Slow walking speed and risk of cardiovascular events in type 2 diabetes: a systematic review

Cardiovascular disease (CVD) is the main cause of mortality in type 2 diabetes mellitus (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.

To see whether there is an association between reduced walking speed and increased CVD incidence in people with T2DM.

Systematic review of studies of people with T2DM.

We searched studies in which usual walking speed was recorded, and participants were followed up for subsequent fatal and non-fatal cardiovascular events. PubMed Central, Web of Science, Cochrane Central 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-Ottawa Scale. Heterogeneity of study populations prevented meta-analysis.

Out of 1281 studies identified, 53 full texts were retrieved and four were included, which were all of good quality. These involved 132 967 individuals with diabetes from the USA, the 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 or hazard ratios ranging from 1.18-5.88 (P<0.001-0.0001).

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.