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Association Between Type 2 Diabetes Mellitus and Subsequent Achilles Tendon Injury: A Retrospective Cohort Study
Abstract   Peer reviewed

Association Between Type 2 Diabetes Mellitus and Subsequent Achilles Tendon Injury: A Retrospective Cohort Study

Zoe Sirotiak, Timothy Fleagle, Micah Wong and Ruth Chimenti
The journal of pain, Vol.41(Supplement), 105995
03/2026
DOI: 10.1016/j.jpain.2025.105995

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Abstract

Type 2 diabetes mellitus (T2DM) has been associated with increased risk of developing musculoskeletal pain conditions including Achilles tendinopathy. Though previous research has investigated the relationship between T2DM and Achilles tendon injuries, the relationship between T2DM and Achilles tendinopathy pain is understudied. This preliminary study examined whether individuals with preexisting T2DM have a higher risk of being diagnosed with Achilles tendinopathy versus those without T2DM. A retrospective cohort analysis used the TriNetX Research Network, utilizing data from on or after January 1, 2020. Adults with and without a diagnosis of T2DM prior to the index date were compared after propensity score matching for race, ethnicity, and overweight/obesity diagnosis. Achilles tendinopathy was defined by ICD-10 diagnosis codes. Patients with T2DM were a mean age of 60.0 (SD=15) years, while patients without T2DM were a mean age of 45.6 (SD=16.8) years. Approximately 55.4% of the patients without T2DM were female, compared to 49.2% of patients with T2DM. Around 45.8% of participants had an overweight/obesity diagnosis code in their record. Time-to-event analysis demonstrated significant differences (log-rank p < 0.001), with a hazard ratio of 1.43 (95% CI = 1.40 - 1.46), indicating that at any time during follow-up, patients with preexisting T2DM had a 42.7% higher risk of being diagnosed with Achilles tendinopathy compared to patients without T2DM. The time-to-event analysis indicates that patients with T2DM may experience Achilles tendinopathy pain earlier during the follow-up period. Further research will be required to clarify the strength and clinical relevance of the identified association.

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