502-P: Significant Inverse Association between Self-Reported Fast Walking and Incident Severe Diabetic Microvascular Complications Including Retinopathy and Initiation of Dialysis

Background & Objective: Whether fast walking is inversely associated with the incidence of severe diabetic retinopathy (DR) and/or diabetic macular edema (DME) or initiation of dialysis remains unknown. We aimed to explore the association between self-reported fast walking and the incidence of these outcomes.

Methods: Japanese with type 2 diabetes were enrolled. Severe DR and DME were defined as vision-threatening treatment-required diabetic eye diseases (TRDED). TRDED and initiation of dialysis were identified according to claims using ICD-10 codes and medical procedures. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the incidence of TRDED and initiation of dialysis were calculated by Cox proportional hazards models using a nationwide database.

Results: Of 11,594 persons, 298 developed TRDED (4.9/1000 person-years) during the study period (mean 5.2y) and 82 of 14,695 participants required initiation of dialysis (1.0/1000 person-years, mean 5.4y). Multivariate Cox analysis demonstrated that self-reported fast walking was inversely associated with both TRDED and initiation of dialysis after adjustment for covariates. HRs for incident TRDED and initiation of dialysis in persons reporting fast walking was 0.67 (95%CI, 0.52-0.86) and 0.54 (0.33-0.88), respectively, compared with those reporting slow-to-average walking. This inverse association was unchanged after additional adjustment for physical activity (HR0.67 [0.52, 0.87] for TRDED and 0.59[0.35, 0.98] for initiation of dialysis).

Conclusions: This information can be a valuable aid to prevent severe microvascular complications because maintaining walking speed is an inexpensive and almost universally applicable tool, although further interventional studies are required to prove this hypothesis derived from the current observational study.