Doctors working with nutrition and metabolism are among those researchers who are bringing attention to osteoarthritis as a whole joint disease. This includes the impact of Type 2 diabetes in osteoarthritis joint healing.

Here are highlights of recent research from Researchers at Sorbonne University in Paris writing in Diabetes research and clinical practice. In this research the role of diabetes is examined in creating a toxic non-healing joint environment.

• For a long time, osteoarthritis was considered the consequence of aging and mechanical stress on cartilage.
• Recent advances in the knowledge of osteoarthritis have highlighted that it is a whole joint disease with early modifications of synovium and subchondral bone but also that it is associated with obesity and metabolic syndrome through systemic mechanisms.
• Recently, type 2 diabetes has been described in two meta-analyzes studies as an independent risk factor for osteoarthritis.
• In animal studies,  diabetic rodents display a spontaneous and a more severe  osteoarthritis than their non-diabetic counterparts, which can be partially prevented by diabetes treatment (insulin, pioglitazone).
• The negative impact of diabetes on joints could be explain by the induction of oxidative stress and pro-inflammatory cytokines but also by advanced age products accumulation in joint tissues exposed to chronic high glucose concentration.
• Insulin resistance might also impair joint tissue because of a local insulin resistance of diabetic synovial membrane but also by the systemic low grade inflammation state related to obesity and insulin resistant state.1

In a study that we cite in other articles of our website published in the prestigious international journal Therapeutic advances in musculoskeletal disease, doctors wrote of excellent patient outcomes in a study of Prolotherapy injections for with knee osteoarthritis you can read that study here: Prolotherapy knee osteoarthritis injections for knee pain

• In patients excluded from the study, because of likelihood of poor outcome were patients with poorly controlled diabetes mellitus with fasting blood sugar greater than 11.1 mmol/L.2
• Another well known study on the success of Prolotherapy treatments for knee osteoarthritis lead by Dr. David Rabago, MD of the University of Wisconsin also excluded patients with uncontrolled diabetes mellitus defined as glycosylated hemoglobin (HbA1c levels) >7.5%).3

Prolotherapy and uncontrolled diabetes

Commonly patients with elevated HbA1c levels will need to drastically change what they perceive as “healthy” eating habits. They are often following one of two types of diets.

(1) The “SAD” diet or the standard American diet which is high in carbs, fat, and processed food, low in vegetables, protein, and good fats OR

(2) the so-called “healthy” American diet that consists of a low-fat, low-sodium, high carb diet. Both of these diets are not the right Diet Type for a person with high HbA1c levels.

The culprit of elevated HbA1c levels is a typically high intake of carbohydrates in various forms such as those mentioned above, as well as high fruit and/or fruit juice consumption. Interestingly enough, many of these individuals would rate their diets as healthy AND high in protein prior to their lab testing. However, things are not always as they seem. We recommend that our patients write down what they eat in a food diary. It is amazing what is revealed through these if the patients are completely honest! People also have misconceptions about what constitutes protein, fat, and carbohydrates as well.

Poor blood glucose control and an elevated HbA1c increase the risk for poor healing, as well as development of adult onset diabetes and its associated health risks, which can lead to heart disease. Every day we treat patients with joint pain, arthritis, and sports injuries whose goal is to heal and return to their normal lives. High glucose levels compromise that goal and put them at risk for further diseases in the future.

1 Courties A, Sellam J. Osteoarthritis and type 2 diabetes mellitus: What are the links?. diabetes research and clinical practice. 2016 Dec 31;122:198-206.

2. Eslamian F, Amouzandeh B. Therapeutic effects of prolotherapy with intra-articular dextrose injection in patients with moderate knee osteoarthritis: a single-arm study with 6 months follow up. Ther Adv Musculoskelet Dis. 2015 Apr;7(2):35-44.

3 Rabago D, Zgierska A, Fortney L, Kijowski R, Mundt M, Ryan M, Grettie J, Patterson JJ. Hypertonic dextrose injections (prolotherapy) for knee osteoarthritis: results of a single-arm uncontrolled study with 1-year follow-up. The Journal of Alternative and Complementary Medicine. 2012 Apr 1;18(4):408-14.

This article was first published by Caring Medical and Rehabilitation Services