Higher levels of physical activity are independently associated with a lower incidence of diabetic retinopathy in Japanese patients with type 2 diabetes: A prospective cohort study, Diabetes Distress and Care Registry at Tenri (DDCRT15)

Abstract

We assessed the prospective association between baseline levels of physical activity (PA) and the incidence of newly developed diabetic retinopathy (DR) in patients with type 2 diabetes. Data from 1,814 patients with type 2 diabetes without DR were obtained from a Japanese diabetes registry at Tenri Hospital, Nara, Japan. To assess the independent correlations between baseline PA levels and newly developed DR, the participants were divided into five categories based on their PA levels. A Cox proportional hazards model with time-varying exposure information was used and adjusted for potential confounders to assess the independent correlations. At baseline, the mean age, BMI, and hemoglobin A1c levels of the patients were 65.5 years, 24.5 kg/m2, and 7.2% (54 mmol/mol), respectively. After 2 years, newly developed DR was confirmed in 184 patients (10.1%). Patients with newly developed DR had longer duration of type 2 diabetes (14.7 versus 11.0 years, p < 0.0001), higher systolic blood pressure (139.2 versus 135.1 mmHg, p = 0.0012), lower estimated glomerular filtration rate (74.0 versus 77.1 mL/min/1.73 m2, p = 0.0382), greater urinary albumin–creatinine ratio (4.00 versus 2.45 mg/mmol, p < 0.0039), and higher HbA1c levels (7.5 versus 7.2%, p = 0.0006) than those without newly developed DR. The multivariable-adjusted hazard ratios for DR development were 0.87 (95% CI, 0.53–1.40; p = 0.557), 0.83 (95% CI, 0.52–1.31; p = 0.421), 0.58 (95% CI, 0.35–0.94; p = 0.027), and 0.63 (95% CI, 0.42–0.94; p = 0.025)for the second, third, fourth, and fifth PA categories, respectively, compared with the reference category of patients with a mean PA of 0 metabolic equivalent of task-hours/week). Higher PA levels are independently associated with a lower incidence of DR in Japanese patients with type 2 diabetes.

Effect of physical activity on reducing the risk of diabetic retinopathy progression: 10-year prospective findings from the 45 and Up Study

“…However, another cross-sectional study from Indonesian reported that PA was not correlated to vision-threatening DR, but had a protective effect on nephropathy, which is another common microvascular complication of diabetes [ 6 ]. Nevertheless, a recent longitudinal study in Japan showed that higher levels of PA were independently associated with a lower incidence of DR in patients with type 2 diabetes (HR = 0.63, 0.42–0.94; p<0.05) but this analysis was based on 2-years follow up data on 1,814 participants [ 9 ].…”

“…Studies conducted in type 2 diabetic patients found that higher levels of PA were associated with milder DR and less likelihood of DR onset; these studies were cross-sectional in design or limited by small sample size [ 6 – 8 ]. There is only one longitudinal study recently published, reporting a lower DR incidence in participants with higher PA levels, but this study was conducted in a small sample of the cohort during 2-year follow-up [ 9 ]. To the best of our knowledge, the longitudinal relationship between PA and progression to a vision-threatening stage of DR has not been reported.…”

Sleep Quality and Associated Factors in Adults with Type 2 Diabetes: A Retrospective Cohort Study

“…Exercise mediates the effects of sleep on energy balance-related health outcomes [ 32 ]. Intensive physical activity levels were also independently associated with a lower incidence of diabetic retinopathy in Japanese patients with DM [ 33 ]. Muscle contractions of the lower extremities during exercise promote venous return to the heart [ 34 ], which helps to alleviate symptoms of nocturia and improves sleep quality.…”

Aerobic exercise can modulate the underlying mechanisms involved in the development of diabetic complications

“…Some evidence suggests that AE may protect retinal cells from diabetes-induced injuries by inhibition of the underlying inflammatory and oxidative stress pathways (Dharmastuti et al, 2018). Loprinzi, Brodowicz, Sengupta, Solomon, and Ramulu (2014) In a cohort study in diabetic patients, Kuwata et al (2017) found that higher levels of AE are associated with a lower incidence of DR,…”