Physical activity is protective against type 2 diabetes (T2D) incidence and supports T2D management. Access to local facilities such as gyms and parks enables leisure-time physical activity (LTPA) . We examined associations between T2D patients’ access to LTPA facilities and parks and whether repeated A1C follow-up tests were within a desired range. We analyzed data on 271,5 patients from the Veterans Administration Diabetes Risk Cohort who developed T2D from 2008-2018. We measured an A1C test as in-range if 5.0-7.0 (<80 years of age) or 5.0-8.5 (≥80 years of age) , density of facilities within street network buffers, and population-weighted distance to the closest 7 parks. We used generalized estimating equations with a logit link function to predict the log odds of an in-range vs. out-of-range A1C test. We tested environment-by-time interactions, controlling for individual and neighborhood demographics and baseline A1C. On average, patients were 60 years of age, male (95%) , white (71%) , and had A1C tests during follow-up. Higher facility density, but not park distance, was narrowly associated with lower odds ofan in-range A1C test (ORdensity=.99, 95% CI=.98, 1.0) . As years since T2D diagnosis increased, the odds of an in-range A1C test decreased (ORtime=.88, 95% CI=.88, .88) . For those living in higher facility density, the odds of an in-range A1C decreased over time by only a slightly lower factor than for those living in lower facility density (P<.0 for interaction term) . For those living farther from parks, the odds of an in-range A1C decreased over time by only a slightly higher factor than for those living closer to parks (P=.001) . As odds of in-range A1C tests decline over time, broader access to facilities and parks may not soften the decline since the modified effects were clinically negligible. Viable interventions for maintaining healthy A1C after diagnosis may include efforts to both increase access to and promote the use of the LTPA environment.


S.L.Orstad: None. P.M.Lopez: None. S.Adhikari: Research Support; Johnson & Johnson. D.C.Lee: None. R.Kanchi: None. M.D.Schwartz: None. F.Alemi: None. B.Elbel: None. L.Thorpe: None.


This study was funded by the Centers for Disease Control and Prevention (5 U01DP006299-02-00; PI: Lorna Thorpe)

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