Physical Activity Levels and Diabetes Prevalence in US Adults: Findings from NHANES 2015–2016

INTRODUCTION: Diabetes is a major public health problem that is strongly influenced by lifestyle-related factors, with previous epidemiologic studies finding an inverse relationship between physical activity and the prevalence of diabetes. We aimed to quantify the prevalence of diabetes and determine whether a dose-response relationship is present between physical activity levels and diabetes. METHODS: Population characteristics were compared between diabetic and nondiabetic subjects. Multiple logistic regression models were used to assess the association between different levels of physical activity and diabetes. Restricted cubic spline analysis was used to examine the dose-response relationship between physical activity and diabetes prevalence. RESULTS: Compared with those in the lowest physical activity quartile, participants in the highest quartile had a 42% lower prevalence of diabetes (odds ratio = 0.58, 95% confidence interval = 0.44–0.75, p < 0.001). A nonlinear dose-response relationship was observed (p nonlinearity < 0.05), with increased physical activity associated with a decreased prevalence of diabetes, with steeper reductions in the prevalence of diabetes at low activity levels than at high activity levels. These results were robust in both subgroup and sensitivity analyses. CONCLUSIONS: Higher levels of physical activity are associated with a lower prevalence of diabetes. The data indicated the presence of a nonlinear dose-response relationship in all of the included subjects, with steeper reductions in the prevalence of diabetes at low activity levels than at high activity levels. Increasing physical activity is therefore potentially a useful intervention for reducing the prevalence of diabetes.