Physical activity trajectories and all-cause mortality in type 1 diabetes: A nationwide longitudinal study

Anastasios Mavridis; Adam Viktorisson; Malin Reinholdsson; Björn Eliasson; Tamar Abzhandadze; Katharina S Sunnerhagen

doi:10.1016/j.diabres.2024.111702

Physical activity trajectories and all-cause mortality in type 1 diabetes: A nationwide longitudinal study

Diabetes Res Clin Pract. 2024 May 7:111702. doi: 10.1016/j.diabres.2024.111702. Online ahead of print.

Authors

Anastasios Mavridis¹, Adam Viktorisson², Malin Reinholdsson³, Björn Eliasson⁴, Tamar Abzhandadze³, Katharina S Sunnerhagen⁵

Affiliations

¹ Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Sweden; School of Medicine, Aristotle University of Thessaloniki, Greece.
² Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Sweden; Department of Rehabilitation Medicine, Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden. Electronic address: adam.viktorisson@gu.se.
³ Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Sweden; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Department of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden; National Diabetes Register, Center of Registries, Gothenburg, Sweden.
⁵ Institute of Neuroscience and Physiology, Rehabilitation Medicine, University of Gothenburg, Sweden; Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden.

PMID: 38723672
DOI: 10.1016/j.diabres.2024.111702

Abstract

Aims: To identify physical activity trajectories, explore the factors associated with them and assess their relationship with all-cause mortality.

Methods: This was a population-based longitudinal cohort study, with data from all specialist care units for type 1 diabetes in Sweden. A total of 48.921 adult patients were included, each with at least 3 registrations of physical activity, and a maximum follow-up of 14 years. The main outcomes were the longitudinal physical activity trajectories and all-cause mortality.

Results: Of 48.921 patients, 55.9% were males and mean (SD) age was 39.7(16.7). Four physical activity trajectories were identified: Steady Low (10.8%), Decreaser (12.7%), Increaser (20.7%) and Steady High (55.8%). Female sex, higher education, higher income, normal BMI, fewer comorbidities and foot free from diabetic disease were significantly associated with sustained high physical activity. Compared to the steady low group, the decreaser, increaser, and steady high physical activity groups exhibited lower adjusted risk of all-cause mortality (53-73% reduction).

Conclusions: Consistently low physical activity is associated with higher all-cause mortality. This study underscores the importance of identifying patients at risk of low physical activity and tailoring personalized approaches to promote sustained physical activity in type 1 diabetes, ultimately improving outcomes.

Keywords: Exercise; Inactivity; Latent class analysis; Lifestyle; Risk reduction behavior; Sedentary behavior.