Daily patterns of physical activity by type 2 diabetes definition: Comparing diabetes, prediabetes, and participants with normal glucose levels in NHANES 2003–2006

• Daily patterning of physical activity was similar regardless of diabetes definition.
• Diabetes participants had significantly less objectively measured physical activity.
• Those with normal glucose levels and prediabetes had similar activity levels.
• Diabetes participant's physical activity dropped significantly more in the afternoon.
• Timing of activity differences can inform interventions to increase activity.

ObjectiveDiabetes is associated with low levels of physical activity (PA), but detailed objective information about how PA patterns vary by diabetes definition is lacking.MethodsPA was measured with ActiGraph accelerometers in older (60 +) adults from the 2003–2006 National Health and Nutrition Examination Survey (n = 1,043) and analyzed in 2014. Diabetes definition (normal glucose levels, prediabetes, and diabetes) was assessed (fasting glucose, hemoglobin A1C, and self-report). Accelerometer data were used to characterize total activity counts (TAC) per day and hour-by-hour activity counts by diabetes definition. Multiple linear regression models explored the relationship between diabetes definition and TAC.ResultsDespite similar patterns of PA, diabetes participants had significantly lower TAC compared to participants with normal glucose levels and prediabetes. Diabetes participants' activity counts per hour declined more rapidly after 12 p.m., with the biggest differences between the groups occurring at 4:00 p.m. Participants with normal glucose levels and prediabetes had similar TAC and daily PA profiles.ConclusionOur novel methodology provides information about PA patterns by diabetes definition. Significantly lower TAC in the diabetes group, their significant drop in afternoon PA, and the similarity of PA between participants with normal glucose levels and prediabetes provide insight into potential targets for intervention.