People Who Accumulate More Steps per Day Have Lower Risk of Diabetes

Type 2 diabetes affects nearly 10% of the United States population, with more than 26 million adults having a T2D diagnosis and another 91.8 million (37.6%) who have prediabetes. Because of the morbidity and mortality associated with diabetes, prevention through physical activity has been recommended by the American Diabetes Association, as prevalence of diabetes is projected to double by 2030.

A study published in the International Journal of Behavioral Nutrition and Physical Activity found that there may be an association between increased daily walking and a lower risk of diabetes. The aim of the study was to determine if the number of steps taken by someone each day could affect their risk of diabetes.

The Hispanic Community Health Study/Study of Latinos, which was the source of data about the study cohort, collected data on Hispanic/Latino adults aged 18 to 74 years who were recruited between 2008 and 2011 from the Bronx, New York; Chicago, Illinois; Miami, Florida; and San Diego, California. All participants wore an accelerometer during waking hours for 1 week, only removing it for sleeping, showering, and swimming. Adherence was defined as at least 3 days of 10 hours of wear.

Participants were excluded if they had diabetes at baseline, did not wear the accelerometer at visit 1, were not adherent, experienced an accelerometer malfunction, or were missing any covariates in the analysis. The top and bottom 1% were also removed to remove extreme outliers.

There were 6634 adults who were included in the study. The mean age of the participants was 39 years, half of them were women, 76% were born outside of the United States, and 41% had prediabetes at baseline. The mean wear time of the accelerometer was 15.9 hours per day (95% CI, 15.7-16.0) and adults had a mean of 8164 steps per day (SE = 92; median = 7317).

In a follow-up period of a median of 5.9 (range, 1-9.6) years, there were 1115 (12.5%) and 740 (8.2%) incident events of diabetes, with incidence rates and HRs generally lower with greater steps per day. The risk of diabetes based on 3 criteria was 2% lower (HR, 0.98; 95% CI, 0.95-1.00) per 1000 steps per day.

The predicted risk of diabetes was 8% (HR, 0.98; 95% CI, 0.85-1.01) and 13% (HR, 0.87; 95% CI, 0.74-1.02) lower at 7000 and 10,000 steps per day, respectively, compared with 3400 steps per day. Analyses also found that the risk of diabetes at 10,000 to 12,500 steps per day was 18% lower (HR, 0.82; 95% CI, 0.57-1.18) compared with those who had fewer than 5000 steps per day.

Although adults with obesity had a higher incidence rate of diabetes, those with obesity who had 10,000 steps per day had 0.81 (95% CI, 0.65-1.01) times the risk of diabetes compared with those who had 3400 steps per day (HR, 1.01; 95% CI, 0.81-1.27).

Adults who had 10,000 steps per day and were 50 years and older had 0.69 (95% CI, 0.52-0.90) times the risk of diabetes compared with those who had 3400 steps per day. The HR of diabetes was 0.67 (95% CI, 0.49-0.92) in women taking 10,000 steps per day compared with women who had 3400 steps a day. There was a weaker inverse association in men.

Adults with prediabetes who had 10,000 steps per day had a 26% (HR, 0.74; 95% CI, 0.58-0.95) lower risk of diabetes compared with adults with prediabetes who had 3400 steps per day.

There were some limitations to this study. Reverse causality could not be ruled out due to not knowing when diabetes developed, and it is possible that adults who developed diabetes close to baseline may have had lower steps per day. Activity patterns may change over time, so these results may not be consistent across a long period of time. It is possible that nonambulatory movement (eg, cycling, swimming) could be beneficial for preventing diabetes, but this type of movement was not measured in the current study.

The researchers concluded that frequent walks with more steps and a faster pace could be beneficial in preventing diabetes, with a 2% to 3% lower 6-year risk of diabetes per 1000 steps per day.

Reference

Cuthbertson CC, Moore CC, Sotres-Alvarez D, et al. Associations of steps per day and step intensity with the risk of diabetes: the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Int J Behav Nutr Phys Act. 2022;19:46. doi:10.1186/s12966-022-01284-2