24-h Movement Behaviors and Pre-diabetes Phenotypes

Sleep, sedentary behavior, light-intensity physical activity, and moderate-to-vigorous physical activity collectively constitute a 24-h day. This study used compositional data analysis (CoDA) to examine the associations of 24-h movement behaviors with pre-diabetes phenotypes (isolated-impaired fasting plasma glucose [i-IFG], isolated-impaired glucose tolerance [i-IGT], and combined IFG + IGT) and diabetes. The study analyzed 1222 participants from the National Health and Nutrition Examination Survey 2005–2006. Time spent in sedentary behavior, light-intensity physical activity, and moderate-to-vigorous physical activity was measured via accelerometer, and sleep duration was determined via self-report. The glycemic status was classified as normoglycemia, pre-diabetes (i-IFG, i-IGT, or combined IFG + IGT), or diabetes based on the American Diabetes Association criteria. The CoDA was performed, adjusting for age, sex, education, and smoking status. The study sample had a mean age of 41.02 years and comprised 47.22% males. On average, participants spent 6.8 h in sleep, 9.4 h in sedentary behavior, 7.3 h in light-intensity physical activity, and 0.5 h in moderate-to-vigorous physical activity over a 24-h day. None of the four movement behaviors was associated with isolated-impaired fasting plasma glucose. In contrast, sedentary behavior was detrimentally associated with isolated-impaired glucose tolerance (OR [95% CI] = 3.49 [1.10, 11.09], p = 0.038), and moderate-to-vigorous physical activity was favorably associated with combined isolated-impaired fasting plasma glucose + isolated-impaired glucose tolerance (OR [95% CI] = 0.57 [0.45, 0.71], p < 0.001). For diabetes, more time spent in sleep (OR [95% CI] = 0.47 [0.25, 0.88], p = 0.025) or moderate-to-vigorous physical activity (OR [95% CI] = 0.55 [0.39, 0.77], p = 0.005), and less time spent in sedentary behavior (OR [95% CI] = 2.33 [1.07, 5.08], p = 0.037), were each associated with lower odds. Findings of this study provide insights for the development of integrated 24-h movement recommendations to optimize diabetes prevention and management. Notably, the associations with 24-h movement behaviors appeared to differ across distinct pre-diabetes phenotypes, providing preliminary evidence for precision prevention strategies.