title: Glycaemic control in people with diabetes influences the beneficial role of physical activity on cardiovascular mortality. Prospective data from the HUNT Study, Norway.
abstract: OBJECTIVE
  To examine whether glycaemic control in people with diabetes, measured as glycated haemoglobin (HbA1c), influences the role of leisure time physical activity on the increased risk of death from cardiovascular disease.
  
  
  METHODS
  We prospectively examined the joint association of diabetes according to glycemic control, measured as glycated haemoglobin (HbA1c), and physical activity with cardiovascular mortality. A total of 53,549 were followed up for 12 years through the Norwegian Cause of Death Registry. Cox proportional adjusted hazard ratios (HRs) with 95% confidence intervals (CI) were estimated.
  
  
  RESULTS
  Overall, 1710 people died from cardiovascular disease during the follow-up. Compared to the reference group of inactive people without diabetes, people with diabetes and HbA1c<8.0%, had a hazard ratio (HR) of 1.46 (95% CI: 0.96, 2.21) if they were physically inactive and a HR of 1.33 (95% CI: 0.81, 2.19) if they were physically active. Among people with diabetes and HbA1c ≥ 8.0%, the corresponding comparison gave HRs 2.69 (95% CI: 2.11, 3.42) and 0.93 (95% CI: 0.64, 1.36), respectively.
  
  
  CONCLUSIONS
  The data suggest that physical activity should be more strongly encouraged as a therapeutic measure additional to medical treatment, especially among those with most severe hyperglycemia.
authors.affiliation: Department of Public Health and General Practice, The Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. Electronic address: borge.moe@ntnu.no.
authors.forename: Børge
authors.initials: B
authors.lastname: Moe
authors.affiliation: Department of Public Health and General Practice, The Faculty of Medicine, Norwegian University of Science and Technology, HUNT Research Centre, Levanger, Norway.
authors.forename: Kristian
authors.initials: K
authors.lastname: Midthjell
authors.affiliation: Department of Public Health and General Practice, The Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Tom I L
authors.initials: TI
authors.lastname: Nilsen
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D002423:Cause of Death; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007899:Leisure Activities; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009664:Norway; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Cardiovascular mortality; Diabetes; Epidemiology; Glycaemic control; Physical activity