Adults with T2DM have a less favourable 24-hour movement behaviour composition compared to adults without T2DM, and no significant changes in movement behaviours were found after 1-year or 2-year follow-up among adults with T2DM.
Key Findings
Results
The 24-hour movement behaviour compositions of adults with T2DM differed significantly from those of controls.
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 difference in 24h-MBs between groups was statistically significant (p=0.026) using multivariate analysis of variance with compositional data analysis.
Adults with T2DM spent significantly less time in light PA (-34.7 min/day) compared with controls.
Adults with T2DM spent significantly less time in moderate to vigorous PA (MVPA) (-24.1 min/day) compared with controls.
The study was community-based and conducted in Belgium between September 2021 and December 2023, with 24h-MBs measured using Actigraph wGT3X+ accelerometers.
Results
Reallocating 30 minutes from any other behaviour to MVPA was associated with significant increases in HDL-cholesterol in adults with T2DM.
Reallocating 30 min from sleep to MVPA was associated with an increase in HDL-cholesterol of 5.05 mg/dL (95% CI: 2.45–7.80), standardised effect size (ES) = 0.53.
Reallocating 30 min from sedentary behaviour to MVPA was associated with an increase in HDL-cholesterol of 4.53 mg/dL (95% CI: 1.93–7.27), ES = 0.47.
Reallocating 30 min from light PA to MVPA was associated with an increase in HDL-cholesterol of 5.29 mg/dL (95% CI: 2.07–8.73), ES = 0.55.
Compositional isotemporal substitution regression models were used to analyse these associations.
These associations were found only in the T2DM group, not in controls.
Results
In the control group, reallocating 30 minutes from sedentary behaviour to sleep was associated with a significant decrease in waist circumference.
Reallocating 30 min from sedentary behaviour to sleep was associated with a decrease in waist circumference of 2.42 cm (95% CI: 0.86–3.97), ES = 0.34.
This association was found in controls but not in the T2DM group.
Cardiometabolic variables measured included adiposity, blood pressure, and advanced glycation end-products.
Results
No significant changes in 24-hour movement behaviours were observed in adults with T2DM after 1 year or 2 years of follow-up.
37 adults with T2DM (mean age 65.0 SD 9.5) provided valid data after 1-year follow-up.
22 adults with T2DM (mean age 67.0 SD 7.7) provided valid data after 2-year follow-up.
Changes in 24h-MBs over time were assessed using a linear mixed model.
No significant change was found at 1-year follow-up (p=0.93) or 2-year follow-up (p=0.79).
Background
Adults with T2DM are suggested to spend more time in sedentary behaviour and less time in physical activity compared with adults without diabetes, highlighting the importance of 24-hour movement behaviour guidelines for T2DM management.
Meeting recommended guidelines for PA, sedentary behaviour, and sleep — collectively referred to as 24-hour movement behaviours (24h-MBs) — is described as crucial for T2DM management.
The study assessed all three components (PA, sedentary behaviour, sleep) simultaneously using compositional data analysis.
Fasting blood samples were collected at baseline and second follow-up only in adults with T2DM.
The study used a combined cross-sectional and longitudinal design.
What This Means
This research suggests that people living with type 2 diabetes (T2DM) move differently throughout their day compared to similar adults without diabetes. Specifically, adults with T2DM spent about 35 fewer minutes per day in light physical activity and about 24 fewer minutes per day in moderate-to-vigorous physical activity (such as brisk walking or exercise) than their counterparts without diabetes. These differences were measured objectively using wrist-worn accelerometers over a 24-hour period and analyzed together as a daily 'movement composition' including sleep, sitting time, and different intensities of activity.
The study also found that theoretically swapping 30 minutes of any other behaviour — whether sleep, sitting, or light activity — for more vigorous exercise was linked to meaningfully higher levels of HDL ('good') cholesterol in adults with T2DM. In contrast, for people without diabetes, shifting 30 minutes from sitting to sleep was associated with a smaller waist circumference. When adults with T2DM were followed over one and two years, their daily movement patterns did not change significantly, suggesting that without specific intervention, people with T2DM are not naturally increasing their activity levels over time.
This research suggests that people with T2DM may benefit from targeted support to increase moderate-to-vigorous physical activity as part of their daily routine, given its potential association with improved cholesterol levels. The lack of spontaneous improvement in movement behaviours over two years indicates that achieving and maintaining healthier activity patterns in this population likely requires active, ongoing effort and possibly structured programs or guidance.
Bogaert L, De Craemer M, Dirinck E, Calders P, Lapauw B, Willems I. (2026). 24-hour movement behaviours and cardiometabolic health in adults with type 2 diabetes: a comparative cross-sectional and longitudinal analysis.. BMJ open. https://doi.org/10.1136/bmjopen-2025-098988