From the Guidelines
Diabetes does not directly cause osteoarthritis, but it is considered a risk factor that can contribute to its development and progression. The relationship between these conditions is complex, with diabetes leading to chronic low-grade inflammation throughout the body, which may accelerate cartilage degradation in joints 1. Additionally, high blood glucose levels can damage joint tissues through the formation of advanced glycation end products (AGEs), which make cartilage more brittle and susceptible to damage. Obesity, which is common in type 2 diabetes, places extra mechanical stress on weight-bearing joints, further increasing osteoarthritis risk.
Some key points to consider in the management of patients with diabetes and osteoarthritis include:
- Maintaining good blood glucose control through medication adherence, regular physical activity, and weight management can help reduce the risk of developing osteoarthritis or slow its progression 1
- Joint-friendly exercises like swimming or cycling are particularly beneficial as they improve glucose metabolism while minimizing joint stress
- Patients with diabetes and peripheral neuropathy are at increased risk of foot ulcers and amputations, and should be counseled about self-foot examination and healthy foot behaviors 1
- Prompt diagnosis and treatment of foot infection are recommended to avoid amputation, and patients with diabetes and peripheral neuropathy should be maintained on a high index of suspicion for foot infection 1
Overall, while diabetes does not directly cause osteoarthritis, it is an important risk factor that should be considered in the management of patients with osteoarthritis. By maintaining good blood glucose control, engaging in joint-friendly exercises, and being aware of the risks of foot ulcers and infections, patients with diabetes can reduce their risk of developing osteoarthritis or slow its progression.
From the Research
Association Between Diabetes and Osteoarthritis
- The relationship between diabetes and osteoarthritis (OA) has been investigated in several studies, with some suggesting a link between the two conditions 2, 3, 4.
- A systematic review and meta-analysis found that type 2 diabetes was significantly associated with the development or presence of OA, even when controlling for body mass index and weight 2.
- Another study found that type 2 diabetes mellitus (T2DM) has a pathogenic effect on OA through oxidative stress and low-grade chronic inflammation, and that T2DM is a risk factor for OA progression 3.
Confounding Factors
- However, other studies have suggested that the association between diabetes and OA may be confounded by body mass index (BMI), a strong risk factor for both conditions 5, 6.
- A meta-analysis found that when adjusting for BMI, there was no increased risk of OA in subjects with diabetes compared to those without 5.
- Another study found that physical activity may play a beneficial role in both diabetes and OA, and that a tailored and adapted physical activity program may be used in the treatment of both diseases 6.
Molecular Mechanisms
- The molecular mechanisms underlying the potential link between diabetes and OA are complex and involve the activation of inflammatory processes and the expression of pro-inflammatory cytokines 3, 6, 4.
- Advanced glycation end-products (AGEs), sorbitol, and diacylglycerol (DAG) are glucose derivatives that may promote the activation of inflammatory pathways in both diabetes and OA 6.
- Further studies are needed to fully understand the mechanisms through which diabetes contributes to OA and to develop more specific and effective therapies for all OA patients 4.