Sitting time may increase risk of all-cause mortality in adults with diabetes

• Meeting accepted physical activity guidelines may offset the increased likelihood of early death that affects people with type 2 diabetes who spend too much time sitting, says a new study.
• For people with diabetes who sit too much and do not get enough exercise, there is a 73% increased risk of early all-cause mortality.
• For people who engage in moderate-to-vigorous physical activity for at least 150 minutes each week, this increase in mortality is eliminated.
• Diet and maintaining healthy blood sugar levels are also critically important measures for avoiding early deaths for people with diabetes.

For people with type 2 diabetes who spend a great deal of their time sitting, a new study finds that meeting recommended physical activity guidelines can offset the reduction in longevity associated with a sedentary lifestyle for people with the disease.

Previous studies have found that physical activity did not improve the all-cause mortality risk of people with diabetes who are sitting for a significant portion of their day. The new study finds otherwise.

The study from Columbia University’s Mailman School of Public Health did suggest, however, the higher mortality rate among people with diabetes who spend too much time sitting and who do not get sufficient exercise.

In their investigation, the researchers analyzed data from the 2007-2018 National Health and Nutrition Examination Surveys (NHANES). This included adults 20 years of age or older in the United States. All had diabetes according to the standards established by the American Diabetes Association or by a physician’s diagnosis. They were followed through 2019.

Participants in NHANES self-reported their activity levels, which the study classified as belonging to one of three categories:

• inactive, with physical activity of less than 10 minutes a week
• insufficiently active, with physical activity from 10 to 149 minutes per week
• active, with physical activity of 150 minutes or more per week.

During a median follow-up of 5.8 years, 1,278 deaths and 354 deaths due to heart disease were documented, with a higher sitting time combined with no or insufficient activity being associated with most of the deaths.

The authors of the study report that inactive U.S. adults with diabetes who sat for eight hours or more each day had a 73% higher risk of all-cause mortality, and insufficiently active people had a 74% increase in risk.

Various health organizations, including the American Diabetes Association and American Heart Association, endorse the 150-minutes-per-week level of physical activity for optimal health for anyone.

People who were classified as active avoided increased all-cause death more often, as well as deaths from heart disease.

The study is published in Diabetes Care .

How sedentary lifestyle affects chronic disease risk

For some people, a sedentary, inactive lifestyle is a choice, while for others — such as drivers and office workers — it is a career necessity. For anyone, and for people with diabetes in particular, it is a hazardous habit.

Senior author of the study, the Mailman School’s Sandra S. Albrecht, PhD , explained why:

“Sitting for a long time can lead to problems with blood flow, especially to the lower body, and can lead to the development of blood clots. Blood clots can trigger heart attacks and stroke, among other consequences.”

Jason Ng, MD , of the Department of Medicine at the University of Pittsburgh, teaching endocrinology and metabolism , who was not involved in the study, provided additional details.

Ng added that sitting has the effect of “slowing blood flow and allowing plaque buildup in blood vessels , slowing down the processing of fats due to lower levels of enzymes in the body that help with that process, increasing insulin resistance , and allowing muscles to get weaker from non-use.”

“These factors can all promote the risk of increasing blood pressure, sugars, and cholesterol levels , which can increase mortality,” Ng noted.

Other mortality risk factors for people with diabetes

“Of course managing one’s diabetes more generally is… really important. This means keeping up with doctors’ appointments, taking the necessary medications to control blood sugar , and eating a healthy diet while also moving and keeping active,” said Albrecht.

Beyond that, both Albrecht and Ng cited smoking cigarettes as a major risk factor for diabetes mortality.

“Thankfully, smoking prevalence has been steadily decreasing over time,” Albrecht noted.

Diet is another critical factor in avoiding early mortality with diabetes.

Beyond avoiding high levels of sugar, Ng, pointed out, “eating a diet high in certain types of fat — saturated, trans fats — and eating a lot of salt can all contribute to higher risk factors for cardiac disease mortality in diabetes.”

Finally, said Albrecht, “A diet high in ultra-processed foods and/or high levels of red meat intake are also linked to increases in mortality.”

The overlap between diabetes and heart disease

If much of this sounds similar to advice for avoiding deaths from cardiovascular disease , that is not a coincidence. Heart issues are often the cause of mortality for people with diabetes, and, said Albrecht, “there is a lot of overlap.”

Ng noted “significant commonalities in risk factors between type 2 diabetes and heart disease.”

Among these are common risk factors such as high blood pressure , elevated cholesterol , and obesity , which can cause various factors such as plaque buildup common to both diabetes and cardiovascular disease.

Any increase in physical activity can help reduce risk

“Diet and physical activity are the key risk factors for so many chronic diseases, including diabetes and heart disease,” said Albrecht. “But it’s also so hard to engage in healthy behaviors in this day and age.”

He added:

“Educating the public about these risk factors is important, but we as a society have to also find ways to make it easier for people to eat healthier and to be more active,” said Albrecht. “Any increase in movement will help reduce risk.”

Albrecht suggested small ways of incorporating physical activity into one’s day, “such as using the stairs instead of an elevator, standing up or doing walking meetings if possible, doing hobbies requiring activity — gardening, dancing, etc.”

For people whose work requires long periods of sitting, Albrecht proposed several strategies. If sitting for a long period of time, try to stand and move around every 30 to 60 minutes or so, or whatever is possible. If moving around is not possible, at least stand.

“Beyond this, busy people can also build in movement as they go about their day. For example, taking transit, walking, and/or biking to work or any other destination is a great way to be more active compared to sitting in a car and driving. For those that do drive, try to park a little further away from your destination and walk the rest of the way,” Albrecht explained.

“Of course,” Albrecht added, “if people do have time to exercise, go with the form of activity that is enjoyable to you. The best form of physical activity is the one that a person will stick with on a regular basis.”