Increased Risk of Tendon Injury Following Structured Care in Patients With Type 2 Diabetes: Post Hoc Analysis of a Large Randomized Controlled Trial With 19 Years of Follow-up

Tendon rupture and tendinopathy can arise from sudden occurrences and repetitive overuse and can result in a permanently reduced physical activity level (1,2). Tendon injuries are prevalent in both physically active and sedentary individuals, but the risk increases with age and with type 2 diabetes (1,3). The latter is likely due to the long-standing glycation and metabolic impact of diabetes on tendon tissue, impairing tendon structure and function, thereby increasing brittleness (2,3). We recently demonstrated that individuals with elevated glycated hemoglobin, even in the prediabetes range (HbA1c >5.7%, >39.8 mmol/L), had three-times-higher odds of developing tendon injury in the lower extremities compared with individuals with normal levels (4). Additionally, hypercholesterolemia (total cholesterol >5 mmol/L) was associated with 1.5-times-higher odds of tendon injury in the upper extremities, and individuals with metabolic syndrome had 2.5-times-higher odds of tendon injury in both upper and lower extremities (4). Hence, it is reasonable to assume that modern type 2 diabetes care, which serves to lower HbA1c and regulate dyslipidemia, would lower the risk of tendon injuries, although it remains to be established.