Diabetes and Tendon Damage

A June 2022 study (1) examined the association between Diabetes mellitus and musculoskeletal complications-including tendon dysfunction and injury. The researchers write: “Patients with Diabetes show altered foot and ankle mechanics that have been attributed to tendon dysfunction as well as impaired recovery post-tendon injury.

Despite the problem of Diabetes-related tendon complications, treatment guidelines specific to this population of individuals are lacking. Diabetes impairs tendon structure, function, and healing capacity in tendons throughout the body, but the Achilles tendon is of particular concern and most studied in the diabetic foot. At macroscopic levels, asymptomatic, diabetic Achilles tendons may show morphological abnormalities such as thickening, collagen disorganization, and/or calcific changes at the tendon enthesis.  . . In addition to dysfunction of the extracellular matrix, tendon cells such as tenocytes and tendon stem/progenitor cells show significant abnormalities in proliferation, apoptosis, and remodeling capacity in the presence of hyperglycemia and advanced glycation end-products, thus contributing to the disruption of tendon homeostasis and healing.”

Diabetes mellitus is associated with a high risk of chronic degenerative Achilles and Patellar tendinopathies and ruptures.  A September 2024 study (2) examined whether pre-existent Diabetes mellitus or Impaired Glucose Tolerance could influence the clinical outcome in subjects undergoing PRP treatment.

  • Sixty patients with diabetes/pre-diabetes and sixty normal glucose levels patients with proximal insertional patellar tendinopathies and Achilles tendinopathy, treated with PRP therapy, were included in the study and assessed three and six months after treatment.
  • Even though the improvement was poor, it was still significant improvement for the patient.
  • PRP treatment in Achilles and patellar chronic tendinopathies resulted in less favorable results in subjects with diabetes compared with normal glucose levels subjects.  The patients with patellar chronic tendinopathies showed better results than those with Achilles tendinopathy. Even though the improvement was poor, it was still significant improvement for the patient.

Diabetes and Lumbar Stenosis

A December 2023 large-scale retrospective case-control study (3) looked at a total of 49,576 patients diagnosed with lumbar spinal stenosis for an association between spinal stenosis and diabetes. The theory was that patients with diabetes mellitus would present a greater risk factor for developing lumbar spinal stenosis. The researchers “found a higher likelihood of lumbar spinal stenosis diagnosis in diabetic patients. Those (patients with HbA1c ≥7% and 1 or more diabetes-related complication also had an elevated likelihood.

A November 2024 (4) study found diabetic patients had significantly higher rates of poor shoulder function compared to non-diabetic patients (89.47% vs. 63.26%. Diabetic patients were more than three times as likely to have subscapularis tendon injuries and massive rotator cuff tears and diabetes was associated with a fourfold increased risk of adhesive capsulitis (frozen shoulder).

Diabetes and knee osteoarthritis

A February 2025 study (5) looked at 600 type 2 Diabetes patients and found knee osteoarthritis was the most prevalent musculoskeletal manifestations of diabetes mellitus involving 22% of the study participants, followed by frozen shoulder, in 12.2%.

References
1 Vaidya R, Lake SP, Zellers JA. Effect of Diabetes on Tendon Structure and Function: Not Limited to Collagen Crosslinking. Journal of Diabetes Science and Technology. 2022 Jun 2:19322968221100842.
2 Abate M, Paganelli R, Pellegrino R, Di Iorio A, Salini V. Platelet Rich Plasma Therapy in Achilles and Patellar Tendinopathies: Outcomes in Subjects with Diabetes (A Retrospective Case-Control Study). Journal of Clinical Medicine. 2024 Sep 13;13(18):5443.
3 Shemesh S, Laks A, Cohen I, Turjeman A, Blecher R, Kadar A. Diabetes Mellitus and Poor Glycemic Control are Associated with a Higher Risk of Lumbar Spinal Stenosis: An Analysis of a Large Nationwide Database. Spine.:10-97.
4 Fuentes-Murguia M, Carrazco-Peña KB, Delgado-Enciso OG, Castellanos-Gomez J, Hernandez-Fuentes GA, Rojas-Larios F, Sanchez-Ramirez CA, Martinez-Fierro ML, Rodriguez-Sanchez IP, Guzmán-Esquivel J, Garza-Veloz I. Types of Injuries and the Severity of Shoulder Dysfunction Associated with Diabetes Mellitus in Patients with Functional Impairment: A Case–Control Study. Biomedicines. 2024 Nov 18;12(11):2634.
5 George K, George S, Bhavani N, Bhaskaran R. Prevalence of musculoskeletal manifestations and its associated factors in patients with type 2 diabetes mellitus in Ernakulam district: A Cross-sectional study. Indian Journal of Endocrinology and Metabolism. 2025 Jan 1;29(1):61-8.