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Ebaa Al Ozairi,1,2 Husain AlSaraf,1,3 Abdullah Al-Ozairi,1,2 Yasmine Hamdan,1 Batool Camille Al Esmaeel,1 Dalal Alsaeed,1 Mohamed Abdalla,1 Stuart R Gray4 1Clinical Research Unit, Dasman Diabetes Institute, Kuwait City, Kuwait; 2Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait; 3Geriatrics and Neuropsychiatry Unit, Amiri Hospital, Kuwait City, Kuwait; 4School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UKCorrespondence: Stuart R Gray, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK, Tel +141 330 2569, Email stuart.gray@glasgow.ac.ukPurpose: The aim of this cross-sectional study was to compare the Arabic version of International Physical Activity Questionnaire (IPAQ) measured moderate-to-vigorous physical activity (MVPA) with accelerometer-measured MVPA in people with diabetes.Methods: From 2020 to 2022 physical activity was measured people ≥ 18 years with type 1 or type 2 diabetes in Kuwait. Self-reported MVPA was measured over 7 days with the Arabic version of the IPAQ. During the same 7-day period wrist worn accelerometers were used to objectively measure MVPA. IPAQ MVPA was calculated both including and excluding walking physical activity. MVPA measures were compared by limits of agreement approach, Pearson correlations and concordance correlations.Results: We recruited 240 participants with type 1 diabetes and 343 participants with type 2 diabetes for the study. In people with type 1 diabetes, there were no concordance correlations between IPAQ MVPA, both including (rho = − 0.011 (− 0.038, 0.017), p = 0.444) and excluding (rho = − 0.001 (− 0.067, 0.065), p = 0.978) walking physical activity. MVPA measured by IPAQ was 43.3(− 85.6, 172.2) min/day higher than accelerometer-measured MVPA, when including walking, and 8.88(− 60.4, 78.2) min/day higher, when excluding walking. In people with type 2 diabetes, there were significant positive concordance correlations between IPAQ MVPA, both including (rho = 0.038 (0.02, 0.06), p < 0.001) and excluding (rho = 0.34 (0.27, 0.41), p < 0.001) walking physical activity. MVPA measured by IPAQ was 62.3 (95% CI − 61.5 to 186.0) min/day higher than accelerometer-measured MVPA, when including walking, and 4.0 (95% CI − 34.1 to 42.0) min/day higher, when excluding walking.Conclusion: In people with type 1 or type 2 diabetes, caution should be exercised when using the Arabic version of the IPAQ to measure MVPA.Keywords: metabolic disease, activity, Arab, validation