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Associations of reallocating sitting time into standing or stepping with glucose, insulin and insulin sensitivity: a cross-sectional analysis of adults at risk of type 2 diabetes
  1. Charlotte L Edwardson1,2,3,
  2. Joe Henson1,2,3,
  3. Danielle H Bodicoat1,3,4,
  4. Kishan Bakrania1,2,3,4,
  5. Kamlesh Khunti1,3,4,
  6. Melanie J Davies1,2,3,
  7. Thomas Yates1,2,3
  1. 1Diabetes Research Centre, University of Leicester, Leicester, UK
  2. 2NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, Leicester, UK
  3. 3Leicester Diabetes Centre, Leicester General Hospital, University Hospitals of Leicester, Leicester, UK
  4. 4NIHR Collaboration for Leadership in Applied Health Research and Care East Midlands, Leicester, UK
  1. Correspondence to Dr Charlotte L Edwardson; ce95{at}


Objective To quantify associations between sitting time and glucose, insulin and insulin sensitivity by considering reallocation of time into standing or stepping.

Design Cross-sectional.

Setting Leicestershire, UK, 2013.

Participants Adults aged 30–75 years at high risk of impaired glucose regulation (IGR) or type 2 diabetes. 435 adults (age 66.8±7.4 years; 61.7% male; 89.2% white European) were included.

Methods Participants wore an activPAL3 monitor 24 hours/day for 7 days to capture time spent sitting, standing and stepping. Fasting and 2-hour postchallenge glucose and insulin were assessed; insulin sensitivity was calculated by Homeostasis Model Assessment of Insulin Secretion (HOMA-IS) and Matsuda-Insulin Sensitivity Index (Matsuda-ISI). Isotemporal substitution regression modelling was used to quantify associations of substituting 30 min of waking sitting time (accumulated in prolonged (≥30 min) or short (<30 min) bouts) for standing or stepping on glucose regulation and insulin sensitivity. Interaction terms were fitted to assess whether the associations with measures of glucose regulation and insulin sensitivity was modified by sex or IGR status.

Results After adjustment for confounders, including waist circumference, reallocation of prolonged sitting to short sitting time and to standing was associated with 4% lower fasting insulin and 4% higher HOMA-IS; reallocation of prolonged sitting to standing was also associated with a 5% higher Matsuda-ISI. Reallocation to stepping was associated with 5% lower 2-hour glucose, 7% lower fasting insulin, 13% lower 2-hour insulin and a 9% and 16% higher HOMA-IS and Matsuda-ISI, respectively. Reallocation of short sitting time to stepping was associated with 5% and 10% lower 2-hour glucose and 2-hour insulin and 12% higher Matsuda-ISI. Results were not modified by IGR status or sex.

Conclusions Reallocating a small amount of short or prolonged sitting time with standing or stepping may improve 2-hour glucose, fasting and 2-hour insulin and insulin sensitivity. Findings should be confirmed through prospective and intervention research.

Trial registration number ISRCTN31392913, Post-results.

  • Posture
  • sedentary behaviour
  • activPAL
  • objective
  • health
  • isotemporal substitution

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  • Disclaimer The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

  • Contributors CLE had the original idea for the analysis and wrote the first draft of the manuscript. DHB and KB contributed to data processing. JH analysed the data. All authors contributed to the interpretation of the data, reviewed/edited the manuscript and approved the final manuscript.

  • Funding The Walking Away trial was funded by the National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care for Leicestershire, Northamptonshire and Rutland. Analysis of fasting and 2-hour insulin was funded by Unilever R&D, UK.

  • Competing interests None declared.

  • Ethics approval Ethical approval was obtained from the Nottingham Research Ethics Committee, UK.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.