Diabetes and impact on joint and soft tissues

Diabetes mellitus is a chronic disease that significantly affects the health of many Australians. Diabetes is responsible for an enormous public health and social burden, and is one of the top 10 causes of death in the country (Australian Institute of Health & Welfare).


Diabetes is a long-term (chronic) condition in which the body loses its ability to control the level of glucose (sugar) in the blood. Insulin is a hormone produced by beta cells in the pancreas that help the body to convert glucose from food into energy. In people with diabetes, insulin is either no longer produced or not produced in sufficient amounts by the body – meaning that glucose stays in the blood instead of being turned into energy, thereby causing blood sugar levels to become high.


Type 1 Diabetes: The pancreas cannot make insulin
Insulin Resistance: Cells do not respond to the insulin properly
Type 2 Diabetes: The pancreas produces inadequate insulin for the body’s increased needs.


Several rheumatologic manifestations are more common in people suffering with diabetes. For example: frozen shoulder, rotator cuff tears, dupuytren’s contracture, trigger finger, achilles tendinopathy and plantar fasciitis.


At the root of joint mobility problems is hyperglycemia. Poor diabetes control is linked to the development of all forms of these syndromes. Elevated glucose levels cause sugar to stick to collagen in bones, cartilage and tendons. When collagen becomes glycosylated, it thickens, resulting in stiffness and preventing bones from moving smoothly through the full range of motion (Schneider, 2008).

Frozen shoulder is one of the more common afflictions. It affects approximately 20% of individuals with diabetes, four times the rate seen in the non-diabetic population. Calcific shoulder periarthritis, which has a similar presentation, is three times more common in those with diabetes (Schneider, 2008).


Rotator cuff tendinopathy shows degenerative changes, such as collagen degradation, increased ground substance levels, disruption of fibres, necrotic areas, hypercellularity or hypocellularity and tears, which are usually present without histologic features of inflammation. The more causative factors include trauma, aging or reduced blood flow and acromial spur impingement (Abate et al, 2013).


Management of the above conditions can be problematic with the presence of comorbid diabetes and often results in a longer recovery process and sometimes sub-optimal outcomes. Patients with diabetes should be encouraged to ensure good management of their diabetes and seek early management of musculo-skeletal conditions if they arise. Merit would exist in the continued undertaking of a regular self-management program aimed to maximize joint mobility and strength. When corticosteroid injections are being considered as part of the patients’ management extra precautions must be taken in patients as the injection may lead to significant insulin resistance.


Staff of Workplace Physiotherapy are very skilled in program development in this regard.


Ref: http://www.aihw.gov.au/what-is-diabetes/#imp http://www.rheumatologynetwork.com/osteoarthritis
http://www.rheumatologynetwork.com/arthritis Schneider G. Diabetes and Limited Joint Mobility. Review of Endocrinology: May, 2008. Abate M, Schiavone C, Salini V, Andia I. Management of limited jont mobility in diabetic patients. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy, 2013:6 197-207.


The comments above are the implicit advice of Workplace Physiotherapy. The views expressed are based on current evidence-based research and accepted best practice approaches. Unless otherwise stated, these comments are not the view of WorkCover NSW or any other professional body. No reproduction or forwarding of this advice is permitted without the consent of the author.


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