Walking Disability Adds Risk for Diabetics with Osteoarthritis

According to a retrospective cohort study from University of Toronto researchers, walking disability from hip or knee osteoarthritis (OA) puts patients with comorbid diabetes at greater risk of experiencing serious complications.

The study linked provincial health administrative databases with surveys from a population cohort of 2,156 patients with at least moderately severe symptomatic hip or knee OA, who were recruited from 1996 to 1998 through a screening survey in Ontario.
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At baseline, 457 patients self-reported diabetes or met criteria for inclusion in the Ontario Diabetes Database, and were without pre-existing retinopathy or renal failure. After censoring patients who died, emigrated, or had insufficient data, 434 patients were included in the current analysis. The study could not differentiate type 1 from type 2 diabetes.

Investigators ultimately found that 37 percent of participants experienced the composite diabetes-specific primary outcome of hospitalization for hypoglycemia or hyperglycemia, soft tissue infection, amputation, or initiation of chronic dialysis, after a median follow-up period of 6.6 years. Among these patients, 51 were hospitalized for hypoglycemia, 11 for hyperglycemia, 127 for soft tissue infections, and 10 for amputations, while 4 patients were put on chronic dialysis.

After adjusting for age, sex, and pre-existing cardiovascular disease (CVD), baseline walking disability was a significant independent predictor of risk for a non-CVD, diabetes-specific complication, according to Gillian Hawker, MD, MSc, FRCPC, professor of medicine and rheumatology at the University of Toronto, and study co-author.

The results remained the same in sensitivity analyses, after additional adjustment for post-baseline receipt of a primary, elective hip- or knee-joint replacement, or when retinopathy was included as an outcome, said Hawker.

“In people with diabetes, OA functional limitations may impede their ability to carry out diabetes self-management activities, increasing their risk for diabetes complications," said Hawker, who presented the study findings at the World Congress on Osteoarthritis, held April 24 – April 27 in Paris, France.

“This is particularly worrisome,” said Hawker, “since the co-prevalence of diabetes with OA is high, with as many as 50 percent to 60 percent of patients with longstanding diabetes also having clinically evident hand, hip, or knee OA.”

At the World Congress on Osteoarthritis, Hawker also stressed a need for the early identification of walking disability after reporting that greater walking disability was an independent predictor of all-cause death, as well as major cardiovascular events in the overall cohort of patients with symptomatic hip or knee OA alone.

—Mark McGraw