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Impact of diabetes mellitus on knee osteoarthritis pain and physical and mental status: Data from the osteoarthritis initiative

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posted on 13.07.2021, 04:46 by Annett Eitner, Adam CulvenorAdam Culvenor, Wolfgang Wirth, Hans‐Georg Schaible, Felix Eckstein
Objective: Diabetes mellitus (DM) appears to increase osteoarthritic knee pain, which may be related to greater adiposity and more advanced disease status often observed in individuals with osteoarthritis (OA) and DM. We aimed to assess whether OA knee pain and health status are worse in individuals with OA and DM, independent of these potential confounders. Methods: We included 202 OA participants with DM and 2,279 without DM from the Osteoarthritis Initiative. Knee pain was evaluated using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and a numeric rating scale (NRS). Physical and mental status were assessed by the Medical Outcomes Study Short Form 12 (SF-12) questionnaire, physical component summary (PCS) score and mental component summary (MCS) score, and by the Center for Epidemiologic Studies Depression Scale (CES-D). Linear regression models assessed the influence of DM, adjusted for age, sex, body mass index (BMI), and radiographic severity. Results: OA participants with DM reported worse knee pain and greater physical and mental issues compared with participants without DM. Individuals with DM had worse KOOS pain (β = –4.72 [95% confidence interval (95% CI) –7.22, –2.23]) and worse NRS pain (β = 0.42 [95% CI 0.04, 0.80]) independent of BMI, OA severity, age, and sex. The negative influence of DM was also apparent for SF-12 PCS (β = –3.49 [95% CI –4.73, –2.25]), SF-12 MCS (β = –1.42 [95% CI –2.57, –0.26]), and CES-D (β = 1.08 [95% CI 0.08, 2.08]). Conclusion: Individuals with knee OA experience on average higher pain intensity and a worse physical and mental health status if they have DM. Linear regression models show that DM is a risk factor for higher pain, in addition to and independent of greater BMI and radiographic OA severity.


This article was prepared using an Osteoarthritis Initiative (OAI) public-use data set, and its contents do not necessarily reflect the opinions or views of the OAI Study Investigators, the NIH, or the private funding partners of the OAI. The OAI is a public-private partnership between the NIH (contracts N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262) and private funding partners (Merck Research Laboratories, Novartis Pharmaceuticals, GlaxoSmithKline, and Pfizer, Inc.) and is conducted by the OAI Study Investigators. Private sector funding for the OAI is managed by the Foundation for the NIH. The authors of this article are not part of the OAI investigative team. Dr. Culvenor's work was supported by a National Health and Medical Research Council of Australia Early Career Fellowship (Neil Hamilton Fairley Clinical Fellowship APP1121173).


Publication Date



Arthritis Care and Research






23p. (p. 540-548)


John Wiley & Sons Inc.



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