Global, regional, and national burden of major diabetes-related complications attributable to physical inactivity

Background: People with diabetes are at high risk for macrovascular and microvascular complications. However, the impact of physical inactivity on this pressing global health problem is unknown.

Methods: We analyzed data from 238,323 middle-aged and older adults from 11 population-based cohort studies. Physical inactivity was defined as not reaching the recommended physical activity (PA) level (i.e., 150 minutes of moderate-to-vigorous PA per week). Diabetes-related complications included macrovascular (i.e., cardiovascular diseases, stroke, coronary heart disease (CHD), heart failure) and microvascular (i.e., retinopathy) complications. We calculated the risk of developing these complications in people with diabetes associated with physical inactivity in longitudinal cohorts. Then, the population attributable fraction (PAF) of physical inactivity for each complication was calculated using the relative risks from a previous meta-analysis and the latest prevalence of physical inactivity in countries and territories worldwide.

Results: We estimated that one in ten cases of diabetes-related macro and microvascular complications is attributable to physical inactivity worldwide. The highest PAF was observed for stroke (11%), retinopathy (10%), and cardiovascular diseases (8.9%). Latin America and the Caribbean and the Eastern Mediterranean showed the largest PAF to physical inactivity for macrovascular and microvascular complications. Kuwait showed the highest PAF (25.8% for stroke) whereas the lowest was observed in Uganda (1.5% for CHD).

Conclusions: The burden of physical inactivity in people with diabetes is elevated worldwide. Promoting PA in this population may reduce the impact of diabetes-related complications on patients’ health.

Practical implications: Our findings underscore the urgent need for targeted strategies to promote physical activity among individuals with diabetes. Healthcare providers and policymakers should prioritize the integration of regular physical activity promotion programs into diabetes management protocols. Finally, we highlighted the importance of tailoring intervention efforts to address region-specific challenges.

Funding: None.