Objective To investigate the association between walking speed and the risk of type 2 diabetes. Design Systematic review and meta-analysis. Data sources PubMed, Scopus, CENTRAL and Web of Science to 30 May 2023. Eligibility criteria for selecting studies We included cohort studies that explored the association between walking speed and the risk of type 2 diabetes in adults. We used random-effects meta-analyses to calculate relative risk (RR) and risk difference (RD). We rated the credibility of subgroup differences and the certainty of evidence using the Instrument to assess the Credibility of Effect Modification ANalyses (ICEMAN) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) tools, respectively. Results Ten cohort studies were included. Compared with easy/casual walking (<3.2 km/hour), the RR of type 2 diabetes was 0.85 (95% CI 0.70 to 1.00); RD=0.86 (95% CI 1.72 to 0) fewer cases per 100 patients; n=4, GRADE=low) for average/normal walking (3.2–4.8 km/hour), 0.76 (95% CI 0.65 to 0.87); RD=1.38 (95% CI 2.01 to 0.75) fewer cases per 100 patients; n=10, GRADE=low) for fairly brisk walking (4.8–6.4 km/hour) and 0.61 (95% CI 0.49 to 0.73; RD=2.24 (95% CI 2.93 to 1.55) fewer cases per 100 patients; n=6, GRADE=moderate) for brisk/striding walking (>6.4 km/hour). There was no significant or credible difference across subgroups based on adjustment for the total volume of physical activity and time spent walking per day. Dose–response analysis suggested that the risk of type 2 diabetes decreased significantly at a walking speed of 4 km/h and above. Conclusions Low to moderate certainty evidence, mainly from studies with a high risk of bias, suggests that walking at faster speeds is associated with a graded decrease in the risk of type 2 diabetes. PROSPERO registration number CRD42023432795. Data are available upon reasonable request.

中文翻译：

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步行速度与 2 型糖尿病风险：系统评价和荟萃分析

目的探讨步行速度与2型糖尿病风险之间的关系。设计系统回顾和荟萃分析。数据来源 PubMed、Scopus、CENTRAL 和 Web of Science 截至 2023 年 5 月 30 日。 选择研究的资格标准 我们纳入了探索成人步行速度与 2 型糖尿病风险之间关系的队列研究。我们使用随机效应荟萃分析来计算相对风险（RR）和风险差（RD）。我们分别使用效果修改分析可信度评估工具 (ICEMAN) 和建议评估、制定和评估分级 (GRADE) 工具对亚组差异的可信度和证据的确定性进行了评估。结果 纳入了十项队列研究。与轻松/随意步行（<3.2公里/小时）相比，2型糖尿病的RR为0.85（95% CI 0.70至1.00）；每 100 名患者中 RD=0.86（95% CI 1.72 至 0）病例减少；n=4，等级=低）对于平均/正常步行（3.2-4.8公里/小时），0.76（95% CI 0.65至0.87）；每 100 名患者中 RD=1.38（95% CI 2.01 至 0.75）病例减少；对于相当快走（4.8-6.4 公里/小时），每 100 名患者的病例数减少 0.61（95% CI 0.49 至 0.73；RD=2.24（95% CI 2.93 至 1.55）；n=10，GRADE=低）；n=6 ，GRADE=中等）适合快步/大步行走（>6.4 公里/小时）。根据对体力活动总量和每天步行时间的调整，各亚组之间没有显着或可信的差异。剂量反应分析表明，步行速度为 4 公里/小时及以上时，患 2 型糖尿病的风险显着降低。结论 低到中等质量的证据（主要来自具有高偏倚风险的研究）表明，更快的速度行走与 2 型糖尿病风险的分级降低相关。PROSPERO 注册号 CRD42023432795。数据可根据合理要求提供。