Background: Youth living with type 2 diabetes (T2D) are characterized by an increased cardiovascular disease (CVD) risk profile. It is unclear if regular vigorous intensity physical activity (PA) modifies this CVD risk.

Methods: Using a cross-sectional design, we compared cardiometabolic risk factors among 164 youth with T2D from the The Improving renal Complications in Adolescents with T2D through REsearch (iCARE) cohort, stratified according to participation in vigorous intensity organized sport. Outcomes of interest were HbA1c, ambulatory blood pressure (BP) parameters from 24 hr monitoring, hypertension according to 2017 American Academy of Pediatrics criteria and albuminuria determined from first morning urine samples. The main exposure, regular (≥ 3 days/week) participation in vigorous intensity organized sport was determined from a validated questionnaire (Adolescent Physical Activity Questionnaire).

Results: Youth were 15�3 yrs, 78% lived in a rural town, 68% were girls, mean BMI Z score was 2.4�1.1 and mean HbA1c was 9.6�2.6%. Youth that participated in regular vigorous intensity organized sport (40%; n= 67) achieved nearly twice the dose of PA than less active peers (176 vs. 108 MET-HR/week; p= 0.001). After adjusting for duration of diabetes, BMI Z score, sex and current smoking status, youth with T2D who engaged in regular vigorous intensity organized sport displayed lower HbA1c (9.1%, vs. 9.9% p= 0.052), diastolic BP (70 vs. 73 mmHg, p= 0.002) and diastolic load (20 vs. 26%, p= 0.023). Compared to youth that did not participate in regular vigorous intensity organized sport, those who did displayed a lower odds of albuminuria (OR: 0.40 95% CI: 0.19-0.84) and hypertension (OR: 0.39 95% CI: 0.16-0.95).

Conclusions: Among youth living with T2D, self-reported frequent participation in vigorous organized sport is associated with lower CVD risk. These data need to be confirmed with prospective observational and experimental data.