Adherence to the 24 h Movement Guidelines and Type 2 Diabetes Risk in the SUN Project: A Prospective Cohort Study

Background: Type 2 diabetes (T2D) is a leading chronic disease worldwide. Physical activity, sedentary time and sleep are modifiable risk factors for T2D that share the same 24 h time budget. The 24 h Movement Guidelines propose an integrated approach to these daily movement behaviors. Objective: To evaluate the association between adherence to the 24 h Movement Guidelines and incident T2D in the ‘Seguimiento Universidad de Navarra’ (SUN) cohort. Methods: We included 13,321 university graduates free of diabetes at baseline (1999–2024). A 24 h movement score (0–3) was computed at baseline by awarding one point for meeting each guideline component (physical activity, sedentary behavior and sleep). Incident T2D was identified in biennial questionnaires and confirmed using additional information. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated with Cox models using age as the underlying time scale. Results: During follow-up (approximately 192,000 person-years), 141 incident T2D cases were confirmed. In multivariable models, participants meeting all three guidelines had a 53% lower risk of T2D compared with those meeting none (HR 0.47; 95% CI 0.24–0.93). Each additional guideline met was associated with a reduction in risk (HR per 1-point increase 0.81; 95% CI 0.66–0.98). Conclusions: Higher adherence to the integrated 24 h Movement Guidelines was associated with a lower incidence of T2D in this cohort.