Compositional analysis of the association between 24 h movement behaviours, HbA_1c and interstitial glucose in children and adolescents with type 1 diabetes mellitus: a two-year longitudinal analysis of the Diactive-1 cohort study

Aims/hypothesis: The aim of this study was to examine the association of physical activity, sedentarism and sleep with HbA_1c and interstitial glucose in children and adolescents with type 1 diabetes through a 24 h compositional analysis. Methods: The study involved 83 young people diagnosed with type 1 diabetes (aged 6–18 years; 45% girls, mean HbA_1c 57.54 ± 9.22 mmol/mol (7.4 ± 0.8%); median interstitial glucose 9.37 mmol/l [IQR 8.68–10.31]) from the Diactive-1 cohort study, followed up for 2 years. A triaxial accelerometer was used to objectively measure 24 h movement behaviours for 9 days. HbA_1c levels were obtained from medical records, and interstitial glucose data were collected through continuous glucose monitoring. Linear mixed models were used to quantify associations between movement behaviours, interstitial glucose and HbA_1c, maintaining the relative nature of the data based on the 24 h day. Results: A higher daily amount of sedentary behaviour, at the expense of sleep time, light or moderate-to-vigorous physical activity, was positively associated with HbA_1c (unstandardised beta coefficient [B]=14.077 [95% CI 4.244, 23.956]; standardised beta coefficient [β]=0.368) and interstitial glucose (B=1.988; 95% CI 0.153, 3.880; β=0.261), while more sleep time, at the expense of sedentary behaviour, light or moderate-to-vigorous physical activity, was associated with a significant reduction in HbA_1c (B=−12.712; 95% CI −25.204, −0.520; β=−0.197). Furthermore, reductions in both interstitial glucose (B=−1.580; 95% CI −2.800, −0.388; β=−0.283) and HbA_1c (B=−9.361; 95% CI −15.856, −2.881; β=−0.330) were observed with increased daily time spent in moderate-to-vigorous physical activity at the expense of sedentary behaviour. Overall, the standardised beta coefficients indicated small to moderate effect sizes. Conclusions/interpretation: Our findings indicate that lower sedentary behaviour and more optimal sleep and physical activity patterns are associated with greater metabolic stability in children and adolescents with type 1 diabetes. These findings support the need for further research on balancing these behaviours for better diabetes management, and encourage adoption of a 24 h movement approach in clinical care.