DOES SHORT-TERM GLYCEMIC CONTROL MODERATE THE EFFECT OF PHYSICAL ACTIVITY ON HEALTH-RELATED QUALITY OF LIFE IN TYPE 2 DIABETES?

O.O. Oyewole¹, O. Odusan², A.O. Ale²

Background: Diabetes is a non-communicable disease of global interest that negatively impact human health. Studies have reported lower health-related quality of life (HRQoL) in people living with diabetes (PLWD) compared with non-diabetics. Sedentary lifestyle, a modifiable risk factor for type 2 diabetes is an independent predictor of poor HRQoL. Physical activity (PA) is an important component of type 2 diabetes management by its effect on altering the body composition, glycemic and blood pressure control, insulin sensitivity and the mental and physical components of HRQoL. However, the impact of PA on HRQoL is not well understood in PLWD irrespective of glycemic control.

Purpose: To assess the effect of PA on HRQoL among PLWD and how the glycemic control moderates this effect. We hypothesized that glycemic control will moderate the interaction between PA and HRQoL.

Methods: This was a re-analysis of a cross-sectional study of PLWD attending a diabetes care centre of a teaching hospital in Nigeria. Their HRQoL was assessed with the Short Form-36 Questionnaire, PA assessed using the long form of the International Physical Activity Questionnaire and categorized as physically active or inactive. The most recent fasting blood glucose values were extracted from patients' record and categorized as short-term good glycemic control or poor control. Data were subjected to Mann-Whitney U test, Spearman’s correlation and moderation analysis.

Results: Study participants were 119 (72 females); mean age 61.8±11.8 years with most physically active (82, 68.9%) and having poor glycemic control (100, 84.0%).  Only 17 (14.3%) achieved good short-term glycemic control with median (inter-quartile) value of 94.0(77.5 – 98.0) mmdl-1. There was significant difference between HRQoL of those physically active compared with inactive [62.53±19.10 vs 50.28±23.10] (p= 0.001) but not between HRQoL of PLWD with and without glycemic control [66.16±23.17 vs 62.20±21.88] (p = 0.496). The effect of PA on HRQoL persisted when adjusted for glycemic control. The HRQoL of PLWD without good short-term glycemic control was significantly different among those physically active and inactive [68.16±19.19 vs 47.62±21.52] (p = 0.001) and no significant difference among those that achieved short-term glycemic control (71.71±18.41 vs 59.93±27.50, p=0.501). The physically active compared with inactive had significantly better HRQoL both in mental health (71.62±19.30 vs 54.75±23.33, p = 0.001) and physical components (65.44±21.09 vs 45.81±24.46, p = 0.001) of HRQoL, respectively. PA and glycemic control account for 14.96% variance on HRQoL (R2 = 0.1496, F3 = 6.628, P = 0.001) though interaction between PA and glycemic control was not statistically significant [b = 0.000, 95% CI (0.000, 0.000), t = 0.153, P = 0.88] indicating that the relationship between PA and QoL is not moderated by glycemic control.

Conclusion(s): Being physically active improves HRQoL. Although, not moderated by short-term glycemic control.

Implications: PLWD need to be physically active to have enhanced HRQoL irrespective of their glycaemic control. Health professionals involved in type 2 diabetes management should encourage patients to engage in structured physical activity.

Funding, acknowledgements: The work was unfunded.

Keywords: Physical activity, Quality of life, Type 2 Diabetes

Topic: Health promotion & wellbeing/healthy ageing/physical activity

Did this work require ethics approval? Yes

Institution: Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria

Committee: Health Research Ethics Committee of Olabisi Onabanjo University Teaching Hospital

Ethics number: OOUTH/DA.326/981