Abstract

Background Cardiovascular disease (CVD) is the main cause of mortality in type 2 diabetes (T2DM) and detection of CVD risk is a key part of routine care. Slow walking speed is strongly correlated with CVD events in the general population. Aim To see if this applies in people with Type 2 diabetes. Design & setting Systematic review of studies of people with Type 2 diabetes Method We searched studies in which usual walking speed was recorded, and participants were followed up for subsequent fatal and non-fatal cardiovascular events. (PROSPERO CRD42024578164) PubMed Central, Web of Science, Cochrane Register of Controlled Trials and Google Scholar were searched in December 2024. Studies were screened by two independent reviewers. Studies reporting walking speed or comparable indices and CVD outcomes in T2DM were included. Study quality was assessed using the Newcastle-Ottowa Scale. Heterogeneity of study populations prevented meta-analysis. Results Out of 1281 studies identified, 53 full-texts were retrieved and four were included, all of good quality. These involved 132 967 individuals with diabetes from USA, UK and Japan. Mean study follow-up was 3-14 years. All four studies assessed walking speed by self-reported questionnaire and reported significant associations between reduced walking speed and increased CVD risk with risk/hazard ratios ranging from 1.18-5.88. Conclusions This is the first systematic review to indicate an association between reduced walking speed and increased CVD incidence in T2DM. This association is seen across diverse populations and settings. Further research in T2DM could explore whether increasing walking speed reduces CVD risk.