Type 2 Diabetes is Associated With a Higher Risk for Musculoskeletal Pain

Written by Kristin Della Volpe

Commentary by Ali Mobasheri, BSc ARCS (Hons), MSc, DPhil (Oxon)

People with type 2 diabetes are at higher risk for musculoskeletal pain than people without diabetes, according to a 10-year, population-based, retrospective cohort study in BMC Musculoskeletal Disorders. The risk was particularly high among people with diabetes ages 30-39 years, Pai et al reported.

“There is increasing evidence to suggest that there are mechanistic links between metabolic diseases such as type 2 diabetes, low grade systemic inflammation and musculoskeletal degeneration, which will eventually lead to musculoskeletal pain,” commented Ali Mobasheri, BSc ARCS (Hons), MSc, DPhil (Oxon) Professor of Musculoskeletal Physiology, University of Surrey, Guildford, Surrey, United Kingdom. Dr. Mobasheri is Section Editor for BMC Musculoskeletal Disorders.

The findings by Pai et al “provide evidence to suggest that people with type 2 diabetes aged 18 to 50 years have a higher 10-year cumulative incidence musculoskeletal pain than the non-diabetic group,” Dr. Mobasheri said. “Diabetics also had a higher mean number of visits to their doctor. Recent epidemiological studies support a role for metabolic factors in a variety of musculoskeletal disorders including osteoarthritis, and accumulating experimental data suggest that diabetes, dyslipidemia, and hypertension may promote musculoskeletal complications such as joint damage.”

Long-Term Follow-up of Taiwanese Database
The analysis was based on 6,586 people with diabetes (newly diagnosed in 2001) and 32,930 people without diabetes. Medical records from the Taiwanese National Health Insurance Research Database were used to track the incidence of musculoskeletal pain in both groups between 2001 and 2010. All subjects were aged 18 to 50 years; elderly patients were not included in the study as a number of potentially confounding factors may influence the incidence of musculoskeletal pain in this group, the study authors noted.

The 10-year cumulative incidence of musculoskeletal pain was significantly higher in the diabetic group than in the nondiabetic group for all age groups and both genders (P<0.05; Table 1) The increased relative risk for musculoskeletal pain for people with diabetes compared with people without diabetes ranged from 1.13-1.39, the study authors reported.

Table 1. 10-Year Cumulative Incidence of Musculoskeletal Pain
In addition, the mean number of doctor visits for musculoskeletal pain per year and over 10 years was significantly higher in the diabetic group (P<0.05), except in 2006, 2007, and 2010.

Location of Musculoskeletal Pain
The diabetic group had a higher mean number of doctor visits for musculoskeletal pain in the neck and shoulders, limbs, lumbar spine, back and pelvis compared with the nondiabetic group (P<0.001; Table 2). In both groups, the most common locations of musculoskeletal pain necessitating doctor visits were pain in the lumbar spine, back and pelvis.

Table 2. Mean Number of Doctor Visits for Musculoskeletal Pain by Location
Improving the Musculoskeletal Pain Management in Patients With Type 2 Diabetes

“The clinical implications of this study are that healthcare professionals should pay closer attention to musculoskeletal status of people with type 2 diabetes,” Dr. Mobasheri said. “It is important to detect and treat the underlying causes of musculoskeletal pain as early as possible. This may involve lifestyle change, such as weight loss and physical activity. Eating a healthier diet and optimizing blood sugar control is also important for reducing the risk of musculoskeletal complications.”

“Physicians, rheumatologists, and basic scientists need to collaborate and develop biomarker tests and assays for the early detection of systemic mediators that are involved in promoting low-grade inflammation, musculoskeletal degradation, and subsequent pain in patients with metabolic complications such as type 2 diabetes,” Dr. Mobasheri said. “Strategies aimed at prevention and better management of diabetes by weight loss and physical exercise may reduce the risk for associated musculoskeletal complications.”

“Furthermore, using antidiabetic drugs also may reduce the risk of musculoskeletal complications,” Dr. Mobasheri noted. “There is evidence to suggest that the antidiabetic drug metformin can slow aging and lengthen lifespan. A Belgian study by doctoral researcher Wouter De Haes and colleagues has provided new evidence that metformin slows aging and increases lifespan. However, it is important to note that this has been shown in the nematode worm Caenorhabditis elegans, which is an ideal species for studying ageing because it has a lifespan of only 3 weeks.”

Dr. Mobasheri concluded “There is existing evidence to suggest that adopting a healthy lifestyle and a calorie restricted diet is also likely to benefit human health and extend longevity without the need for antidiabetic drugs.”




Pai LW, Hung CT, Li SF, Chen LL, Chung Y, Liu HL. Musculoskeletal pain in people with and without type 2 diabetes in Taiwan: a population-based, retrospective cohort study. BMC Musculoskelet Disord. 2015;16(1):364.

Sellam J, Berenbaum F. Is osteoarthritis a metabolic disease? Joint Bone Spine. 2013;80(6):568-573.

De Haes W, Frooninckx L, Van Assche R, et al. Metformin promotes lifespan through mitohormesis via the peroxiredoxin PRDX-2. Proc Natl Acad Sci U S A. 2014;111(24):E2501-9.

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