Tendinopathy in type 2 diabetes: a condition between specialties?

INTRODUCTION

People with diabetes have a threefold increased risk of all musculoskeletal conditions, but are particularly vulnerable to tendon conditions, which are more treatment-resistant 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. This article highlights key features of tendinopathy within diabetes and current evidence for treatment. Increased awareness may facilitate early diagnosis and improved outcome.

Up to 50% of people who drop out of exercise interventions for type 2 diabetes do so due to musculoskeletal symptoms.¹ A significant proportion of these will be due to tendinopathy. Common manifestations are Achilles tendinopathy, rotator cuff syndrome, lateral epicondylitis, and trigger finger. 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. Approximately 5% of a GP diabetes caseload will develop tendinopathy annually.¹ This compares with a background prevalence of approximately 2%.³