From sedentary volume to sedentary content in older inpatients with type 2 diabetes: a multicenter study.

BACKGROUND: Sedentary behavior is common in older inpatients with type 2 diabetes mellitus (T2DM) and may coexist with poor metabolic control and functional decline. OBJECTIVE: To identify factors associated with high sedentary time status and examine screen-based sedentary content in this population. METHODS: This multicenter cross-sectional study recruited 419 older inpatients with T2DM from three tertiary hospitals in northwestern, central and southern China. Sedentary time and 10 types of sedentary content were assessed using a validated questionnaire. Personal, social, environmental and exercise-related psychological factors were obtained from medical records, field-based assessments and standardized instruments. A two-stage sequential modeling approach was used. Model I (n = 419) used hierarchical logistic regression to examine factors associated with high sedentary time status. Model II (n = 279) used binary logistic regression in the high-sedentary-time subgroup to examine factors associated with high screen tendency. The Mann-Whitney U test descriptively compared activity composition between participants in the high- and low-screen-tendency groups. Continuous-outcome sensitivity analyses assessed robustness to the operational classifications. RESULTS: Of 419 participants, 279 (66.6%) were classified as having high sedentary time. Within this subgroup, 165 (59.1%) had a high proportion of screen-based sedentary time. High sedentary time status was associated with physical function, living context and exercise-related cognition. High screen tendency was characterized by age, postprandial glucose level, and living arrangement, gait speed showed only a category-specific contrast. Item-level analysis showed that participants with high screen tendency spent more time watching television, using computers and mobile phones, and less time chatting, eating, engaging in hobbies, napping and seated work. The Nagelkerke R 2 values for Model I and Model II were 0.383 and 0.218, respectively. Continuous-outcome sensitivity analyses broadly supported the overall patterns. CONCLUSION: Sedentary behavior among older inpatients with T2DM was characterized not only by accumulated sedentary time but also by differences in sedentary content. These findings suggest that future sedentary behavior management could consider not only reducing total sedentary time but also identifying what patients do while sitting. Functional assessment, environmental support and strategies related to exercise outcome expectations and self-efficacy may represent potential intervention components that better reflect daily life, although their effects require confirmation in longitudinal and interventional studies.