Physical inactivity drives a significant share of diabetes complications worldwide; new global study finds

Stroke, heart failure, and coronary heart disease are some of the major macrovascular complications that, together with retinopathy, exert a devastating toll on the health of people living with diabetes. A major new global study shows that physical inactivity, defined as not achieving at least 150 minutes per week of moderate-to-vigorous physical activity, is a substantial and preventable driver of these complications worldwide. Analyzing data from more than 2.3 million adults with diabetes across multiple world regions, researchers estimate that up to 10% of these complications could be attributed to physical inactivity among people living with type 2 diabetes.

The study is the first to quantify the global, regional, and national population-attributable fractions of diabetes complications linked specifically to physical inactivity, providing urgently needed evidence to guide prevention strategies.

“Diabetes complications are often seen as inevitable consequences of the disease,” said lead author Jayne Feter, researcher in the School of Medicine at the Universidade Federal do Rio Grande do Sul. “Our findings challenge this idea by showing that a meaningful proportion of these complications could be prevented through achievable increases in physical activity among people living with diabetes.”

Key findings

Globally, physical inactivity accounts for:

10.2% of strokes
9.7% of diabetic retinopathy
7.3% of heart failure
Around 5–7% of cardiovascular disease and coronary heart disease cases in people with diabetes.

Regional disparities are striking:

The highest attributable burdens were observed in high-income Asia Pacific, Latin America and the Caribbean, and Central Asia, North Africa, and the Middle East.
Women and people with lower educational attainment consistently experienced higher proportions of complications attributable to physical inactivity, highlighting deep social inequities.

Countries with higher national income showed higher PAFs, but within countries, adults with lower education bore a disproportionate share of preventable complications.

Why this matters

Diabetes affects more than 589 million people worldwide and is a leading cause of cardiovascular disease, disability, vision loss, and premature death. Treating its complications consumes a growing share of health budgets, especially in regions already facing strained health systems.

“This study reframes physical activity as a core component of diabetes complication prevention,” Dr. Feter explained. “Promoting physical activity among people with diabetes could reduce hospitalizations, disability, and healthcare costs, while improving quality of life.” The analysis combined population-based cohort studies and national surveys with risk estimates from large international meta-analyses and global physical activity surveillance systems, including data aligned with recommendations from the World Health Organization.

Implications for policy and practice

The authors emphasize that one-size-fits-all approaches will not work. Patterns of physical activity differ widely across regions: leisure-time activity dominates in high-income countries, while transport- and work-related activity is more common in low- and middle-income settings. Women and socioeconomically disadvantaged groups face additional barriers such as safety concerns, caregiving responsibilities, and limited access to supportive environments.

“Integrating physical activity promotion into routine diabetes care and national noncommunicable disease strategies is no longer optional,” added Natan Feter, coauthor and researcher in the Department of Biological Sciences at the University of Southern California. “Policies must be tailored to local realities and explicitly address social and gender inequalities.”

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