Introduction: Physical activity (PA) is an important contributor to health. However, little is known regarding the prevalence of insufficient PA in Kazakhstan. Aim: To study the prevalence of insufficient PA and associated factors among type 2 diabetic patients in Almaty, Kazakhstan. Methods: A cross-sectional questionnaire-based study. In total, 480 patients selected using the national diabetes registry. Associations between insufficient PA and age, gender, education, occupation, alcohol consumption, smoking, intake of vegetables and fruits were studied using chi-squared tests and multivariable Poisson regression with robust variance estimation. In addition, the patients were asked about the reasons for not practicing PA as well as about the source of advice on PA. The results are presented as crude and adjusted prevalence ratios (PR) with 95 % confidence intervals (CI). Results: The overall prevalence of insufficient PA was 60.4 (95 % CI: 56.0; 64.7) %. Education (PR = 0.80, 95 % CI: 0.68; 0.88), employment (PR = 0.74, 95 % CI: 0.64; 0.88), daily consumption of fruits (PR = 0.78, 95 % CI: 0.67; 0.92) and vegetables (PR = 0.80, 95 % CI: 0.70; 0.92) were all significantly associated with lower prevalence of insufficient PA in crude analysis. However, after adjustment for other factors, only employment (PR = 0.72, 95 % CI: 0.60; 0.86) remained significantly associated with the outcome. In total, 61.7 % of the patients received no counseling on PA. The lowest prevalence of insufficient PA (21.6 %) was observed in attenders of commercial sports centers. Conclusions: High prevalence of insufficient PA combined with poor counseling practices warrant intersectoral cooperation in the development of a strategy to improve PA among type 2 diabetes patients and general population in Kazakhstan.