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Background: Physical inactivity and Type 2 diabetes mellitus (T2DM)–associated inflammatory biomarkers are correlated with poor quality of life (QoL). However, no study has investigated the synergistic effect of physical activity (PA) and lower neutrophil–lymphocyte ratio (NLR) on QoL. Objective: We examined the independent and synergistic effects of PA and inflammatory biomarkers on three domains of QoL in T2DM. Methods: This cross-sectional study included 294 patients with T2DM from community clinics in Indonesia. The 36-item Short Form Survey and a questionnaire about PA engagement were used to measure QoL and metabolic equivalent of task (MET)-hr/week, respectively. Inflammatory biomarkers were measured in fasting blood. Adjusted coefficients β and 95% confidence interval (CI) were estimated using multiple linear regression. The synergistic effect was analyzed using additive interaction for linear regression. Results: Patients with PA ≥ 7.5 MET-hr/week exhibited significantly higher total QoL (β = 8.41, 95% CI = [6.04, 10.78]) and physical component score (PCS; β = 13.90, 95% CI = [10.52, 17.29]) than those with PA < 7.5 MET-hr/week. Patients with NLR < 1.940 had significantly higher total QoL (β = 4.76, 95% CI = [3.41, 6.11]), mental component score (MCS; β = 2.62, 95% CI = [0.75, 4.49]), and PCS (β = 6.89, 95% CI = [4.97, 8.82]) than patients with NLR ≥ 1.940. PA ≥ 7.5 MET-hr/week and NLR < 1.940 exhibited a synergistic effect on total QoL, MCS, and PCS. Conclusions: High PA level and low NLR had a positive synergistic effect on QoL among patients with T2DM. [ABSTRACT FROM AUTHOR]

Secondhand smoke (SHS) and physical inactivity are thought to be associated with type 2 diabetes mellitus (T2DM), but the synergistic effect of SHS with physical inactivity and their relationships with T2DM-associated inflammation biomarkers have not been estimated. We investigated the roles of SHS exposure and physical inactivity and their synergistic effect on T2DM risk and their relationships with T2DM associated inflammation biomarkers, neutrophil-lymphocyte ratio (NLR) and white blood cells (WBCs). A case-control study was conducted in total 588 participants (294 case T2DM and 294 healthy controls) from five community clinics in Indonesia. Participants completed a standardized questionnaire on demographic information, smoking status, physical activity habits and food consumption. WBCs and NLR levels were determined using an automated hematology analyzer. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were analyzed using multiple logistic regression model. The synergistic effect was analyzed using additive interaction for logistic regression. Physical inactive people exposed to SHS exhibited a synergistically increased 7.78-fold risk of T2DM compared with people who were not exposed to SHS and who were physically active. SHS is significantly correlated with a high NLR, WBCs and has a synergistic effect with physical inactivity on increasing susceptibility to T2DM.