Exercise is important to managing type 2 diabetes, but the condition may also make a person prone to tendon pain, which can interfere with exercise, researchers say.
Based on an analysis of past studies, researchers found that people with type 2 diabetes are more than three times as likely as those without the disease to have tendon pain, known as tendinopathy. And people with diagnosed tendinopathy have 30 per cent higher odds of having diabetes.
The findings may indicate a problem healthcare providers need to be aware of, the study's senior author said.
"People with diabetes are more likely to develop tendinopathy, but the opposite is also true - people with tendinopathy are more likely to have undiagnozed diabetes," Jamie Gaida told Reuters Health in an email.
"Tendinopathy is a problem for two key reasons," he said. "First, feeling pain during movements that load the tendon is unpleasant, and second, having a painful tendon stops you being physically active."
People with diabetes "should absolutely be physically active, as it is one of the most effective treatments for diabetes," said Gaida, an assistant professor and physiotherapist at the University of Canberra in Australia.
Tendinopathy refers to injuries and inflammation of the tendons, the soft tissues that connect muscles to bones, usually due to overuse or repetitive movements. Having injured tendons may make it difficult to stick with exercise programs, which are essential for management of diabetes.
One past research review has also linked diabetes and increased risk of tendinopathies, the authors of the new study note in the British Journal of Sports Medicine.
To examine the relationship further, Gaida and colleagues reviewed 31 previous studies. Twenty-six of them focused on people with type 2 diabetes while five focused on people with diagnosed tendinopathy.
When they combined and reanalyzed the data in all the studies, Gaita's team found that people with type 2 diabetes were 3.67 times more likely to develop tendinopathy compared to control participants without diabetes. People with tendinopathy were 1.3 times more likely than controls to have diabetes.
The study team also found that people with diabetes were more likely to have thickened tendons, which is often seen in tendinopathy. And people with both tendinopathy and diabetes typically had been diagnosed diabetic for longer than those with diabetes but no tendon problems.
"The risk of tendinopathy increases with the number of years that you've had diabetes," Gaida said.
Physical activity is one of the most effective treatments for diabetes and tendinopathy can be one of the worst things for diabetes management as it stops physical activity, he said, adding that people who develop tendon pain should seek medical advice early for the speediest recovery.
"Physiotherapists/Physical Therapists are uniquely skilled to help you recover from tendinopathy and return to your chosen activity," Gaida said.
People with diabetes shouldn't see this study as a reason to stop exercising, stressed Dr. I. Martin Levy, director of the orthopedic surgery residency programme at Montefiore Medical Center in New York.
Levy said that people with diabetes should take a measured approach to any type of exercise or activity. "I think whatever exercise programme that you are going to take, use common sense, and start off slowly."
People sometimes "launch themselves too aggressively into exercise programs and hurt themselves," he said. "Any exercise that you take on, you should do it in a progressive manner. Start off gently and then increase in a rational way, and constantly observing results of your exercise to determine if in fact you are having any problems from the exercise programme that you are on."
Gaida said the risk of tendinopathy for anyone can be minimized by gradually increasing activity levels and the rate of progression should be slower for someone with diabetes.
Gaida also noted that good control of blood sugar levels can minimise the increased risk of tendinopathy in people with type 2 diabetes.