Limited data exist regarding the global contribution of physical inactivity to diabetes-related complications. A pooled analysis of population-based cohort studies and cross-sectional surveys evaluated the population attributable fractions (PAFs) of macrovascular complications and retinopathy associated with physical inactivity in adults with diabetes. The results of the analysis were published in the Journal of Sport and Health Science.

The analysis included 2,374,714 adults from representative cohorts and surveys across high-income Western countries (11 studies), Latin America and Caribbean (4), high-income Asia Pacific (3), East and South-East Asia (3), Sub-Saharan Africa (3), South Asia (2), and Central and Eastern Europe (1). Complications examined included cardiovascular disease, stroke, coronary heart disease (CHD), heart failure, and retinopathy.

The highest PAFs attributable to physical inactivity were observed for stroke (10.2%; 95% uncertainty interval [UI] 5.1%–16.6%), retinopathy (9.7%; 95% UI 4.1%–16.5%), and heart failure (7.3%; 95% UI 3.1%–12.5%). High-income Asia Pacific, Latin America and Caribbean, and Central Asia–North Africa–Middle East regions showed the largest PAFs. Higher country income was associated with higher PAFs, while adults with low educational attainment demonstrated higher attributable fractions, particularly for cardiovascular disease and CHD. The largest sex disparity was observed for retinopathy.

In this pooled analysis of more than 2.3 million adults with diabetes, physical inactivity was associated with measurable population attributable fractions for macrovascular complications and retinopathy. The highest attributable fractions were observed for stroke, retinopathy, and heart failure, with regional, income, and educational disparities noted.

Limitations included binary activity classification, inclusion of cross-sectional data, limited subgroup data by diabetes type, and potential residual confounding.