Sex Differences in Physical Activity Among Individuals With Type 2 Diabetes Across the Life Span: A Systematic Review and Meta-analysis

Association Between Physical Activity and Adherence to Nutritional Recommendations in Individuals with Diabetes: Analysis of Self-Reported Data from the 2020 European Health Survey in Spain

Background/Objectives: This study compares dietary and physical activity (PA) habits between Spanish adults with and without diabetes and analyzes the association between PA, sociodemographic variables, and adherence to nutritional recommendations among individuals with diabetes. Methods: A cross-sectional case-control study was conducted using data from the 2020 European Health Survey for Spain (EESE). Diabetes and PA levels were self-reported. Each participant with diabetes was matched with a control without diabetes by age, gender, and region of residence. Food intake was assessed using a food frequency questionnaire, and adherence to nutritional guidelines was evaluated based on the recommendations of the Spanish Agency for Food Safety and Nutrition. The PA levels were classified as "sedentary/low" or "moderate/high". Results: A total of 2053 matched pairs were analyzed. The participants with diabetes adhered to significantly more nutritional recommendations than those without diabetes (6.19 vs. 5.30; p < 0.001). However, 88.6% of the individuals with diabetes reported sedentary or low PA levels. Among those with diabetes, women showed better adherence to nutritional recommendations, while men reported higher PA levels. Moderate/high PA was associated with greater adherence to nutritional recommendations (OR 1.991; 95% CI: 1.201-3.146). Older age was also positively associated with adherence. Conclusions: Although individuals with diabetes demonstrated better adherence to nutritional recommendations than controls, most reported low PA levels. Higher PA levels, female gender, and older age were linked to greater adherence to nutritional recommendations among people with diabetes. However, the use of self-reported data made it impossible to judge whether the participants under- or over-reported their PA levels and diabetes status. Public health strategies should aim to promote both PA and healthy eating habits in this population.

The relationship between physical inactivity and sexual dysfunction among patients receiving hemodialysis

BACKGROUND

Chronic Kidney Disease (CKD), in its final stage, requires renal replacement therapy, such as hemodialysis (HD) to maintain vital functions; nevertheless, it imposes lifestyle changes. For example, physical activity (PA) levels are lower than the World Health Organization recommendations, consequently affecting physical performance. On the other hand, up to 80% of patients receiving HD have reported sexual dysfunction. Therefore, this study aimed to associate physical inactivity with sexual dysfunction in patients receiving HD.

METHODS

an analytical cross-sectional study was conducted on 116 ambulatory HD patients. Self-reported questionnaires for sexual dysfunction, IIEF and IFSF, and physical performance tests, such as the IPAQ-SF for physical activity levels, the six-minute walk test, the handgrip strength test, and the sit-to-stand test, were used to assess patients. A multivariate regression model was performed to identify predictors of sexual dysfunction.

RESULTS

86.4% of women and 84.2% of the men reported sexual dysfunction. An association between physical inactivity and sexual dysfunction was found (OR = 5.6, 95% CI 1.77-17.71, p = 0.003). Logistic regression revealed that PA (OR = 0.997, p = 0.004), diabetes (OR = 7.558, p = 0.028), handgrip strength (OR = 1.819, p =  < 0.001), and sit-to-stand repetitions (OR = 0.779, p = 0.004) were predictors of sexual dysfunction.

CONCLUSION

Our study found that physical inactivity increases the risk of sexual dysfunction in CKD patients receiving HD, where the presence of diabetes is the main risk factor, and physical performance has a protective effect. Therapeutic exercise programs should be implemented as part of an integral approach in HD units, to improve patients' physical and sexual function.

The Effect of a 12-Week Physical Exercise Program on Glycemic Indices in Adults at Community Wellness Services, Primary Health Care Corporation, Qatar, in 2023

BACKGROUND

 The substantial rise in various risk factors for noncommunicable diseases in Qatar is well-documented, underscoring their contribution to premature morbidity and mortality. Physical exercise (PE) is pivotal, offering significant benefits for biochemical and anthropometric parameters while serving as a therapeutic and preventive measure. Community-based wellness centers within primary care provide a valuable opportunity to assess the impact of PE on different health aspects, including glycemic indices and anthropometric measurements.

METHODS

 This retrospective cohort study examines the data of adults who completed a 12-week PE in Primary Health Care Corporation (PHCC) wellness centers from 2021 to 2023. A total of 909 patient data sets were extracted from electronic medical records across the seven wellness centers at PHCC. Participants completed three moderate-intensity PE sessions of 60 minutes weekly over the 12 weeks. Eligible patient data were assessed by the availability of the hemoglobin A1c glycated (HbA1c) in percentage and fasting blood glucose (FBG) levels before and after the program, looking for the mean difference significance in the two parameters. Further analysis was done to correlate the sociodemographic and anthropometrics to the glycemic indices and consider the significance at p < 0.05.

RESULTS

 In an eligible cohort of 739 data sets, the mean age was 48.75 ±12.83 years, and 74.56% were women. The body mass index (BMI) preintervention was 31.15 ± 5.39 kg/m2, and the fat mass (FM) was 33.91 ± 8.42 kg, indicating obese patients. The majority of the data suggested that normoglycemic individuals were at the prediabetes stage (14.34%) and within the uncontrolled diabetes range (4.48%). The mean reduction in FBG post-PE was 0.18 mmol/L (95% CI = 0.016-0.401; p = 0.000; paired t-test). In contrast, the HbA1c% decreased by a mean of 0.050% (95% CI = 0.006-0.135), with a significant association favoring the PE (p = 0.035, paired t-test). Notably, 31.13% of 106 patients with prediabetes normalized their HbA1c% after PE, while 40% of uncontrolled patients with diabetes transitioned to a controlled glycemic state out of 35 cases. All the anthropometrics demonstrated a statistically significant relation in their mean difference, favoring the effect of PE, where weight (0.95 kg; 95% CI = 0.61-1.44), BMI (0.27 kg/m2; 95% CI = 0.23-0.49), and FM (1.4 kg; 95% CI = 0.94-1.7) also correlate with the change in glycemic indices.

CONCLUSION

 The 12-week structured PE intervention at PHCC wellness centers elicited a profound and statistically significant amelioration in glycemic indices. The observed reductions substantiate the metabolic benefits of sustained PE, with notable implications for insulin sensitivity and glucose homeostasis. These results accentuate the indispensable role of exercise as a therapeutic and preventive modality, which supports the need for integrating such programs into primary healthcare frameworks.

Transgender healthcare: metabolic outcomes and cardiovascular risk

Transgender identity is often associated with gender dysphoria and minority stress. Gender-affirming hormone treatment (GAHT) includes masculinising or feminising treatment and is expected to be lifelong in most cases. Sex and sex hormones have a differential effect on metabolism and CVD in cisgender people, and sex hormone replacement in hypogonadism is associated with higher vascular risk, especially in ageing individuals. Using narrative review methods, we present evidence regarding metabolic and cardiovascular outcomes during GAHT and propose recommendations for follow-up and monitoring of metabolic and cardiovascular risk markers during GAHT. Available data show no increased risk for type 2 diabetes in transgender cohorts, but masculinising GAHT increases lean body mass and feminising GAHT is associated with higher fat mass and insulin resistance. The risk of CVD is increased in transgender cohorts, especially during feminising GAHT. Masculinising GAHT is associated with a more adverse lipid profile, higher haematocrit and increased BP, while feminising GAHT is associated with pro-coagulant changes and lower HDL-cholesterol. Assigned male sex at birth, higher age at initiation of GAHT and use of cyproterone acetate are separate risk factors for adverse CVD markers. Metabolic and CVD outcomes may improve during gender-affirming care due to a reduction in minority stress, improved lifestyle and closer surveillance leading to optimised preventive medication (e.g. statins). GAHT should be individualised according to individual risk factors (i.e. drug, dose and form of administration); furthermore, doctors need to discuss lifestyle and preventive medications in order to modify metabolic and CVD risk during GAHT. Follow-up programmes must address the usual cardiovascular risk markers but should consider that biological age and sex may influence individual risk profiling including mental health, lifestyle and novel cardiovascular risk markers during GAHT.

Sex Differences Across the Lifespan: A Focus on Cardiometabolism

Women's health and sex differences research remain understudied. In 2022, to address the topic of sex differences, the Ludeman Family Center for Women's Health Research (LFCWHR) at the University of Colorado (LudemanCenter.org) held its third National Conference, "Sex Differences Across the Lifespan: A Focus on Metabolism." The research presentations and discussions from the 2022 conference addressed cardiometabolic sex differences across the lifespan and included sessions focusing on scientific methods with which to study sex differences, effects of estrogen on metabolism, and sex differences in cardiovascular disease-implications for women and policy among others. Over 100 participants, including basic scientists, clinical scientists, policymakers, advocacy group leaders, and federal agency leadership participated. The meeting proceedings reveal that although exciting advances in the area of sex differences have taken place, significant questions and gaps remain about women's health and sex differences in critical areas of health. Identifying these gaps and the subsequent research that will result may lead to important breakthroughs.

Effect of Pre-Hospitalization Fall History on Physical Activity and Sedentary Behavior After the Implementation of a Behavioral Change Approach in Patients with Minor Ischemic Stroke: A Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

We aimed to determine whether a history of falls before admission affected physical activity levels and sedentary behavior negatively after implementing a behavior modification approach in patients with minor ischemic stroke.

METHODS

This study constituted a secondary analysis of an intervention trial. In the intervention study, patients with minor ischemic stroke were randomly assigned to two groups: intervention and control groups. The intervention group was encouraged to reduce sedentary behavior during hospitalization and after discharge, while the control group was encouraged to increase physical activity levels solely during hospitalization. The study included 52 patients who completed the intervention trial. The exposure factor examined was a history of falls. Upon admission, patients were queried about any falls experienced in the year preceding admission and subsequently classified into fall and non-fall groups based on their responses. The primary outcome of interest focused on changes in physical activity levels (step count, light-intensity physical activity, and moderate-to-vigorous-intensity physical activity) and sedentary behavior. Measurements were obtained at two time points: before the intervention, during hospitalization (baseline), and 3 months after discharge (post-intervention).

RESULTS

Only a significantly lower change in the number of steps taken in the fall group than in the non-fall group was found.

CONCLUSION

Those with a history of falls showed a lesser change in the number of steps taken before and after implementing a behavior change approach compared with those without a history of falls. Those with a history of falls may have engaged in activities other than walking.

Dietary Habits, Physical Activity and Body Mass Index in Transgender and Gender Diverse Adults in Italy: A Voluntary Sampling Observational Study

Transgender and gender-diverse (TGD) individuals continue to experience harassment and discrimination across various aspects of life, significantly impacting their physical and mental health. The scarcity of data on their general health, particularly regarding dietary habits, remains a challenge in developing effective healthcare strategies for this population. To address this gap, we analyzed selected dietary habits, physical activity (PA), and body mass index (BMI) among Italian TGD adults compared to the Italian general population (IGP). An online anonymous survey was conducted via the Computer Assisted Web Interviewing technique from June 2020 to June 2021. Participants were enrolled through clinical centers and TGD organizations. Data from 959 TGD adults were analyzed using chi-squared tests and logistic regression models. Key findings indicated that approximately 70% of TGD individuals consumed fewer servings of fruit and vegetables (FV) than recommended (five or more servings per day). Although red meat consumption was lower overall, a greater percentage of TGD individuals reported consuming more than three servings per week. Additionally, 58% of TGD participants indicated that they did not engage in any PA, compared to 36% of the IGP. Notably, significant differences in BMI were identified, with higher rates of overweight and obesity among TGD individuals assigned female at birth. These results underscore the urgent need for tailored nutritional guidelines and inclusive public health strategies to meet the specific health needs of the Italian TGD population. Expanding access to targeted interventions could contribute to improving overall well-being in this marginalized group.

Association between weekend warrior physical activity pattern and all-cause mortality among adults living with type 2 diabetes: a prospective cohort study from NHANES 2007 to 2018

BACKGROUND

It is uncertain whether the weekend warrior pattern is associated with all-cause mortality among adults living with type 2 diabetes. This study explored how the 'weekend warrior' physical activity (PA) pattern was associated with all-cause mortality among adults living with type 2 diabetes.

METHODS

This prospective cohort study investigated US adults living with type 2 diabetes in the National Health and Nutrition Examination Survey (NHANES). Mortality data was linked to the National Death Index. Based on self-reported leisure-time and occupational moderate-to-vigorous PA (MVPA), participants were categorized into 3 groups: physically inactive (< 150 min/week of MVPA), weekend warrior (≥ 150 min/week of MVPA in 1 or 2 sessions), and physically active (≥ 150 min/week of MVPA in 3 or more sessions).

RESULTS

A total of 6067 participants living with type 2 diabetes [mean (SD) age, 61.4 (13.5) years; 48.0% females] were followed for a median of 6.1 years, during which 1206 deaths were recorded. Of leisure-time and occupational activity, compared with inactive individuals, hazard ratios (HRs) for all-cause mortality were 0.49 (95% CI 0.26-0.91) and 0.57 (95% CI 0.38-0.85) for weekend warrior individuals, and 0.55 (95% CI 0.45-0.67) and 0.64 (95% CI 0.53-0.76) for regularly active individuals, respectively. However, when compared leisure-time and occupational weekend warrior with regularly active participants, the HRs were 0.82 (95% CI 0.42-1.61) and 1.00 (95% CI 0.64-1.56) for all-cause mortality, respectively.

CONCLUSIONS

Weekend warrior PA pattern may have similar effects on lowering all-cause mortality as regularly active pattern among adults living with type 2 diabetes, regardless of leisure-time or occupational activity. Therefore, weekend warrior PA pattern may be sufficient to reduce all-cause mortality for adults living with type 2 diabetes.

Age, Race, Sex and Cardiorespiratory Fitness: Implications for Prevention and Management of Cardiometabolic Disease in Individuals with Diabetes Mellitus

Physical inactivity and poor cardiorespiratory fitness (CRF) are strongly associated with type 2 diabetes (DM2) and all-cause and cardiovascular morbidity and mortality. Incorporating physical activity promotion in the management of DM2 has been a pivotal approach modulating the underlying pathophysiology of DM2 of increased insulin resistance, endothelial dysfunction, and abnormal mitochondrial function. Although CRF is considered a modifiable risk factor, certain immutable aspects such as age, race, and gender impact CRF status and is the focus of this review. Results show that diabetes has often been considered a disease of premature aging manifested by early onset of macro and microvascular deterioration with underlying negative impact on CRF and influencing next generation. Certain races such as Native Americans and African Americans show reduced baseline CRF and decreased gain in CRF in randomized trials. Moreover, multiple biological gender differences translate to lower baseline CRF and muted responsivity to exercise in women with increased morbidity and mortality. Although factors such as age, race, and sex may not have major impacts on CRF their influence should be considered with the aim of optimizing precision medicine.

Gender differences in the association between physical activity and cognitive subdomains among elders with type 2 diabetes and mild cognitive impairment: a cross-sectional study

OBJECTIVES

The objective of this study was to evaluate the gender differences in the correlation between physical activity (PA) and cognitive subdomains in elderly individuals with type 2 diabetes (T2D) and mild cognitive impairment (MCI).

DESIGN

Cross-sectional study.

SETTING

The research was carried out in communities located in Fuzhou, Fujian Province and Beijing Municipality.

PARTICIPANTS

Community-dwelling elders with T2D and MCI aged 60 years or older were eligible for this study.

PRIMARY OUTCOME MEASURES AND ANALYSES

The weekly PA score was assessed using the International Physical Activity Questionnaire (IPAQ). The cognitive subdomains were evaluated through a battery of cognitive assessments, including the Rey Auditory Verbal Learning Test (RAVLT), Trail Making Test Part B, Digit Symbol Substitution Test (DSST) and the Stroop Color-Word Test (SCWT). Multiple linear regression models were employed to examine the association between PA and cognitive subdomains in both male and female individuals.

RESULTS

In older men, higher total IPAQ score was positively correlated with higher RAVLT (P=0.011) and SCWT (P=0.049). There was a significant interaction between the total PA score and gender in relation to RAVLT (P=0.008) and SCWT (P=0.027). Moreover, there was a positive correlation between moderate-vigorous PA level and RAVLT in older men (P=0.007). Additionally, a positive correlation was found between moderate-vigorous PA level and DSST in older women (P=0.038).

CONCLUSION

In older individuals with T2D and MCI, the association between PA and cognitive subdomains differs between men and women. This discrepancy may impact the customisation of exercise recommendations.

Predictors associated with an increase in daily steps among people with prediabetes or type 2 diabetes participating in a two-year pedometer intervention

BACKGROUND

This study aimed to explore predictors associated with intermediate (six months) and post-intervention (24 months) increases in daily steps among people with prediabetes or type 2 diabetes participating in a two-year pedometer intervention.

METHODS

A secondary analysis was conducted based on data from people with prediabetes or type 2 diabetes from two intervention arms of the randomised controlled trial Sophia Step Study. Daily steps were measured with an ActiGraph GT1M accelerometer. Participants were divided into two groups based on their response to the intervention: Group 1) ≥ 500 increase in daily steps or Group 2) a decrease or < 500 increase in daily steps. Data from baseline and from six- and 24-month follow-ups were used for analysis. The response groups were used as outcomes in a multiple logistic regression together with baseline predictors including self-efficacy, social support, health-related variables, intervention group, demographics and steps at baseline. Predictors were included in the regression if they had a p-value < 0.2 from bivariate analyses.

RESULTS

In total, 83 participants were included. The mean ± SD age was 65.2 ± 6.8 years and 33% were female. At six months, a lower number of steps at baseline was a significant predictor for increasing ≥ 500 steps per day (OR = 0.82, 95% CI 0.69-0.98). At 24 months, women had 79% lower odds of increasing ≥ 500 steps per day (OR = 0.21, 95% CI 0.05-0.88), compared to men. For every year of increase in age, the odds of increasing ≥ 500 steps per day decreased by 13% (OR = 0.87, 95% CI 0.78-0.97). Also, for every step increase in baseline self-efficacy, measured with the Self-Efficacy for Exercise Scale, the odds of increasing ≥ 500 steps per day increased by 14% (OR = 1.14, 95% CI 1.02-1.27).

CONCLUSIONS

In the Sophia Step Study pedometer intervention, participants with a lower number of steps at baseline, male gender, lower age or higher baseline self-efficacy were more likely to respond to the intervention with a step increase above 500 steps per day. More knowledge is needed about factors that influence response to pedometer interventions.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT02374788.

Type 2 diabetes is linked to higher physiologic markers of effort during exercise

Background

People with type 2 diabetes (T2D) have lower rates of physical activity (PA) than the general population. This is significant because insufficient PA is linked to cardiovascular morbidity and mortality, particularly in individuals with T2D. Previously, we identified a novel barrier to physical activity: greater perceived effort during exercise in women. Specifically, women with T2D experienced exercise at low-intensity as greater effort than women without T2D at the same low-intensity - based on self-report and objective lactate measurements. A gap in the literature is whether T2D confers greater exercise effort in both sexes and across a range of work rates.

Objectives

Our overarching objective was to address these gaps regarding the influence of T2D and relative work intensity on exercise effort. We hypothesized that T2D status would confer greater effort during exercise across a range of work rates below the aerobic threshold.

Methods

This cross-sectional study enrolled males and post-menopausal females aged 50-75 years. Measures of exercise effort included: 1) heart rate, 2) lactate and 3) self-report of Rating of Perceived Exertion (RPE); each assessment was during the final minute of a 5-minute bout of treadmill exercise. Treadmill exercise was performed at 3 work rates: 1.5 mph, 2.0 mph, and 2.5 mph, respectively. To determine factors influencing effort, separate linear mixed effect models assessed the influence of T2D on each outcome of exercise effort, controlling for work rate intensity relative to peak oxygen consumption (%VO2peak). Models were adjusted for any significant demographic associations between effort and age (years), sex (male/female), baseline physical activity, or average blood glucose levels.

Results

We enrolled n=19 people with T2D (47.4% female) and n=18 people (55.6% female) with no T2D. In the models adjusted for %VO2peak, T2D status was significantly associated with higher heart rate (p = 0.02) and lactate (p = 0.01), without a significant association with RPE (p = 0.58).

Discussions

Across a range of low-to-moderate intensity work rates in older, sedentary males and females, a diagnosis of T2D conferred higher objective markers of effort but did not affect RPE. Greater objective effort cannot be fully attributed to impaired fitness, as it persisted despite adjustment for %VO2peak. In order to promote regular exercise and reduce cardiovascular risk for people with T2D, 1) further efforts to understand the mechanistic targets that influence physiologic exercise effort should be sought, and 2) comparison of the effort and tolerability of alternative exercise training prescriptions is warranted.

Evaluations of virtual exercise programmes for adults with mobility limitations: a scoping review protocol incorporating an equity lens to inform the development of strategies to optimise participation of under-represented groups

INTRODUCTION

For individuals with mobility limitations, virtual exercise programmes can address the challenges of in-person participation in community exercise programmes. A synthesis of studies of virtual exercise programmes targeting mobility limitations provided outside of conventional rehabilitation services and strategies used to optimise equitable access and inclusivity in these programmes is lacking. We aim to characterise evaluations of virtual exercise programmes for adults with mobility limitations, and the nature of and extent to which equity, diversity and inclusion considerations are integrated in the research process.

METHODS AND ANALYSIS

A scoping review following a six-stage methodological framework, including a consultation exercise, is proposed. A comprehensive strategy will be used to search Medline, Embase, PEDro, CINAHL and Scopus to identify peer-reviewed studies evaluating virtual exercise programmes for adults with mobility limitations living in the community. Three trained reviewers will select studies independently. Data (eg, study methodology, programme structure and content, participant characteristics) will be extracted using a standardised form, and collated and summarised using quantitative and qualitative methods. The PROGRESS-Plus and International Classification of Functioning, Disability and Health frameworks will be used to classify participant characteristics and study outcomes, respectively. During the consultation exercise, key knowledge users, including exercise participants, programme providers and coordinators, and members of community organisations for persons living with disabilities and under-represented groups, will be asked to provide insights regarding the applicability of review findings. A directed content analysis of data from the consultation exercise will be performed.

ETHICS AND DISSEMINATION

The research ethics board at the University of Toronto approved the consultation exercise. Findings will be disseminated through peer-reviewed publications and conference presentations. Findings will enhance understanding of current research evaluating virtual exercise programmes and inform future research and strategies for promoting equitable access and outcomes for individuals with mobility limitations.

REGISTRATION DETAILS

https://doi.org/10.17605/OSF.IO/X5JMA.

A framework of biomarkers for skeletal aging: a consensus statement by the Aging Biomarker Consortium

The skeleton is an important structural and metabolic organ in human body, while aging is the physiological basis for degenerative skeletal diseases. China has the largest aging population in the world and faces great challenges in preventing and managing diseases related to skeletal aging. To address these challenges, the Aging China Biomarkers Consortium (ABC) has reached an expert consensus on biomarkers of skeletal aging by synthesizing the literature and insights from scientists and clinicians. The consensus provides a comprehensive assessment of biomarkers associated with skeletal aging and proposes a systematic framework that categorizes biomarkers into three dimensions, namely, functional, structural, and humoral dimensions. Within each dimension, the ABC recommended clinical and evidential research-based biomarkers for physiological aging and degenerative pathologies of the skeleton. This expert consensus aims to lay the foundation for future studies to assess the prediction, diagnosis, early warning, and treatment of diseases associated with skeletal aging, with the ultimate goal of improving the skeletal health of elderly populations in China and around the world.

Child self-care autonomy in health (scale for parents): development, internal structure, and sex/age correlates

Autonomy in self-care practices in the health sphere is a critical characteristic for the survival of humans throughout the life span. Notably, however, the current literature lacks psychometrically sound instruments that measure this phenomenon among children without diagnosed chronic health conditions. The purpose of the present exploratory study was to develop, test, and provide data regarding the reliability and validity of the Child Self-Care Autonomy in Health (CSAH) scale. The piloted version of the CSAH yielded an 11-item instrument designed to reflect the parent's perspective in measuring the extent of autonomy in self-care actions related to health for a child, whether diagnosed with a chronic illness or not. Data were collected through an online survey of a non-random sample of Russian-speaking parents currently residing in Russia (N = 349). The analysis focused on scale structure via principal component analysis and age/sex associations. The proposed CSAH may be of interest to social workers, health professionals, and parents seeking to ascertain schoolers' autonomy in self-care practices in the health sphere and support building a stronger self-care mindset.

Sex differences in cardiovascular risk, lifestyle, and psychological factors in patients with type 2 diabetes: the Fukuoka Diabetes Registry

BACKGROUND

The excess risk of cardiovascular diseases associated with diabetes is greater in women than in men. The present study aimed to examine sex differences in the control of cardiovascular risk factors, as well as lifestyle and psychological factors, in patients with type 2 diabetes.

METHODS

A total of 4923 Japanese patients with type 2 diabetes were included in this cross-sectional study. Female/male differences in cardiovascular risk factor levels, and corresponding odds ratios for achieving recommended ranges for preventing cardiovascular diseases and having unhealthy lifestyle and psychological factors were computed by linear and logistic regression models.

RESULTS

Women were less likely than men to achieve recommended ranges for glycated hemoglobin, low-density lipoprotein cholesterol, non-high-density lipoprotein cholesterol, and obesity-related anthropometric indices such as body mass index and waist circumference, but were more likely than men to be on target for high-density lipoprotein cholesterol and triglycerides. Women were also more likely than men to have an unhealthy lifestyle and psychological factors, including less dietary fiber intake, less leisure-time physical activity, shorter sleep duration, more constipation, and more depressive symptoms. Similar findings were observed when the participants were subgrouped by age (< 65 and ≥ 65 years) and past history of cardiovascular disease.

CONCLUSIONS

We observed significant sex differences for a range of cardiovascular risk factors, as well as lifestyle and psychological factors, suggesting the importance of adopting a sex-specific approach for the daily clinical management of diabetes.

Cross Sectional and Case-Control Study to Assess Time Trend, Gender Differences and Factors Associated with Physical Activity among Adults with Diabetes: Analysis of the European Health Interview Surveys for Spain (2014 & 2020)

(1) Background: We aim to assess the time trend from 2014 to 2020 in the prevalence of physical activity (PA), identify gender differences and sociodemographic and health-related factors associated with PA among people with diabetes, and compare PA between people with and without diabetes. (2) Methods: We conducted a cross-sectional and a case-control study using as data source the European Health Interview Surveys for Spain (EHISS) conducted in years 2014 and 2020. The presence of diabetes and PA were self-reported. Covariates included socio-demographic characteristics, health-related variables, and lifestyles. To compare people with and without diabetes, we matched individuals by age and sex. (3) Results: The number of participants aged ≥18 years with self-reported diabetes were 1852 and 1889 in the EHISS2014 and EHISS2020, respectively. The proportion of people with diabetes that had a medium or high frequency of PA improved from 48.3% in 2014 to 52.6% in 2020 (p = 0.009), with 68.5% in 2014 and 77.7% in 2020 being engaged in two or more days of PA (p < 0.001). Males with diabetes reported more PA than females with diabetes in both surveys. After matching by age and gender, participants with diabetes showed significantly lower engagement in PA than those without diabetes. Among adults with diabetes, multivariable logistic regression showed confirmation that PA improved significantly from 2014 to 2020 and that male sex, higher educational level, and better self-rated health were variables associated to more PA. However, self-reported comorbidities, smoking, or BMI > 30 were associated to less PA. (4) Conclusions: The time trend of PA among Spanish adults with diabetes is favorable but insufficient. The prevalence of PA in this diabetes population is low and does not reach the levels of the general population. Gender differences were found with significantly more PA among males with diabetes. Our result could help to improve the design and implementation of public health strategies to improve PA among people with diabetes.

Sex Differences in the Feasibility of Aerobic Exercise Training for Improving Cardiometabolic Health Outcomes in Adults with Type 2 Diabetes

Females with type 2 diabetes (T2D) have a 25-50% greater risk of developing cardiovascular disease compared with males. While aerobic exercise training is effective for improving cardiometabolic health outcomes, there is limited sex-segregated evidence on the feasibility of aerobic training in adults with T2D. A secondary analysis of a 12-week randomized controlled trial examining aerobic training in inactive adults with T2D was conducted. Feasibility outcomes were recruitment, retention, treatment fidelity, and safety. Sex differences and intervention effects were assessed using two-way analyses of variances. Thirty-five participants (14 females) were recruited. The recruitment rate was significantly lower among females (9% versus 18%; p = 0.022). Females in the intervention were less adherent (50% versus 93%; p = 0.016), and experienced minor adverse events more frequently (0.08% versus 0.03%; p = 0.003). Aerobically trained females experienced clinically meaningful reductions in pulse wave velocity (-1.25 m/s, 95%CI [-2.54, 0.04]; p = 0.648), and significantly greater reductions in brachial systolic pressure (-9 mmHg, 95%CI (3, 15); p = 0.011) and waist circumference (-3.8 cm, 95%CI (1.6, 6.1); p < 0.001) than males. To enhance the feasibility of future trials, targeted strategies to improve female recruitment and adherence are needed. Females with T2D may experience greater cardiometabolic health improvements from aerobic training than males.