Physical activity (PA) is considered beneficial for lowering cardiovascular risks following type 2 diabetes mellitus (T2DM) and prediabetes, but existing evidence relies mainly on self-reported measurements. We aimed to describe the intensity-specific dose-response associations of PA and sedentary behavior (SB) with macrovascular and microvascular events among individuals with T2DM and prediabetes. This study included 11,474 individuals with T2DM and prediabetes from the UK Biobank. PA, including total PA, moderate-to-vigorous intensity PA (MVPA), light intensity PA (LPA), and SB, were measured by accelerometers over 7 days. MVPA was categorized according to the American Diabetes Association guideline-recommended level (at least 150 min/week), and total PA, LPA, and SB were grouped by tertiles. The outcomes were incidences of macrovascular events, microvascular events, heart failure (HF), and their combination (composite events). The events were ascertained using the ICD-10 codes on the hospital or death records. During a median follow-up of 6.8 years, 1680 cases were documented, including 969 macrovascular events, 839 microvascular events, and 284 incidents of HF. Accelerometer-measured PA, irrespective of intensity, was inversely associated with the risk of composite events and each outcome in the dose–response patterns. Regarding categorized PA, engagement in total PA (high . low) was associated with decreased risk of macrovascular events (hazard ratio (HR) = 0.80; 95% confidence interval (95%CI): 0.67–0.95), microvascular events (HR = 0.76; 95%CI: 0.63–0.93), and HF (HR = 0.46; 95%CI: 0.32–0.66). Adherence to MVPA, but not LPA, above the guideline-recommended level (at least 150 min/week) was associated with reduced risk of macrovascular events (HR = 0.80; 95%CI: 0.68–0.95), microvascular events (HR = 0.76; 95%CI: 0.63–0.92), and HF (HR = 0.65; 95%CI: 0.46–0.92). The minimum dose of MVPA for lowering the risk of composite events was approximately 59.0 min/week. More time spent in SB was associated with an increased risk of composite events (high . low, HR = 1.17; 95%CI: 1.02–1.35) and HF (high . low, HR = 1.54; 95%CI: 1.09–2.20). Replacement of 30 min of SB (HR = 0.73; 95%CI: 0.65–0.81) and LPA (HR = 0.74; 95%CI: 0.66–0.83) with MVPA dramatically reduced the risk of composite events. Adherence to a higher amount of accelerometer-measured PA, especially MVPA at least 59 min/week, is associated with reduced risks of macrovascular and microvascular events among individuals with T2DM and prediabetes. Replacement of SB and LPA with MVPA helped lower the risk of diabetic vascular events.

中文翻译：

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加速度计测量 2 型糖尿病和糖尿病前期患者的体力活动、久坐行为以及大血管和微血管事件的发生率


体力活动 (PA) 被认为有益于降低 2 型糖尿病 (T2DM) 和糖尿病前期后的心血管风险，但现有证据主要依赖于自我报告的测量结果。我们的目的是描述 T2DM 和糖尿病前期患者中 PA 和久坐行为 (SB) 与大血管和微血管事件的强度特异性剂量反应关联。这项研究包括来自英国生物银行的 11,474 名 T2DM 和糖尿病前期患者。 PA，包括总 PA、中强度 PA (MVPA)、光强度 PA (LPA) 和 SB，通过加速度计测量了 7 天。 MVPA 根据美国糖尿病协会指南推荐水平（至少 150 分钟/周）进行分类，总 PA、LPA 和 SB 按三分位数分组。结果是大血管事件、微血管事件、心力衰竭（HF）及其组合（复合事件）的发生率。这些事件是通过医院或死亡记录上的 ICD-10 代码来确定的。在中位随访 6.8 年期间，记录了 1680 例病例，其中包括 969 例大血管事件、839 例微血管事件和 284 例心力衰竭事件。加速度计测量的 PA，无论强度如何，与复合事件的风险和剂量反应模式中的每个结果呈负相关。关于 PA 分类，总 PA 参与度（高.低）与大血管事件风险降低相关（风险比 (HR) = 0.80；95% 置信区间 (95%CI)：0.67–0.95）、微血管事件风险降低（HR = 0.76；95%CI：0.63–0.93）和 HF（HR = 0.46；95%CI：0.32–0.66）。坚持 MVPA（而非 LPA）高于指南推荐水平（至少 150 分钟/周）与大血管事件风险降低相关（HR = 0.80；95% CI：0.68-0.95）、微血管事件（HR = 0.76；95%CI：0.63-0.92）和心力衰竭（HR = 0.65；95%CI：0.46-0.92）。降低复合事件风险的 MVPA 最小剂量约为 59.0 分钟/周。在 SB 上花费的时间越长，复合事件（高.低，HR = 1.17；95%CI：1.02–1.35）和心力衰竭（高.低，HR = 1.54；95%CI：1.09–2.20）的风险增加相关。 。用 MVPA 替代 30 分钟的 SB（HR = 0.73；95%CI：0.65–0.81）和 LPA（HR = 0.74；95%CI：0.66–0.83）可显着降低复合事件的风险。坚持较高量的加速计测量的 PA，尤其是每周至少 59 分钟的 MVPA，可以降低 T2DM 和糖尿病前期患者发生大血管和微血管事件的风险。用 MVPA 替代 SB 和 LPA 有助于降低糖尿病血管事件的风险。