Tendinopathy in diabetes mellitus patients—Epidemiology, pathogenesis, and management

Abstract

Chronic tendinopathy is a frequent and disabling musculo-skeletal problem affecting the athletic and general populations. The affected tendon is presented with local tenderness, swelling, and pain which restrict the activity of the individual. Tendon degeneration reduces the mechanical strength and predisposes it to rupture. The pathogenic mechanisms of chronic tendinopathy are not fully understood and several major non-mutually exclusive hypotheses including activation of the hypoxia-apoptosis-pro-inflammatory cytokines cascade, neurovascular ingrowth, increased production of neuromediators, and erroneous stem cell differentiation have been proposed. Many intrinsic and extrinsic risk/causative factors can predispose to the development of tendinopathy. Among them, diabetes mellitus is an important risk/causative factor. This review aims to appraise the current literature on the epidemiology and pathology of tendinopathy in diabetic patients. Systematic reviews were done to summarize the literature on (a) the association between diabetes mellitus and tendinopathy/tendon tears, (b) the pathological changes in tendon under diabetic or hyperglycemic conditions, and (c) the effects of diabetes mellitus or hyperglycemia on the outcomes of tendon healing. The potential mechanisms of diabetes mellitus in causing and exacerbating tendinopathy with reference to the major non-mutually exclusive hypotheses of the pathogenic mechanisms of chronic tendinopathy as reported in the literature are also discussed. Potential strategies for the management of tendinopathy in diabetic patients are presented.

Tendinopathy in type 2 diabetes: a condition between specialties?

“…Vascular integrity and healing are often impaired, and collagen and matrix production abnormal. 2 Obesity, hypertension, ageing, alcohol, and smoking often coexist, and are independent and exacerbating factors. 1 The pathological processes accumulate over years preceding clinical symptoms.…”

“…6 Diabetes-associated tendinopathy is little researched and is managed in a similar way to overuse tendinopathy, but may respond less well, due to greater underlying degeneration. 2 The National Institute for Health and Care Excellence recommends specific Systematic Reviews and Clinical Knowledge Summaries for assessment and treatment of specific tendons. Early physiotherapy referral for specific exercise programmes is essential and forms the mainstay of treatment.…”

“…People with diabetes have a threefold increased risk of all musculoskeletal conditions, but are particularly vulnerable to tendon conditions, which are more treatmentresistant than in patients without diabetes. 1,2 This is important as such problems can limit the opportunity to exercise as part of diabetes management. 1 Discriminating between tendonitis and tendinopathy, conflicting evidence on treatment, and slow recovery can make these conditions challenging for GPs to manage.…”

“…Patients with type 1 or type 2 diabetes have an increased risk of developing these conditions, although the mechanism for this is unclear. 2 Symptoms can often last several months and cause considerable loss of function. Within the authors' own practice, 18% of patients with diabetes have been affected in the past 5 years, with a mean symptom duration of 3 months.…”

Pioglitazone attenuates advanced glycation end products‐induced apoptosis and calcification by modulating autophagy in tendon‐derived stem cells

“…Diabetes mellitus (DM), as a systemic metabolic disorder, is an important risk factor for the development and poor prognosis of tendinopathy. 1,2 Tendon-derived stem cells (TDSCs) are isolated from tendon tissues and possess the capacity of self-renewing and differentiating into tendon-like tissues. 3 TDSCs can promote tendon repair and regeneration, and maintain tendon homeostasis.…”