ORIGINAL RESEARCH article
Front. Med.
Sec. Rheumatology
This article is part of the Research TopicMixed Pain: A challenging diseaseView all 7 articles
Linking Diabetes to Worsening Knee Osteoarthritis Symptoms and Disability: Evidence from the Osteoarthritis Initiative
Provisionally accepted
Aqeel M Alenazi1*
Sultan Alanazi2
Abdullah M Alqathami3Mohammed K Alanazi4Bader A Alqahtani5
Norah A Alhwoaimel5Ahmad D Alanazi6
Sattam Almutairi7
Mohammed Alghamdi8
Yasir S. Alshehri9
Vishal Vennu, MSc., Ph.D.10
Saad Bindawas10- 1Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- 2Majmaah University College of Applied Medical Sciences, Al Majmaah, Saudi Arabia
- 3King Khalid Hospital at Alkharj, Alkharj, Saudi Arabia
- 4Comprehensive Rehabilitation Center, Arar, Saudi Arabia
- 5Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
- 6Majmaah University, Al Majmaah, Saudi Arabia
- 7Qassim University, Buraydah, Saudi Arabia
- 8Umm Al-Qura University, Mecca, Saudi Arabia
- 9Taibah University, Medina, Saudi Arabia
- 10King Saud University, Riyadh, Saudi Arabia
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Objective: To examine the impact of baseline diabetes mellitus (DM) on longitudinal knee symptoms and disability in participants with knee osteoarthritis (OA). Methods: This was a secondary analysis using publicly available data from a longitudinal study design (Osteoarthritis Initiative). Data from 4,796 participants (45-79 years of age) were obtained, and only participants with grade ³2 in either knee, using the Kellgren and Lawrence grading at baseline, were included in the current analysis. Based on self-reported DM, the participants were categorized into two groups: knee OA and DM or knee OA only. Symptoms and disability were measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale and pain severity across 7-and 30-days at seven visits from baseline to 96 months of follow up. Results: A total of 2,486 participants were included and categorized into knee OA and DM (n=221) and knee OA only (n=2265). The longitudinal analyses results (n=2483) showed that participants with knee OA and DM had significantly increased knee symptoms over time using the WOMAC total score (beta (B) = 3.20, p=0.004), WOMAC pain subscale (B=0.71, p=0.003), WOMAC stiffness subscale (B=0.22, p=0.036), and WOMAC disability subscale (B= 2.26, p=0.005) compared with participants with knee OA only. Knee OA and DM was not associated with increased knee pain severity over a 7-day period (B=0.28, p=0.10) and over a 30-day period (B=0.20, p=0.23) when compared to knee OA only. Conclusion: This longitudinal cohort study provides evidence supporting the association between baseline DM and increased knee symptoms and disability among individuals with knee OA.
Keywords: Arthritis, Diabetics, Disability, pain intensity, Physical functions
Received: 02 Dec 2025; Accepted: 28 Jan 2026.
Copyright: © 2026 Alenazi, Alanazi, Alqathami, Alanazi, Alqahtani, Alhwoaimel, Alanazi, Almutairi, Alghamdi, Alshehri, Vennu, MSc., Ph.D. and Bindawas. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Aqeel M Alenazi
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