Dr Emily Cox

Objectives: People with type 2 diabetes (T2D) are more likely to develop a range of rheu-matological and musculoskeletal symptoms (RMS), and experience both chronic and widespread pain, compared with the general population. However, these symptoms are not commonly acknowledged by researchers, which hampers our understanding of the impact on this population. Since exercise is a key lifestyle management strategy for T2D and participation levels are typically low, understanding the potential impact of RMS on exercise participation is critical. The aim of this review is to summarise the literature regarding the prevalence and pathophysiology of RMS in T2D, the evidence for the benefits and risks associated with exercise on RMS, and the currently available tools for the reporting of RMS in both research studies and community settings. Methods: A narrative review. Results: There are numerous exercise trials in T2D, but few have sufficiently reported pain-related ad-verse events and even fewer have investigated the effects of exercise on RMS and chronic pain. Discussion: Recommendations for future research are provided.

Background. Patients with diabetes have 44% greater risk of tendon rupture requiring hospitalisation. Despite this, in vivo research of the associations of diabetes and other cardiovascular disease risk factors on structural and mechanical properties of the Achilles tendon are sparsely studied. Methods. Inactive individuals with type 2 diabetes (n=33) underwent ultrasound and shear wave elastography imaging of their Achilles tendons bilaterally to measure thickness and shear wave velocity (SWV), an index of tendon elastic modulus. In a separate session, participants underwent assessment of body composition, cardiorespiratory fitness and blood biomarkers. Seven inactive individuals without type 2 diabetes were recruited for comparison of tendon structural and mechanical properties. Results. In participants with diabetes, free tendon SWV displayed large negative correlations with hip circumference (r=-0.67, P <0.001), waist circumference (r=-0.59, P <0.001) and body mass index (r=-0.52, P <0001), and a moderate positive correlation with VO2 peak (r=0.34, P =0.006). SWV was lower in participants with diabetes taking statins compared to not taking statins (Free tendon: median difference 8%, P=0.004); insertion: 11%, P =0.001). Compared to the control group, the diabetes group had thicker Achilles free tendon (median difference 15%, P<0.001) and Achilles insertion (17%, P=0.006), but no differences in SWV (P=0.490 or 0.577 respectively). Conclusions. Achilles tendons from individuals with type 2 diabetes were thicker compared to inactive individuals without diabetes. Adiposity, statin use and low cardiorespiratory fitness were associated with inferior Achilles tendon mechanical properties in people with diabetes.