BMJ Open. 2026 Jan 6;16(1):e098988. doi: 10.1136/bmjopen-2025-098988.
ABSTRACT
INTRODUCTION: Meeting the recommended guidelines for physical activity (PA), sedentary behaviour (SB) and sleep, collectively referred to as 24-hour movement behaviours (24h-MBs), is crucial for type 2 diabetes mellitus (T2DM) management and is associated with favourable health outcomes. However, it is suggested that adults with T2DM spend more time in SB and less time in PA compared with adults without diabetes.
OBJECTIVES: This study aims to compare 24h-MBs between adults with and without T2DM (ie, controls with similar characteristics except for having T2DM), investigate how this is associated with cardiometabolic health, and assess changes in 24h-MBs after two years of follow-up (FU) in adults with T2DM.
DESIGN: Cross-sectional and longitudinal study.
SETTING: Community-dwelling adults with T2DM and controls in Belgium.
PRIMARY OUTCOME MEASURES: This study took place between September 2021 and December 2023. The 24h-MBs were measured using accelerometers (Actigraph wGT3X+); cardiometabolic variables (adiposity, blood pressure and advanced glycation end-products) were collected in both groups. In adults with T2DM, fasting blood samples were collected at baseline and second FU. Compositional data analysis was used to explore group differences in 24h-MBs using multivariate analysis of variance, and regression models analysed associations with cardiometabolic health. Changes in 24h-MBs over time in adults with T2DM were assessed using a linear mixed model.
RESULTS: 52 adults with T2DM (mean age 63.2 SD 10.6) and 74 controls (mean age 62.7 SD 9.4) were included in the cross-sectional analysis. The 24h-MBs of adults with T2DM differed significantly from the controls (p=0.026). Adults with T2DM spent significantly less time in light (-34.7 min/day) and moderate to vigorous PA (MVPA) (-24.1 min/day) compared with controls. In adults with T2DM, reallocating 30 min from any behaviour to MVPA was associated with a significant increase in high-density lipoprotein-cholesterol (sleep: 5.05 mg/dL (2.45; 7.80), standardised effect size (ES)=0.53; SB: 4.53 mg/dL (1.93; 7.27), ES=0.47; light PA: 5.29 mg/dL (2.07; 8.73), ES=0.55) whereas in the control group significant decreases in waist circumference were found when reallocating 30 min from SB to sleep (2.42 cm (0.86-3.97), ES=0.34). 37 (mean age 65.0 SD 9.5) and 22 (mean age 67.0 SD 7.7) adults with T2DM provided valid data after 1 year and 2 years of FU, respectively. No significant changes in 24h-MBs were found after 1-year (p=0.93) or 2-year (p=0.79) FU among adults with T2DM.
CONCLUSION: Adults with T2DM have a less favourable 24h-MB composition compared to adults without T2DM, indicating the need for additional effort to achieve and maintain the guidelines. Despite the limited associations found, time reallocations from other behaviours to MVPA theoretically suggest the biggest health benefits.
TRIAL REGISTRATION: NCT04993482.
PMID:41500620 | DOI:10.1136/bmjopen-2025-098988