Associations of Physical Activity and Sedentary Behaviour with Vision-Threatening Diabetic Retinopathy in Indonesian Population with Type 2 Diabetes Mellitus: Jogjakarta Eye Diabetic Study in the Community (JOGED.COM)

ABSTRACT

Purpose: To investigate the association of physical activity (PA) and sedentary behaviour with diabetic retinopathy (DR) in type 2 diabetes adults.

Methods: A community-based cross-sectional study of adults with type 2 diabetes. DR was assessed from disc- and macula-centred fundus photograph, and categorised into mild, moderate non-proliferative DR (NPDR), and Vision-Threatening DR (VTDR). Worse eye was used to determine the person’s DR severity. PA was assessed using WHO Global Physical Activity Questionnaire (GPAQ). All of the PA components, including daily sitting time, walking distance, sleeping duration, and exercise were converted based on the physical activity ratio and then calculated to obtain the mean physical activity level (PAL). The mean PAL was then classified into sedentary, moderate, and vigorous lifestyle.

Results: There were 1116 participants, 43.1% with any DR and 26.3% VTDR. The prevalence of DR/VTDR in sedentary, moderate, and vigorous physical activity group was 41.9%/22.7%, 39.2%/23.9%, and 32.7%/20.4% respectively. A longer duration of daily sedentary lifestyle (>3 hours) was significantly associated with presence of DR (OR 1.66; 95% CI 1.17–2.35; p < 0.01) and VTDR (OR 1.74; 1.16–2.62; p < 0.01). These associations remained significant after adjusting for age, gender, duration of diabetes, systolic blood pressure and physical activity. There was no significant association between sleeping duration, walking distance, and vigorous activity and DR.

Conclusions: In this study, prolonged daily sedentary activity was strongly associated with VTDR. This finding suggests that public health campaign for reducing daily sedentary activities in individuals with type 2 diabetes may offer benefit to reduce the burden of DR and VTDR.

KEYWORDS:

• Diabetic retinopathy
• physical activity
• sedentary behaviour

Acknowledgement

We thank to the LHA Jogjakarta Province for the technical assistance.

Declaration of interest

SPK is the Senior Program Manager for Eye health programs in Hellen Keller International (HKI) in Indonesia and PG is the Country Director of HKI in Indonesia. None of other authors have any proprietary interests or conflicts of interest related to this submission. This submission has not been published anywhere previously and that it is not simultaneously being considered for any other publication.

Funding

This study received Technical and Operational Support from the Hellen Keller International (HKI), and received partial funding from the community fund of the Faculty of Medicine, Universitas Gadjah Mada;

Additional information

Funding

This study received Technical and Operational Support from the Hellen Keller International (HKI), and received partial funding from the community fund of the Faculty of Medicine, Universitas Gadjah Mada;

Notes on contributors

S Pawiroranu

D.P.D contributed to data collection, partial data analysis and manuscript writing. A.N.A. supervised, contributed to discussions, and critically reviewed and edited the manuscript. F.W. contributed to data collection, data management and drafting the manuscript. S.P. reviewed and edited the manuscript. Z.M.S researched data interpretation and discussion. F.S.W. reviewed and edited the manuscript. S.H. reviewed and edited the manuscript. T.W.W. reviewed and edited the manuscript. S.P.K. reviewed and edited the manuscript. M.B.S. obtained funding, supervision, contributed to study design and to discussion, critically reviewed and edited the manuscript.