Aims Regular physical activity plays a major role, in both prevention and treatment of type 2 diabetes. Less is known whether vigorous physical activity during young adulthood is associated with costs of diabetes medication in later life. The aim of this study is to evaluate this question. Methods The study population consisted of 1314 former elite-class athletes and 860 matched controls. The former athletes were divided into three groups based on their active career sport: endurance, mixed and power sports. Information on purchases of diabetes medication between 1995 and 2009 was obtained from the drug purchase register of the Finnish Social Insurance Institution. Results The total cost of diabetes medication per person year was significantly lower among the former endurance (mean 81 theta [95% CI 33-151 theta ]) and mixed group athletes (mean 272 theta [95% CI 181- 388 theta]) compared with the controls (mean 376 theta [95% CI 284- 485 theta]), (p <0.001 and p = 0.045, respectively). Of the former endurance athletes, 0.4% used insulin, while 5.2% of the controls used insulin (p = 0.018). Conclusions A career as former endurance, sprint, jumper or team game athlete seems to reduce the costs of diabetes medication in later life.