Is knee pain the missing piece in diabetes care?

Nearly one in five patients with Type 2 diabetes also suffers from knee osteoarthritis, so how could joint pain management be better integrated into diabetes care? A Canadian survey of healthcare professionals aims to offer solutions.Joint pain in diabetic patients is still too often undertreated, despite its negative impact on disease control. A qualitative study—conducted in Ontario with about 15 general practitioners, endocrinologists and nurse practitioners—suggests the way follow-up appointments are structured may be a major barrier to osteoarthritis treatment.One of the endocrinologists consulted described the effect of knee osteoarthritis on Type 2 diabetes as a chronic vicious cycle. “You have knee pain, so you don’t exercise. You're sedentary, you eat more, you gain weight and your knees hurt even more. The result is your diabetes is even less well controlled.” A widespread conditionKnee osteoarthritis affects up to 17% of diabetic patients, with these patients reporting greater feelings of isolation and abandonment when it comes to managing their co-occurring chronic illnesses.Joint pain is a problem raised by virtually all affected patients, noted the healthcare professionals interviewed. In the vast majority of cases, patients themselves bring up the issue, they said, but the quality of the discussion varies depending on their relationship with their healthcare professional, the length of the appointment and the frequency of visits.These professionals recognized that when time was allotted during the appointment to discuss the patient's concerns, the topic of osteoarthritis frequently came up in conversation. Beyond limiting physical activity, they explained how joint pain can impair blood sugar control due to the presence of inflammatory markers. Some healthcare professionals also discussed the detrimental effects of pain on their patients' sleep and mental health.Diverging prioritiesDespite the consequences of knee osteoarthritis observed in their diabetic patients, some consulted healthcare professionals said they felt compelled to adhere to diabetes care tracking sheets, within the limited time available to them. For patients, it is the pain related to osteoarthritis that seems to overshadow everything concerning the management of their diabetes. These diverging priorities appear to contribute to widening the gap between their respective concerns.“I think diabetes, hypertension, cholesterol . . . don’t cause any symptoms for the patient, so it’s hard for them to care about it. But pain is always front of mind,” acknowledged one of the endocrinologists in the study.The Toronto research team behind the study asserted that it is essential to implement initiatives that integrate osteoarthritis care into diabetes consultations. They believe that diabetes tracking sheets used by healthcare professionals could provide a way to incorporate discussions about osteoarthritis into overall diabetes management.The researchers also noted that vaccination status, mental health and sexual function have already been added to some tracking sheets, reflecting a trend toward a patient-centered approach.ReferenceDu J, Waugh EJ, Voth R, et al. “It’s a Chronic, Vicious Cycle”: Diabetes Health-care Professionals’ Perceptions of the Impact of Knee Osteoarthritis on Type 2 Diabetes Management. Canadian Journal of Diabetes, 2025; 50, 8-14.e2This article was initially published on our sister site ProfessionSanté.ca and has been translated from its original French.

Is knee pain the missing piece in diabetes care?

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