A composite activity-sleep index is associated with metabolic syndrome severity in adults with diabetes

To investigate the association between Activity Sleep Index (ASI) and Metabolic Syndrome Severity (MSS) scores in a nationally representative sample of U.S. adults with diabetes.

We conducted an analysis of the 2011-12 and 2013-14 cycles of the National Health and Nutrition Examination Survey (NHANES). MSS scores were calculated using sex, systolic blood pressure, diastolic blood pressure, triglycerides, high-density lipoprotein cholesterol, blood glucose, and waist circumference. A higher MSS was indicative of worse cardiometabolic health. ASI was calculated based on average time spent in moderate-to-vigorous physical activity (MVPA), light-intensity physical activity (LIPA), sedentary behavior, and sleep derived from raw accelerometer data. Multivariable linear regression was used to assess the association between ASI and MSS.

Overall, 437 adults with diabetes were included in the current analysis. The mean age of participants was 60.7 years. A majority of participants had obesity (60.5%) but only 27.1% had a history of at least one cardiovascular event. Higher ASI z-score was significantly associated with lower MSS after adjusting for all relevant covariates (B=-0.44, 95% CI: -0.70, -0.18). We also found that current use of insulin and oral antihyperglycemic medications as well as never-married status were associated with significantly higher MSS. In contrast, increasing age was associated with lower MSS.

Healthier physical activity and sleep patterns were associated with lower cardiometabolic risk among adults with diabetes.

Not applicable.

The online version contains supplementary material available at https://doi.org/10.1007/s40200-026-02072-6.