Osteoarthritis (OA) is the most prevalent form of arthritis, and in Western populations, it remains one of the leading causes of chronic pain, functional decline, and disability among adults (1,2). It most frequently affects the joints of the hands, feet, knees, and hips, while involvement of the ankle, wrist, elbow, and shoulder is comparatively uncommon (3). The occurrence, progression, and severity of OA are influenced by several factors, including age, sex, genetic predisposition, comorbid conditions, dietary habits, lifestyle, muscle strength, and obesity (4,5). Radiological signs of OA are observed in a majority of individuals by the age of 65 and in approximately 80% of those over 75 years (6). Recent research has proposed categorizing OA into phenotypic subtypes—such as age-related, post-traumatic, and metabolic syndrome-related forms—to improve understanding of its underlying mechanisms (7). This classification approach helps clarify how existing conditions and lifestyle differences contribute to disease progression. Of particular interest is the growing prevalence of OA associated with metabolic syndrome. OA shares several risk factors and pathogenic features with type 2 diabetes mellitus (T2DM) (7). Evidence from the US Third National Health and Nutrition Examination Survey (NHANES III) demonstrated a higher prevalence of diabetes among individuals with OA compared to the general population (8). Furthermore, diabetes appears to play a distinctive role in OA pathogenesis (9). Hyperglycemia contributes to disease progression through mechanisms such as the accumulation of advanced glycation end products (AGEs), oxidative stress, and altered cartilage metabolism (10). Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia, resulting from either insufficient insulin production or impaired insulin utilization (11). Type 1 diabetes mellitus (T1DM) results from inadequate insulin secretion, whereas type 2 diabetes mellitus (T2DM) is primarily due to insulin resistance (12). While some studies have found no significant association between OA and T2DM (13,14,15), others predict that the prevalence of both conditions will continue to rise globally (16). Establishing a relationship between OA and T2DM raises the question of whether diabetes influences OA pathophysiology beyond the mechanical effects of obesity, which often accompanies T2DM. Further research is needed to explore the association between diabetes and pain in erosive hand OA, including the potential contribution of low-grade inflammation linked to metabolic syndrome in both T1DM and T2DM.

This cross-sectional study was conducted on 150 patients with osteoarthritis between February 2020 and December 2021 in MKCG Medical College and Hospital , Brahmapur in Odisha. Ethical clearance for the study was obtained from the Institutional Ethics Committee. All participants underwent a comprehensive medical history assessment and clinical examination. Laboratory investigations included complete blood count (CBC), erythrocyte sedimentation rate (ESR), peripheral blood film (PBF), C-reactive protein (CRP), and random blood glucose tests, all performed in the hospital laboratory. Data were collected through direct interviews using a structured questionnaire. Informed consent was obtained from all participants. The diagnosis of diabetes was based on the World Health Organization (WHO) criteria (17). Data collected from participants were compiled in Microsoft Excel, organized into tables, and analyzed using descriptive statistics, primarily percentages. Further statistical analysis was performed using R software.

A total of 150 patients with osteoarthritis (OA) were included in the study. Among them, 78 (52%) were males and 72 (48%) were females (Table 1). Table 1. Gender Distribution of Osteoarthritis Patients (n = 150) Gender No. of Patients Percentage (%) Male 78 52 Female 72 48 Total 150 100 The age distribution of the participants ranged from 21 years to over 80 years. The highest proportion of cases was observed in the 41–60 years age group, comprising 74 patients (49.33%). This was followed by 61–80 years, with 54 patients (36%), while 21–40 years accounted for 21 patients (14%). Only 1 patient (0.67%) was aged above 80 years (Table 2). This indicates that OA occurrence was most prevalent among middle-aged individuals. Table 2. Age Distribution of Osteoarthritis Patients Age Group Age Range No. of Patients Percentage (%) Group 1 21–40 years 21 14.00 Group 2 41–60 years 74 49.33 Group 3 61–80 years 54 36.00 Group 4 >80 years 1 0.67 Total — 150 100 Analysis of blood glucose levels among OA patients revealed that the majority, 119 patients (79.33%), had normal blood glucose levels (70–140 mg/dl). Seventeen patients (11.33%) had moderately elevated glucose levels (140–200 mg/dl), while 14 patients (9.33%) exhibited significantly elevated levels (>200 mg/dl). None of the participants showed hypoglycemia (<70 mg/dl) (Table 3). This finding indicates that a considerable proportion of OA patients presented with abnormal glucose metabolism. Table 3. Distribution of Blood Glucose Levels Among Osteoarthritis Patients Blood Glucose Level No. of Patients Percentage (%) Normal (70–140 mg/dl) 119 79.33 Decreased (<70 mg/dl) 0 0.00 Increased (140–200 mg/dl) 17 11.33 Significantly increased (>200 mg/dl) 14 9.33 Total 150 100

Osteoarthritis (OA) is a multifactorial and heterogeneous joint disorder that can be broadly classified into three phenotypic categories: age-related, metabolic, and post-traumatic types. These phenotypes reflect the diverse underlying mechanisms contributing to disease onset and progression. Recent research indicates that metabolic risk factors — such as obesity, diabetes mellitus, hypertension, and dyslipidemia — and their clustering within the metabolic syndrome may significantly influence the pathogenesis of OA (18). According to the World Health Organization (WHO), diabetes mellitus is diagnosed based on one or more of the following criteria: fasting plasma glucose ≥ 7.0 mmol/L (126 mg/dl), 2-hour plasma glucose ≥ 11.1 mmol/L (200 mg/dl) following a 75 g oral glucose tolerance test (OGTT), HbA1c ≥ 6.5% (48 mmol/mol), or random blood glucose ≥ 11.1 mmol/L (200 mg/dl) in the presence of classic diabetes symptoms (18). In the present study, a total of 150 OA patients were included, comprising 52% males and 48% females. Participants ranged in age from 20 to over 80 years, with the highest proportion (49.3%) belonging to the 41–60 years age group. Similar age distribution trends were reported by Mariely Nieves-Plaza et al., who found a comparable peak prevalence (19). Chandra Prakash Pal et al. observed the highest OA prevalence among individuals aged above 70 years (54.1%) (20), while Aiyong Cui et al. reported a higher prevalence among women compared to men in this age group (21). Among the study participants, 119 (79.33%) had normal blood glucose levels, 17 (11.33%) exhibited elevated glucose levels, and 14 (9.33%) showed markedly increased glucose levels (>200 mg/dl). These findings suggest a notable proportion of OA patients with hyperglycemia, highlighting a potential metabolic link. Several studies have reported an association between OA and diabetes mellitus. K.B. King et al. emphasized that OA is a complex disease with multifaceted causes, and the impact of diabetes-related metabolic alterations on OA pathogenesis remains incompletely understood (22). F. Eymard et al. reported that type 2 diabetes (6.6%) was a significant predictor of joint space narrowing in men with established knee OA (23). Moreover, Mariely Nieves-Plaza et al. found that individuals with diabetes were more likely to develop OA of the hands or knees, with females showing a higher risk compared to males (19). Other investigations have consistently demonstrated a significant relationship between OA and diabetes mellitus, further supporting the metabolic contribution to OA pathogenesis (24–30).

This study underscores the high prevalence of OA among individuals with diabetes mellitus and highlights a significant association between these two common chronic conditions. The findings support the classification of diabetes-associated OA as a distinct metabolic phenotype, suggesting that metabolic dysregulation plays an important role in OA development and progression. To fully elucidate the mechanisms by which diabetes influences OA pathophysiology, further research is warranted. A deeper understanding of these metabolic interactions could advance our knowledge of OA pathogenesis in general and contribute to the development of more targeted and effective therapeutic strategies for all OA patients. Conflict of Interest: None declared.

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