Introduction: The coexistence of Knee osteoarthritis (OA) and diabetes mellitus (DM) can be explained by shared risk factors such as age and obesity. Both conditions adversely affect gait speed, however, longitudinal studies investigating the relationship between gait speed and DM incidence in people with or at elevated risk for knee OA are lacking. Therefore, the aim was to investigate the association between baseline gait speed and risk of DM incidence among people with or at risk for knee OA. Methods: Participants from the osteoarthritis initiative, aged 45 to 79 years, who were at risk or had knee OA and followed up from baseline to 96-month visit were included. Self-reported diabetes was used over a 4-time points to identify DM incidence. Gait speed was measured at baseline using 20 meter walk test. Body mass index (BMI) was measured and included as a time-dependent covariate. Generalized estimating equations with logistic regression were utilized to examine the association between baseline gait speed and DM incidence. Results: Increased baseline gait speed was significantly associated with decreased odds of incident DM after adjustments for covariates (OR 0.52). The risk of DM incidence decreased 48% for each 0.1 m/s increase in gait speed at baseline for individuals with established or at risk of knee OA. Sensitivity analysis showed that the significant results were maintained with those at risk of OA (OR 0.45) but not in those with established knee OA. Conclusion: Increasing baseline gait speed in general was significantly associated with a lower risk of DM incidence over time. However, the association disappeared after adjustments for BMI in people with established knee OA, suggesting that the majority of this association might be explained by higher weight. Therefore, future research should examine closely the link between gait speed and well-defined DM risk using objective measures such as glucose level. Disclosure A.M. Alenazi: None. B. Alqahtani: None. M.M. Alshehri: None. A.D. Alanazi: None. K. Khunti: Advisory Panel; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Board Member; Self; AstraZeneca, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novo Nordisk A/S, Sanofi-Aventis. Consultant; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. Research Support; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck Sharp & Dohme Corp., Novartis AG, Novo Nordisk A/S, Pfizer Inc., Sanofi-Aventis, Servier. Speaker’s Bureau; Self; Amgen, AstraZeneca, Bayer AG, Berlin-Chemie AG, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Menarini Group, Merck Sharp & Dohme Corp., Napp Pharmaceuticals, Novartis AG, Novo Nordisk A/S, Roche Pharma, Sanofi-Aventis, Servier. V. Vennu: None. N.A. Segal: None. S.M. Bindawas: None.