Combined effects of physical activity and diabetes medications on glycemic control: a real-world data study

Monitoring and modeling population health is essential for understanding the impact of lifestyle behaviors and pharmacologic therapies on chronic disease management. In this study, we used a nationwide Japanese health insurance claims and health checkup database to investigate the associations between physical activity and glycemic control among 24,830 treatment-naïve adults with type 2 diabetes receiving DPP-4 inhibitors, SGLT2 inhibitors, or metformin. The odds of achieving hemoglobin A1c (HbA1c) < 6.5% at follow-up were assessed according to physical activity status, determined using standardized questionnaires. In this real-world population, physically active individuals had higher odds of achieving glycemic control than sedentary individuals among those treated with DPP-4 inhibitors or SGLT2 inhibitors, whereas no statistically significant association was observed among those treated with metformin. These findings support the potential value of integrating physical activity with pharmacologic therapy in type 2 diabetes management in real-world clinical settings.