Caring Medical - Where the world comes for ProlotherapyKnee osteoarthritis and unmanaged Type 2 diabetes

Marion Hauser Curcumin and osteoarthritisMarion Hauser, MS, RD

In this article we will explore the challenges people with unmanaged type 2 diabetes face with knee pain and their ability to heal damaged knee bone and cartilage. Recently, type 2 diabetes has been described as an independent risk factor for osteoarthritis. This means type 2 diabetes can cause a toxic non-healing joint environment and causes joint damage and joint erosion by itself, no wear and tear necessary.

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 type 2 diabetes is examined.

  • Development of knee osteoarthritis IS associated with obesity and metabolic syndrome.
  • The negative impact of diabetes on joints could be explain by the induction of oxidative stress and pro-inflammatory cytokines and  by advanced age products accumulation in joint tissues exposed to chronic high glucose concentration.
    • Look down at your swollen knee, if you have type 2 diabetes. What these researchers are saying is that your knee is under oxidant stress and this is causing toxic inflammation. The swelling you see, that can also be the result chronic high glucose concentration. In simplest terms – you have “sugar on the knee.”
  • 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 other words Insulin resistance, this is where you cannot produce enough insulin to manage your sugar levels and in your swollen knee, this not only leads to inflammation as we just mentioned, but also a chronic low grade inflammation that is constantly eating at your knee.

As you can see the impact of type 2 diabetes on degenerative joint disease is multi-factoral and a battle your body fights on many fronts.

Knee osteoarthritis and Type 2 diabetes

The problem of bone remodeling in patients with type 2 diabetes

All the factors mentioned in the research above significantly impacts how your knee repairs itself from wear and tear damage.

In the medical journal Bone research, a team of researchers from among China’s leading medical universities investigated Type 2 diabetes’ association with knee osteoarthritis. They found that patients with type 2 diabetes have unique abnormal subchondral bone remodeling and microstructural and mechanical knee  impairments which caused greater cartilage degradation.(2)

  • In other words, the type 2 diabetes prevents proper bone remodelling/healing. This abnormal bone compromises the structure of the articular cartilage of the knee. Type 2 diabetes accelerates knee osteoarthritis. Type 2 diabetes is attacking the whole knee.
  • In other words all the components of a recommendation to knee replacement are coming into play.

The more severe or unmanaged Type 2 diabetes, the worse the knee osteoarthritis

An international team of researchers lead by the University of California at San Francisco publishing in February 2018 in the Journal of magnetic resonance imaging found that not only did Diabetes type 2 accelerate knee osteoarthritis, the more unmanaged or severe the diabetes the more severe the cartilage degeneration.(3)

In other words, the more you ignore this or unmanage your type 2 diabetes the greater the likelihood that you will need knee replacement. Before you think knee replacement is an good solution, read on:

The problems with knee replacement complications and type 2 diabetes.

There is a lot of research into knee replacement complications. Those surrounding type 2 diabetes find complication rates higher because of many factors including the compromised ability of the patient’s bone to heal. This was noted in The Journal of arthroplasty by a leading team of Japanese medical university researchers who noted restricted knee range of motion and poorer functional recovery after total knee replacement.(4

Medical university doctors in China writing in Medical science monitor wrote in May 2017 that successful outcomes for patients with knee replacement and Diabetes Type 2 required close monitoring for deep vein thrombosis, preventing post-surgical infections, and monitoring heart and lung function.(5)

Prolotherapy and uncontrolled type 2 diabetes – why were type 2 patients were excluded from research?

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 (6) you can read that study here: Prolotherapy knee osteoarthritis injections for knee pain.

  • Unfortunately there were patients excluded from the study. The reason? Likelihood of poor outcome because of poorly controlled diabetes mellitus with fasting blood sugar greater than 11.1 mmol/L. 
  • Another well known study on the success of Prolotherapy treatments for knee osteoarthritis lead by our friend and colleague Dr. David Rabago, MD of the University of Wisconsin also excluded patients with uncontrolled diabetes mellitus defined as glycosylated hemoglobin (HbA1c levels) >7.5%). (7)

Commonly patients with elevated HbA1c levels (you are not controlling your diabetes well) will need to drastically change what they perceive as “healthy” eating habits. The problem is that 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.

Do you have questions about diabetes, joint repair and Prolotherapy?
You can get help and information from our Caring Medical staff.

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. [Google Scholar]
2 Chen Y, Huang YC, Yan CH, Chiu KY, Wei Q, Zhao J, Guo XE, Leung F, Lu WW. Abnormal subchondral bone remodeling and its association with articular cartilage degradation in knees of type 2 diabetes patients. Bone research. 2017 Nov 7;5:17034. [Google Scholar]
3 Chanchek N, Gersing AS, Schwaiger BJ, Nevitt MC, Neumann J, Joseph GB, Lane NE, Zarnowski J, Hofmann FC, Heilmeier U, Mcculloch CE. Association of diabetes mellitus and biochemical knee cartilage composition assessed by T2 relaxation time measurements: Data from the osteoarthritis initiative. Journal of Magnetic Resonance Imaging. 2018 Feb 1;47(2):380-90. [Google Scholar]
4 Wada O, Nagai K, Hiyama Y, Nitta S, Maruno H, Mizuno K. Diabetes is a risk factor for restricted range of motion and poor clinical outcome after total knee arthroplasty. The Journal of arthroplasty. 2016 Sep 1;31(9):1933-7. [Google Scholar]
5 Liu P, Liu J, Xia K, Chen L, Wu X. Clinical Outcome Evaluation of Primary Total Knee Arthroplasty in Patients with Diabetes Mellitus. Medical science monitor: international medical journal of experimental and clinical research. 2017;23:2198. [Google Scholar]
6 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. [Google Scholar]
7 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. [Google Scholar]



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