Are pain and glycemic control linked? New research says one particular type of pain could, in fact, limit how well a patient’s blood sugar regulates.

Patients with type 2 diabetes and high levels of pain from knee osteoarthritis are 40% less likely to achieve glycemic control, according to the study, published in Arthritis Care & Research.

Breaking Down the Research

While knee osteoarthritis pain is well-documented, the association with diabetes management presents valuable considerations for clinical practice in primary care settings.

Lauren King, MD, PhD, rheumatologist and clinician scientist at St Michael’s Hospital and assistant professor in the Department of Medicine at the University of Toronto, Toronto, Ontario, Canada, was the study’s corresponding author. She and the research team conducted a cross-sectional analysis of 351 individuals with type 2 diabetes, with an average age of 66.2 years, recruited from three academic centers in Canada. Of the participants, 28.5% met the criteria of knee osteoarthritis, while 43.9% achieved the glycemic target, defined as an A1c level of 7% or lower, the study outlined.

Participants filled out online questionnaires about demographics, medical history, and joint symptoms. This data was compiled to analyze the links between knee osteoarthritis and glycemic control and was adjusted for age, gender, education, and BMI.

“We know from prior studies that people with knee osteoarthritis frequently live with other chronic conditions, and having painful osteoarthritis can lead to worse outcomes,” King said. “One condition that commonly overlaps with knee osteoarthritis is type 2 diabetes. We wanted to understand specifically if having knee osteoarthritis was associated with worse diabetes blood glucose control.”

King told Medscape Medical News there were two analyses in a cohort of individuals with type 2 diabetes.

“After adjusting for potential confounders, there was a strong effect (odds ratio, 0.65); those with knee osteoarthritis were less likely to be at their diabetes target — but it wasn’t statistically significant. This may relate to our relatively small sample size,” she said.

In the study’s second analysis, the team looked at the effect of having knee osteoarthritis with an average pain level of greater than 20 out of 100 — those who have more regular or troubling symptoms. “Here, the effect was even stronger (odds ratio, 0.58), and it was statistically significant,” King summarized.

According to King, these results provide an important signal that having knee osteoarthritis can affect diabetes blood glucose control, particularly beyond a minimum threshold of pain severity.

“I should say, however, that these findings should be viewed as exploratory given the cross-sectional design of our study. Hopefully this sets up future studies to increasingly clarify the impact of knee osteoarthritis in these individuals,” she noted.

Furthermore, according to the research, unadjusted analysis results showed that individuals with knee osteoarthritis were less likely than their counterparts without knee osteoarthritis to achieve target glycemic control. Moreover, in the adjusted analysis, participants with knee osteoarthritis who reported pain levels of at least 20 on a scale of 0-100 demonstrated a statistically significant negative association with target glycemic control, King cited.

Ajaykumar D. Rao, MD, MMSc, chief of the Section of Endocrinology, Diabetes, and Metabolism at the Lewis Katz School of Medicine at Temple University in Philadelphia, weighed in on the study as an independent medical evaluator.

He said the relevance of the study was important, as often patients living with type 2 diabetes also have osteoarthritis.

“I am not surprised by the findings; I would think any sort of condition that prevents patients living with type 2 diabetes from being active would affect their overall achieved A1c goals and, hence, complication risk,” Rao told Medscape Medical News. 

Osteoarthritis is a serious disease that significantly affects lives beyond physical function. 

“This really underscores a need for a proactive approach to identify when people have osteoarthritis and make sure they have the opportunity to engage in treatment,” King said. “I hear frequently, ‘There’s nothing that can be done for osteoarthritis,’ but that’s simply not true. It is important and worthwhile to ensure those with osteoarthritis have access to care.”

The takeaway from this study can also be applied to primary care settings. 

“Try to always ask patients living with type 2 diabetes if they are having issues with mobility and make sure those things are getting addressed, as that could affect risk of complications,” Rao said.

No reported disclosures.