Pain is often a partner of diabetes, with studies indicating that anywhere from 20% to 60% of people with diabetes live with chronic pain. And while pain from conditions such as diabetic neuropathy (nerve damage) or peripheral arterial disease are often the culprit, new research out of Australia shows that people with Type 2 diabetes are more than three times as likely as those without diabetes to have tendon pain.
Physical activity is an important part of controlling blood sugar levels, but musculoskeletal pain can interfere with a person’s ability and willingness to stick with an exercise program. In fact, according to some estimates, as many as 50% of people with diabetes stop exercising due to this type of pain.
Because chronically high blood sugar can increase the risk of developing tendinopathy (painful and inflamed tendons), researchers from several universities in Australia conducted a meta-analysis (analysis of data from several clinical trials) to investigate the potential association between tendon pain and Type 2 diabetes. They focused on 31 studies, 26 of which concentrated on people with diabetes and 5 of which centered on people with diagnosed tendinopathy.
When they combined and reexamined the data, the researchers found that people with Type 2 diabetes were 3.67 times more likely to have tendinopathy than those without diabetes, and those with tendinopathy were 1.3 times more likely to have Type 2 diabetes. Those with diabetes were also more likely to have thickened tendons, a common feature of tendinopathy. Those who had tendinopathy and diabetes had generally been diagnosed with diabetes for longer than those who had diabetes but no tendon problems, which may suggest that “the risk of tendinopathy increases with the number of years that you’ve had diabetes,” according to the researchers.
Factors such as high blood sugar levels, increased cholesterol, excess body fat, and statin use may be linked to the increased rates of tendinopathy seen in people with diabetes, the study authors note.
Those with diabetes should not see this study as a reason to stop being physically active, but rather should ease into an exercise program, notes Martin Levy, MD, who was not involved in the study. “People sometimes launch themselves too aggressively into exercise programs and hurt themselves… Any exercise that you take on, you should do it in a progressive manner. Start off gently and then increase in a rational way, and constantly observing the results of your exercise to determine if in fact you are having any problems from the exercise program that you are on.”
Maintaining good blood sugar control is also important for reducing the risk of developing tendinopathy, study author Jamie E. Gaida, PhD, said in an e-mail response.
While further research is needed to determine exactly how many people with diabetes are affected by tendon pain and why the association exists, this study “provides strong evidence” that there is a link between the two conditions — a fact that “should be taken into consideration when health-care providers discuss exercise regimens with their patients,” according to one source.
For more information, see the article “Tendon pain linked to Type 2 diabetes” or the study’s abstract in the British Journal of Sports Medicine. And for strategies to reduce pain, see the article “Managing Chronic Pain,” by nurse David Spero.
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Diane Fennell: Diane Fennell has been an editor at Diabetes Self-Management magazine since 2003. She is currently the Editorial Director. (Diane Fennell is not a medical professional.)
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