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Knee OA and Diabetes: Risk Factors

30th March 2022

One of the worst parts of knee OA is its susceptibility to various other diseases. In particular, cardiovascular and metabolic diseases constitute high-risk factors for knee joint damage. Diabetes is a condition that can have negative effects on your body, especially when combined with osteoarthritis.

This article looks at the mechanism behind diabetes that worsens knee OA symptoms.

Diabetes & OA


Can Diabetes Alone Impact Knee OA?

Majority of studies indicate body mass index (BMI) and age as primary risk factors. Excessive weight puts more pressure on your knees and speeds up cartilage erosion. However, the emergence of OA in non-weight-bearing joints prompted scientists to shift their focus to metabolic causes.

Although preliminary studies suggest that high blood glucose levels could play a role in knee OA development, the direct correlation between the two was not explored until recently.

A 2013 study was one of the pioneers investigating diabetes as an independent predictor of osteoarthritis. In the study, conducted with 927 patients of ages 40-80, the researchers looked at the effect of type 2 diabetes by adjusting the statistics for the other factors, such as gender, age, and BMI. After a 20-year follow-up period, they found a two-fold increase in knee OA risk and severity with type 2 diabetes. As expected, the diabetes patients also reported worse knee pain and more stiffness [1].

In 2015, a Basel-based study looked at the effect of insulin therapy on the progression of radiographic changes in knee OA. They observed that the diabetes patients on insulin therapy developed far fewer bone spurs in the knee than those not on insulin [2].

Taken together, these findings clearly show us that metabolic diseases should not be underestimated with respect to knee OA.

How Does Diabetes Increase Knee OA Risk?

Although more research is needed to confirm the underlying mechanism, several suggestions have been made.

High blood glucose levels seem to alter the activity of chondrocytes, responsible for cartilage production. In the case of hyperglycemia (i.e., when there is too much sugar in the blood), chondrocytes start to express proteins, such as inflammatory cytokines and matrix metalloproteases (MMPs) that promote inflammation and cartilage degeneration [3].

Another possible link between diabetes and knee OA is neuropathy, often associated with a burning or stabbing sensation, reported by many patients. Because of neuropathy and the associated nerve inflammation, patients often tend to change their alignment in a way that puts more pressure on the knee joint [4].

How to Prevent Type 2 Diabetes to Reduce Knee OA Risk?

Fortunately, the steps needed for preventing type 2 diabetes benefit knee joint health as well. With smart exercise and diet choices, you can simultaneously keep diabetes and knee OA at bay.

  • Reducing your added sugar and processed carbohydrate intake will reduce diabetes risk. Coincidentally, this is also a necessity for knee OA prevention.
  • Research shows that exercise increases insulin resistance, meaning that your body can regulate blood sugar levels with more ease. In addition, losing excess fat reduces the risk of neuropathy.
  • Studies also found a strong correlation between smoking and type 2 diabetes, although the exact mechanism is vaguely understood.
  • Fibre-rich food is also shown to keep blood sugar levels within the normal range, so consuming fruits and vegetables on a regular basis will protect you from developing diabetes. As we mentioned in our previous blog posts, a high-fibre diet is essential for knee health.
Reduce Risk of Diabetes

[1] Schett, Georg, et al. "Diabetes is an independent predictor for severe osteoarthritis: results from a longitudinal cohort study." Diabetes care 36.2 (2013): 403-409.

[2] Al-Jarallah, Khaled, et al. "Knee osteoarthritis in type 2 diabetes mellitus: does insulin therapy retard osteophyte formation?." Medical Principles and Practice 25.1 (2016): 12-17.

[3] Henrotin, Y. E., P. Bruckner, and J-PL Pujol. "The role of reactive oxygen species in homeostasis and degradation of cartilage." Osteoarthritis and cartilage 11.10 (2003): 747-755.

[4] Slemenda, Charles, et al. "Quadriceps weakness and osteoarthritis of the knee." Annals of internal medicine 127.2 (1997): 97-104.

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