Summary
This observational cohort study from the All of Us Research Program linked Fitbit accelerometer data to electronic health records in 5,677 participants to examine the relationship between objectively measured physical activity and incident type 2 diabetes over 3.8 years of follow-up. Greater daily step counts and longer duration at any activity intensity were associated with substantially reduced diabetes risk (44% hazard reduction comparing 10,700 to 6,000 daily steps), with benefits consistent across age, sex, BMI, and sedentary time subgroups. The findings suggest that real-world wearable device data offer an improved method for characterising physical activity's protective effect against type 2 diabetes compared to traditional single-timepoint questionnaire approaches.
UK applicability
The findings are broadly applicable to UK populations, as the association between physical activity and diabetes risk is likely generalisable across high-income countries with similar healthcare systems and demography. However, the study population was predominantly White (89%) and female (74%), which may limit generalisability to more ethnically diverse UK populations; UK public health policy already recommends physical activity for diabetes prevention, and these objective wearable-derived data could support implementation strategies in NHS digital health programmes.
Key measures
Daily step count (primary metric: 10,700 vs 6,000 steps); duration of activity at different intensities (lightly active, fairly active, very active); hazard ratios with 95% confidence intervals; effect modification assessed by age, sex, BMI, and sedentary time
Outcomes reported
The study measured the association between longitudinal physical activity (assessed via Fitbit accelerometer data) and incident type 2 diabetes mellitus over a median follow-up of 3.8 years. Primary outcomes included hazard ratios for diabetes risk stratified by daily step count and duration of activity at various intensities.
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