Retrospective Study
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Jun 15, 2025; 16(6): 105496
Published online Jun 15, 2025. doi: 10.4239/wjd.v16.i6.105496
Does low physical activity cause cognitive decline in elderly type 2 diabetes patients: A propensity score matching analysis
Yi-Xin Ma, Jing Li, Si-Cong Si, Huan Zhao, Jia Liu, Long-Feng Lv, Kai Yang, Wei Yang
Yi-Xin Ma, Jing Li, Si-Cong Si, Huan Zhao, Jia Liu, Long-Feng Lv, Kai Yang, Wei Yang, Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, Beijing 100053, China
Author contributions: Ma YX contributed to conceptualization, data curation, formal analysis, investigation, software, validation, visualization, writing-original draft, writing-review and editing; Li J contributed to supervision, writing-review and editing; Si SC, Zhao H, Liu J, Lv LF and Yang K contributed to data curation, writing-review and editing; Yang W contributed to funding acquisition, project administration, writing-review and editing.
Supported by The Capital Funds for Health Improvement and Research, No. 2024-2-1033; The Beijing Municipal Administration of Hospitals Incubating Program, No. PX2022032; Post-subsidy Fund from the National Clinical Research Center, the Ministry of Science and Technology of China, No. 303-01-001-0272-08; and The Beijing Municipal Public Welfare Development and Reform Pilot Project for Medical Research Institutes, No. JYY2023-13.
Institutional review board statement: The protocol for this study was approved by the ethics committee of Xuanwu Hospital of Capital Medical University and adhered to the principles outlined in the Declaration of Helsinki.
Informed consent statement: All patients and their families were informed of the study objectives and provided written informed consent.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Yang, MD, Associate Professor, Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Diseases, No. 45 Changchun Street, Xicheng District, Beijing 100053, China. yangw_79@163.com
Received: January 24, 2025
Revised: April 7, 2025
Accepted: May 20, 2025
Published online: June 15, 2025
Processing time: 140 Days and 6.3 Hours
Abstract
BACKGROUND

The relationship between low physical activity and cognitive impairment in type 2 diabetes mellitus (T2DM) patients remains unclear.

AIM

To explore this association and identify risk factors for cognitive impairment in elderly T2DM patients.

METHODS

A retrospective analysis was conducted on 245 elderly T2DM patients treated at Xuanwu Hospital, Beijing, in 2023. Patients were categorized into low physical activity (n = 126) and non-low physical activity (n = 119) groups. After propensity score matching (PSM) of 100 pairs, univariate and binary logistic regression analyses identified risk factors for cognitive impairment. A predictive model was constructed and evaluated using receiver operating characteristic curve analysis.

RESULTS

Before PSM, the percentage of cognitive impairment was higher in the low physical activity group (P < 0.05), but after PSM, this difference was not significant (P > 0.05). Additionally, on regression analyses after PSM, age, occupation type, history of stroke, malnutrition, and frailty remained independent factors associated with cognitive impairment, while low physical activity did not. The constructed risk prediction model for cognitive impairment in elderly T2DM patients exhibited an area under the curve of 0.77.

CONCLUSION

Low physical activity was not associated with cognitive impairment in our study population. Some results differed before and after PSM analysis, indicating that PSM supports objective assessment of risk factors by controlling for selection bias and confounding factors related to population characteristics. The constructed cognitive risk model provides insight for the development of a clinical tool for early prevention of cognitive impairment in elderly T2DM patients.

Keywords: Type 2 diabetes mellitus; Propensity score matching; Cognitive impairment; Low physical activity

Core Tip: The relationship between physical activity and cognitive impairment in elderly diabetes patients remains controversial. For this investigation of risk factors for cognitive impairment in these patients, we applied propensity score matching between groups with low and non-low levels of physical activity. After adjusting for confounders and balancing baseline differences, we surprisingly found no significant association between low physical activity and cognitive decline in this population, challenging prior research. These results emphasize the complexity of factors affecting cognitive decline in diabetes. Potential contributors include social environment, sarcopenia, frailty, and multifactorial elements, offering new perspectives on managing cognitive health in diabetic populations.