Association of Accelerometer Measured Physical Activity with Presence of Diabetic Retinopathy

Purpose: Diabetes and its microvascular complications have significant social and economic impact, and targeted prevention strategies are paramount. Wearable technology may play an important role in personalized diabetes management. This study assesses the association between physical activity measured by wearable activity trackers and the presence of diabetic retinopathy (DR) in individuals with diabetes. Methods: Retrospective chart review of accelerometer data obtained on personal fitness (Fitbit) trackers from adults with diabetes who had >1 month of linked activity tracking data registered in the All of Us Research Program Registered Tier dataset (version 7). Binary logistic regression models were used to assess adjusted associations between presence of DR and physical activity measures of mean number of daily steps and mean number of daily minutes spent on moderate-to-vigorous activities. Results: Of the 668 participants, 63% were female and 37% were male, 80% were non-Hispanic White, and 42.5% had a history of smoking. Mean age was 64.3 years (range, 25-91 years). A unit increase of 1000 daily steps walked by participants was significantly associated with a 45% reduction in the odds of having DR (odds ratio [OR] 0.55, 95% CI 0.33-0.91). A 1-minute unit increase in the mean number of daily minutes spent on moderate-to-vigorous activity was significantly associated with a 24% reduction in the odds of having DR (OR 0.76, 95% CI 0.63-0.92). Conclusions: These findings demonstrate that increased physical activity, as measured through objective quantification of both daily steps and minutes of activity, is inversely correlated with the presence of DR. This may indicate a role for wearable technology in personalizing diabetes management.