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How are Knee Pain and Diabetes Related?

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How are Knee Pain and Diabetes Related?

— By Dawn M. Sweet, Ph.D

Understanding knee pain location in patients with diabetes could lead to interdisciplinary treatment approaches.

Walking is one of the safest and most effective ways to jumpstart an exercise routine, and it is an important activity and function of day-to-day life. Walking facilitates energy expenditure, which is an important component of weight loss, so when daily walking is interrupted with knee pain, energy expenditure becomes more challenging. Knee pain in patients with obesity is problematic because it could signal osteoarthritis, which is a risk factor of excess weight. Approximately one third of adults with obesity have arthritis.1 The American College of Rheumatology recommends weight loss to decrease joint load and to decrease the risk of or delay the progression of knee osteoarthritis.2


Knee pain in diabetic patients can be especially problematic because type 2 diabetes has been found to be an independent risk factor for knee osteoarthritis.3 Additionally, hyperglycemia produces glycation products that can be deposited throughout body, including joints.4 Glycated products are deposited in the joints can result in bone fragility and cartilage stiffness and thus make walking challenging and/or painful.5 Understanding the location of knee pain in diabetic patients is important because this knowledge can lead to interdisciplinary approaches to treatment.

Knee Pain and Diabetes

A 20204 study investigated knee pain in participants with osteoarthritis and diabetes (n = 236), knee osteoarthritis only (n = 1554). Locations of knee pain were classified as no pain, localized pain, regional pain, or diffuse pain. When one or two fingers could indicate the area of pain, it was classified as localized pain. When a participant’s hand could cover the painful area, it was classified as regional pain. When the pain was experienced everywhere, it was classified as diffuse.

Knee pain was assessed following a 20-meter walking test. Participants were asked to rate the maximum amount of pain they experienced using a 0 to 10-point scale. To determine walking speed, the time it took to walk 20 meters was averaged across two trials. Results suggest that diabetes was associated with regional knee pain, a slower walking speed, and a pain rating of moderate to severe.

Participants with diabetes were roughly 1.77 times more likely to report regional pain and 1.77 to 2.5 times more likely to report moderate to severe pain. Participants with diabetes walked more slowly than non-diabetic counterparts, achieving a mean walking speed of 1.12 m/s compared to 1.24 m/s in non-diabetic participants. Contrary to predictions, diabetes was not associated with diffuse pain once BMI was controlled for.

The authors suggest additional research is needed to fortify our understanding of how comorbidities affect knee pain. Knowing how diabetes affects knee pain could lead to the identification of clinical osteoarthritis phenotypes, improve treatment for knee pain that consider diabetes management, and help monitor pain.

Knee Pain in Patients with Obesity

Excess weight can cause or exacerbate knee pain and it can expedite the progression of osteoarthritis. To help patients with obesity lead healthier lives, developing a weight loss program tailored to their needs is important. A Low Calorie Diet (LCD) or Very Low Calorie Diet (VLCD), combined with nutritionally formulated meal replacements, can help patients lose weight which in turn can lead to decrease knee pain, a slower progression of osteoarthritis, and walking at a faster rate of speed free of pain. The increased walking speed can lead to greater energy expenditure, which, in turn, leads to quicker weight loss and quicker relief from knee pain.


1 Weight loss changed gait kinematics in individuals with obesity and knee pain
2 2022 American College of Rheumatology Guideline for exercise, rehabilitation, diet, and additional integrative interventions for Rheumatoid Arthritis

3 Type 2 diabetes and osteoarthritis: a systematic review and meta-analysis

4 The association of diabetes with knee pain locations, pain while walking, and walking speed: Data from the Osteoarthritis Initiative

5 Metabolic stress-induced joint inflammation and osteoarthritis

About the Author: Dr. Dawn M. Sweet has over 20 years of experience in the field of communication. Dr. Sweet has given several invited talks to and workshops for academic and private sector audiences on the role of nonverbal and verbal communication in achieving positive outcomes and mitigating bias. Her research has been published in several top ranked peer-review journals, and it has been featured on NPR’s River to River / All Things Considered, Buzzfeed, and Science Daily. Her research has also been used to inform expert testimony.

About Robard: For 45 years, Robard Corporation’s medical obesity treatment programs and nutrition products have been utilized by physicians, surgeons and hospitals across the United States to successfully treat patients living with obesity. To learn more about us and how we can help your practice and patients, visit us online at, email us at, or call (800) 222-9201.

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