DIFFERENTIAL ASSOCIATIONS BETWEEN PHYSICAL ACTIVITY AND GLYCEMIC CONTROL ACROSS BODY MASS INDEX IN TYPE 2 DIABETES: A COMPARATIVE ANALYSIS OF HBA1C AND FRUCTOSAMINE.

Physically active participants with type 2 diabetes exhibited significantly lower HbA1c levels compared to sedentary participants.

• HbA1c was 6.84% in physically active participants versus 8.07% in sedentary participants (p<0.0001).
• Physically active participants engaged in ≥150 minutes of activity per week for over 3 months (n=98).
• Sedentary group comprised 87 participants.
• Study was cross-sectional, conducted at Thumbay Labs in the United Arab Emirates from January to October 2025.

Physically active participants with type 2 diabetes exhibited significantly lower fructosamine levels compared to sedentary participants.

• Fructosamine was 301.0 µmol/L in physically active participants versus 362.0 µmol/L in sedentary participants (p=0.0001).
• Fructosamine reflects glycemic regulation over a period of 2-3 weeks, providing short-term monitoring.
• Total sample included 185 persons with Type 2 Diabetes.

A significant Activity × BMI interaction was found for HbA1c, indicating decreased glycemic benefits of physical activity with higher BMI.

• The Activity × BMI interaction coefficient for HbA1c was β=0.156 (p=0.0002).
• This interaction persisted after controlling for diabetes medications.
• Multivariable linear regression models controlled for age, sex, BMI, and primary glucose-lowering drug classes.
• The finding indicates that higher BMI is associated with attenuated glycemic benefit from physical activity as measured by HbA1c.

A significant but weaker Activity × BMI interaction was also found for fructosamine.

• The Activity × BMI interaction coefficient for fructosamine was β=7.481 (p=0.0019).
• The effect was described as 'similar but weaker' compared to the HbA1c interaction.
• This suggests BMI attenuates the short-term glycemic benefits of physical activity as well, but to a lesser degree than for long-term glycemic control.

No notable sex differences were observed in the association between physical activity and glycemic markers when BMI was accounted for.

• The multivariable models explicitly tested for an Activity × Sex interaction.
• No significant Activity × Sex interaction was detected for either HbA1c or fructosamine.
• Models controlled for age, sex, BMI, and primary glucose-lowering drug classes.

HbA1c was identified as a more reliable marker than fructosamine for capturing activity-related metabolic benefits in stable type 2 diabetes.

• HbA1c reflects glycemic control over 2-3 months, while fructosamine reflects glycemic regulation over 2-3 weeks.
• The stronger Activity × BMI interaction for HbA1c (p=0.0002) compared to fructosamine (p=0.0019) supports HbA1c's greater sensitivity to long-term activity-related metabolic changes.
• Fructosamine was described as 'a useful short-term indicator but not interchangeable' with HbA1c.
• The authors note fructosamine may provide supplementary short-term monitoring functions for detecting acute metabolic enhancements from lifestyle modifications.

Individuals with type 2 diabetes and increased BMI were identified as requiring stronger lifestyle interventions to achieve glycemic benefits comparable to those with lower BMI.

• The Activity × BMI interaction for HbA1c (β=0.156, p=0.0002) indicates obesity diminishes the glycemic effect of physical activity.
• This effect was described as persisting after controlling for diabetes medications.
• The finding was consistent across both short-term (fructosamine) and long-term (HbA1c) glycemic markers, though more pronounced for HbA1c.