Physical activity associated with reduced risk of diabetes at high CVD risk

12/08/2018

A subanalysis of the NAVIGATOR-trial showed a significant association between physical activity and reduced risk of the development of diabetes in patients at high CVD risk, independent of gender.

Relationship between baseline physical activity assessed by pedometer count and new-onset diabetes in the NAVIGATOR trial
Literature - Kraus WE, Yates T, Tuomilehto J et al. - BMJ Open Diab Res Care 2018;6:e000523. doi:10.1136/ bmjdrc-2018-000523

Introduction and methods

Physical activity is related to all-cause mortality, CVD, stroke and diabetes, independently of body mass [1,2], and is therefore an important component of lifestyle intervention studies for CVD [3-6] and diabetes [7-10]. However, the effects of physical activity alone have rarely been investigated in trials in individuals at high risk of CVD or diabetes.

A subanalysis of the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR)-study [11] investigated whether physical activity is related to the development of diabetes in subjects with CVD or at high CVD risk.

The NAVIGATOR was a double-blind, randomized, placebo-controlled trial and included individuals with decreased glucose tolerance and with CVD or at high CVD risk, who were randomized to either valsartan or placebo and participated in lifestyle modification programs with a mean follow-up of 6.4 years. At baseline, ambulant physical activity was measured during waking hours by using pedometers for seven consecutive days. In this subanalysis the relation between the number of daily steps at baseline and progression to diabetes was assessed.

The primary outcome was the development of diabetes, defined as fasting plasma glucose levels ≥7,0 mmol/L and glucose levels ≥200 mg/dL (≥11,1 mmol/L) confirmed on oral glucose tolerance test.

Main results

  • Mean (SD) daily steps at baseline in quartiles were Q1: 1831 (1151), Q2: 4652 (659), Q3: 7096 (800) and Q4: 11.240 (2344). Several biochemical, anthropometric, and behavioral variables of study participants showed significant differences between quartiles.
  • 35% of participants developed diabetes during study period.
  • After full adjustments, each 2000 extra steps, up to 10.000, was associated with 4% reduced risk of progression to diabetes (HR: 0.96, 95%CI: 0.94-0.99, P<0.0042).
  • The interaction between gender and the number of steps was not significantly associated with progression to diabetes.

Conclusion

Physical activity was significantly associated with reduced risk of development of diabetes in patients at high CVD risk, independently of gender. This study shows that measurements of physical activity should be implemented in trials and clinical practice.

References

1. Surgeon General's report on physical activity and health. From the Centers for Disease Control and Prevention. JAMA 1996;276:522.

2. Physical activity guidelines advisory committee report. Washington DC: US Department of Health and Human Services, 2008.

3. Leon AS, Connett J. Physical activity and 10.5 year mortality in the Multiple Risk Factor Intervention Trial (MRFIT). Int J Epidemiol 1991;20:690–7.

4. Leon AS, Myers MJ, Connett J. Leisure time physical activity and the 16-year risks of mortality from coronary heart disease and all-causes in the Multiple Risk Factor Intervention Trial (MRFIT). Int J Sports Med 1997;18(Suppl 3):S208–15.

5. The multiple risk factor intervention trial (MRFIT). A national study of primary prevention of coronary heart disease. JAMA 1976;235:825–7.

6. Forum: the multiple risk factor intervention trial (MRFIT). The methods and impact of intervention over four years. Prev Med 1981;10:387–553.

7. Laaksonen DE, Lindström J, Lakka TA, et al. Physical activity in the prevention of type 2 diabetes: the Finnish diabetes prevention study. Diabetes 2005;54:158–65.

8. Tuomilehto J, Lindström J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001;344:1343–50.

9. The Diabetes Prevention Program. The diabetes prevention program. Design and methods for a clinical trial in the prevention of type 2 diabetes. Diabetes Care 1999;22:623–34.

10. Li G, Zhang P, Wang J, et al. Cardiovascular mortality, all-cause mortality, and diabetes incidence after lifestyle intervention for people with impaired glucose tolerance in the Da Qing diabetes prevention study: a 23-year follow-up study. Lancet Diabetes Endocrinol 2014;2:474–80.

11. Califf RM, Boolell M, Haffner SM, et al. Prevention of diabetes and cardiovascular disease in patients with impaired glucose tolerance: rationale and design of the Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) Trial. Am Heart J 2008;156:623–32.

Find this article online at BMJ Open Diab Res Care

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