Association between sedentary behavior and mortality in patients with type 2 diabetes: A dose-response relationship analysis

Objective To estimate the dose-response relationship between sedentary behavior with mortality in patients with type 2 diabetes. Methods A total of 17 786 type 2 diabetic patients were recruited as participants, who were included in National Basic Public Health Service in Changshu County of Suzhou City, Qinghe District and Huai′an District in Huai′an City of Jiangsu Province. Cox proportional hazards regression model and restricted cubic spline model were employed to estimate the dose-response relationship between sedentary behavior with all-cause and cause specific mortality in patients with type 2 diabetes. Results Among 78 114.34 person-years of the fo1low-up, the median of follow-up time was 4 years, and 1 285 deaths occurred during that period. Compared to patients with sedentary behavior≤2 h/d, the multivariate adjusted hazard ratios of all-cause death associated with sedentary behavior levels of 3-4 h/d, 5-6 h/d, and≥7 h/d were 1.05(95%CI 0.92-1.20), 1.20(95%CI 1.03-1.42), and 1.39(95%CI 1.16-1.65), respectively. Eevry increase of 1 h/d in sedentary behavior was associated with an increased hazard of death from cardiovascular disease(CVD)of 4%(HR=1.04, 95%CI 1.01-1.07)and from other causes of 6%(HR=1.06, 95%CI 1.03-1.09). However, no significant association between sedentary behavior and malignant tumor death was found. The multivariable restrictive cubic spline regression indicated that the linear dose-response relationships were found between sedentary time with the all-cause, CVD cause, and other cause of mortality(Non-linear test, P>0.05). Conclusion Longer sedentary behavior could increase the risk of mortality in patients with type 2 diabetes. Key words: Diabetes mellitus, type 2; Sedentary behavior; Mortality; Restricted cubic spline