pace categories (slow, average, and brisk) were collected through self-reported methods. Glycaemia, glycosylated hemoglobin (HbA1c), gamma glutamyl transferase (GGT), vitamin D2, vitamin D3, systolic and diastolic blood pressure, and lipid profile (Total, HDL, LDL, VLDL, No HDL cholesterol and triglycerides) were determined using blood sample tests and measured with the standardized methods described in the CNHS 2016-2017.

RESULTS

People who had a brisk walking pace were associated with lower levels of glycaemia, HbA1c, GGT, systolic and diastolic blood pressure, and higher vitamin D3 levels compared with those with a slow walking pace. Moreover, people with a brisk walking pace had lower levels of VLDL cholesterol compared with those with a slow walking pace. However, after adjusting the model to include sociodemographic background, nutritional status, and lifestyle variables, the differences remained only for glycaemia, HbA1c and systolic blood pressure levels.

CONCLUSIONS

A brisk walking pace was associated with better cardiometabolic health markers and lipid profile compared with a slow walking pace.

The association between walking pace and grip strength and all-cause mortality: A prospective analysis from the MAUCO cohort

OBJECTIVE

This study investigated the individual and combined association of walking pace and grip strength with all-cause mortality in Chilean adults.

STUDY DESIGN

8813 participants (54.6 % women) from the MAUCO population-based cohort were included in this prospective study.

MAIN OUTCOME MEASURES

Individual and combined associations of grip strength (normal or low grip) and walking pace (normal or slow walking) with all-cause mortality were investigated using Cox proportional-hazard models. Analyses were adjusted for sociodemographic, lifestyle, and health-related factors.

RESULTS

Over a median follow-up of 4.74 years, 151 and 206 participants included in the analyses of walking pace and grip strength died. Individuals with low grip strength had a risk of dying 2.40 times (95 % CI: 1.64 to 3.51) higher than their counterparts with normal grip strength. Similar results were identified for slow walkers (HR: 1.77 [95 % CI: 1.25 to 2.50]). When the two factors were combined and the associations investigated, individuals with normal walking pace but with low grip strength had a higher risk of all-cause mortality than those with normal walking pace and normal grip strength (HR: 3.56 [95 % CI: 1.99 to 6.36]). The associations remained even after including a 1- and 2-year landmark period in the analyses.

CONCLUSIONS

Slow walking pace and low grip strength were associated with a higher risk of mortality (both in isolation and combined). These factors might be early markers of all-cause mortality, and should be measured more frequently in middle-aged and older adults in clinical practice.

Cognitive function and cardiorespiratory fitness affect gait speed in type-2 diabetic patients without neuropathy

AIM

To identify physical, cognitive, and metabolic factors affecting gait speed in patients with type-2 diabetes mellitus (T2DM) without neuropathy.

METHODS

This cross-sectional study enrolled 71 diabetic patients without neuropathy (mean age 55.87±7.74 years, 85.9% women). Neuropathy status was assessed with Douleur Neuropathique 4. We used a cut-off point for gait speed of 1 m/s to classify the participants into two groups: slow walkers (SW) and average and brisk walkers (ABW). The groups were compared in terms of age, sex, body mass index (BMI), hemoglobin A1c (HbA1c), fasting glucose, systolic blood pressure, maximal aerobic capacity (VO2 max), percentage of muscle mass, percentage of lower extremity muscle mass, Mini-Mental State Examination (MMSE) score, and years of education.

RESULTS

Compared with the ABW group, the SW group had significantly lower VO2 max (14.49±2.95 vs 16.25±2.94 mL/kg/min) and MMSE score (25.01±3.21 vs 27.35±1.97), fewer years of education, and these patients were more frequently women (P<0.05). In the multivariate regression models, the combination of VO2 max, sex, and MMSE score explained only 23.5% of gait speed (P<0.001). MMSE score and VO2max independently determined gait speed after adjustment for age, BMI, HbA1c, fasting glucose, systolic blood pressure, percent of muscle mass, percent of lower extremity muscle mass, and years of education.

CONCLUSION

In diabetic patients without neuropathy, physical impairment and disability could be prevented by an improvement in aerobic capacity and cognitive function.

Cognitive function and cardiorespiratory fitness affect gait speed in type-2 diabetic patients without neuropathy

AIM

To identify physical, cognitive, and metabolic factors affecting gait speed in patients with type-2 diabetes mellitus (T2DM) without neuropathy.

METHODS

This cross-sectional study enrolled 71 diabetic patients without neuropathy (mean age 55.87±7.74 years, 85.9% women). Neuropathy status was assessed with Douleur Neuropathique 4. We used a cut-off point for gait speed of 1 m/s to classify the participants into two groups: slow walkers (SW) and average and brisk walkers (ABW). The groups were compared in terms of age, sex, body mass index (BMI), hemoglobin A1c (HbA1c), fasting glucose, systolic blood pressure, maximal aerobic capacity (VO2 max), percentage of muscle mass, percentage of lower extremity muscle mass, Mini-Mental State Examination (MMSE) score, and years of education.

RESULTS

Compared with the ABW group, the SW group had significantly lower VO2 max (14.49±2.95 vs 16.25±2.94 mL/kg/min) and MMSE score (25.01±3.21 vs 27.35±1.97), fewer years of education, and these patients were more frequently women (P<0.05). In the multivariate regression models, the combination of VO2 max, sex, and MMSE score explained only 23.5% of gait speed (P<0.001). MMSE score and VO2max independently determined gait speed after adjustment for age, BMI, HbA1c, fasting glucose, systolic blood pressure, percent of muscle mass, percent of lower extremity muscle mass, and years of education.

CONCLUSION

In diabetic patients without neuropathy, physical impairment and disability could be prevented by an improvement in aerobic capacity and cognitive function.

Association of Self-reported Walking Pace With Type 2 Diabetes Incidence in the UK Biobank Prospective Cohort Study

OBJECTIVE

To investigate the association between self-reported walking pace and type 2 diabetes (T2D) incidence and whether it differed by physical activity levels and walking time.

METHODS

There were 162,155 participants (mean age, 57.1 years; 54.9% women) from the UK Biobank prospective study, recruited between 2006 and 2010, included in the study. Walking pace was self-reported and classified as brisk, average, or slow. Total physical activity and walking time were self-reported using the International Physical Activity Questionnaire. Association between walking pace and T2D incidence and the potential moderating role of physical activity and walking time were investigated using Cox proportional hazards models.

RESULTS

The median follow-up was 7.4 (interquartile range, 6.7 to 8.2) years. There were 4442 participants in whom T2D developed during the follow-up period. In the fully adjusted model (sociodemographic factors, diet, body mass index, and physical activity), average walking pace (hazard ratio [HR], 1.28; 95% CI, 1.14 to 1.44) and slow walking pace (HR, 1.91; 95% CI, 1.62 to 2.24) were associated with a higher T2D risk compared with brisk walking among women. Among men, average walking pace (HR, 1.28; 95% CI, 1.17 to 1.40) and slow walking pace (HR, 1.73; 95% CI, 1.50 to 1.99) were also associated with higher T2D risk. Compared with slow walkers, brisk walkers have the same diabetes incidence rate 18.6 and 16.0 years later, for women and men, respectively.

CONCLUSION

Average and slow walking pace was associated with a higher risk of incident T2D in both men and women, independent of major confounding factors. The associations were consistent across different physical activity levels and walking time.