Musculoskeletal manifestations of diabetes mellitus – an update✰

Introduction: Diabetes mellitus (DM) is a persistent metabolic condition frequently associated with musculoskeletal (MSK) complications such as diabetic cheiroarthropathy, frozen shoulder, osteoarthritis, and neuropathic arthropathy. These complications can cause significant morbidity and significantly impact quality of life. The study was conducted to determine the prevalence of MSK complications among individuals with DM and to assess their association with disease duration, glycemic control, and microvascular complications (retinopathy and albuminuria). Methods: A total of 240 patients with diabetes aged 18–60 years were enrolled from both outpatient and inpatient departments from a tertiary care referral center. Clinical, laboratory, and radiological assessments were conducted to evaluate MSK complications. Statistical analysis was performed using SPSS version 20. Results: The study found a high prevalence of diabetes-related complications, including microvascular complications such as diabetic neuropathy (35.4%), retinopathy (17.9%), and albuminuria (29.2%), as well as MSK manifestations such as limited joint mobility (18.8%), frozen shoulder (13.3%), and osteoporosis (14.2%). Significant correlation was observed between the duration of diabetes and MSK complications like frozen shoulder ( P = 0.024), Charcot joint ( P = 0.016), and osteoporosis ( P = 0.001). However, glycemic control (glycated hemoglobin levels) did not show a significant relationship with MSK complications. Additionally, albuminuria and diabetic retinopathy were also associated with various MSK disorders, including carpal tunnel syndrome (odds ratio [OR] 1.23), frozen shoulder (OR 1.55), and diabetic muscle infarction (OR 5.09). Conclusion: MSK complications are frequent in diabetes, especially with longer disease duration and microvascular involvement. Early recognition and management are essential to reduce disability.

BackgroundDiabetes mellitus is one of the most common medical conditions all over the world. A variety of musculoskeletal (MSK) conditions have been associated with diabetes mellitus (DM). These MSK symptoms...

Diabetes mellitus is one of the most prevalent chronic non-communicable diseases worldwide and constitutes a major public health challenge due to its growing incidence, high morbidity and mortality, and substantial socioeconomic burden. Insufficient physical activity has been identified as a key modifiable risk factor contributing to the development and progression of diabetes, particularly type 2 diabetes mellitus, but also influencing metabolic control and complication risk in type 1 diabetes mellitus. The present narrative review summarizes current evidence regarding the role of physical activity in the prevention and control of diabetes mellitus. A comprehensive analysis of peer-reviewed original studies, systematic reviews, and clinical guidelines was conducted. The available evidence demonstrates that regular physical activity significantly reduces the risk of developing type 2 diabetes, improves glycemic control and insulin sensitivity in individuals with established diabetes, and exerts beneficial effects on cardiovascular fitness, body composition, inflammatory status, and oxidative stress. Furthermore, physical activity has been shown to attenuate the progression of both microvascular and macrovascular complications. These findings support the inclusion of structured physical activity as a fundamental component of diabetes prevention strategies and routine clinical management. Background:Diabetes mellitus is a chronic metabolic disorder characterized by persistent hyperglycemia resulting from impaired insulin secretion, impaired insulin action, or a combination of both. The global prevalence of diabetes has increased markedly over recent decades, driven by population aging, urbanization, obesity, sedentary lifestyles, and unfavorable dietary patterns. Type 2 diabetes mellitus accounts for more than 90% of all cases and is strongly associated with modifiable lifestyle factors, whereas type 1 diabetes mellitus is primarily autoimmune in origin but similarly associated with elevated cardiovascular risk and reduced life expectancy. Physical inactivity has emerged as an independent risk factor for insulin resistance, impaired glucose tolerance, cardiovascular disease, and premature mortality. Skeletal muscle, the primary site of insulin-mediated glucose uptake, plays a central role in glucose homeostasis and represents a key target for exercise-induced metabolic adaptations. Regular physical activity improves glucose uptake through both insulin-dependent and insulin-independent mechanisms and induces favorable changes in mitochondrial function, lipid metabolism, inflammatory signaling, and antioxidant defense systems. Consequently, increasing attention has been directed toward physical activity as a cost-effective and scalable intervention for diabetes prevention and long-term disease control. Aim:The aim of this review was to evaluate the role of physical activity in the prevention of diabetes mellitus and in the metabolic control and complication management of individuals with established type 1 and type 2 diabetes mellitus. Material and Methods:This narrative review was based on an analysis of peer-reviewed scientific literature, including original research articles, randomized controlled trials, observational studies, systematic reviews, and expert consensus statements. The included publications focused on epidemiology, pathophysiological mechanisms, clinical outcomes, and exercise prescription related to physical activity in diabetes prevention and management. Results:The reviewed evidence consistently demonstrates that regular physical activity is associated with a substantial reduction in the risk of developing type 2 diabetes mellitus. In individuals with established diabetes, physical activity improves glycemic control, insulin sensitivity, lipid profile, blood pressure, and cardiorespiratory fitness. Both aerobic and resistance exercise modalities provide metabolic benefits, with combined training programs yielding the most pronounced effects. Additionally, regular physical activity reduces markers of systemic inflammation and oxidative stress and attenuates the progression of diabetes-related microvascular and macrovascular complications. Conclusions:Physical activity represents a fundamental, evidence-based component of diabetes prevention and management. Its regular incorporation into lifestyle interventions and clinical care is essential for improving metabolic control, reducing complication risk, and enhancing long-term health outcomes in individuals at risk of or living with diabetes mellitus.

Diabetes mellitus-related musculoskeletal disorders: Unveiling the cluster of diseases

Background: Type 2 Diabetes mellitus (T2DM) may affect the musculoskeletal (MSK) system in a variety of ways. The impacts can be debilitating enough to impair functional ability and quality of life. MSK complications are the most common endocrine arthropathies which are often under-recognized and poorly treated. This study was done to evaluate the prevalence of MSK complications and its correlation with microvascular complications of T2DM given the paucity of similar studies in India particularly South India. Materials and Methods: A cross-sectional study was conducted on 130 diabetic patients at a tertiary care hospital in Bengaluru. The patient’s demographic details, clinical profile including history, general physical examination, systemic examination, and relevant investigations were done to record microvascular complications. A thorough MSK system examination along with imaging of bones and joints was also performed. Results: Out of 130 diabetic patients, 21 patients (16.2%) had MSK complications of which 47.6% (n = 10) of them had carpal tunnel syndrome and 42.8% (n = 9) had frozen shoulder and 9.5% (n = 2) had diabetic amyotrophy. It was also noted that patients who were on oral hypoglycemic agents alone were more likely to develop MSK complications (57.14%) than patients solely on insulin (14.2%). Poor glycemic control, existing microvascular complications, and low high-density lipoprotein were found to be associated with increased risk of MSK complications. Conclusion: The prevalence of MSK complications in T2DM patients is quite significant and is also associated with microvascular complications. Improved glycemic control in T2DM was found to reduce the burden of such complications. Early identification of MSK complications can improve the quality of life in diabetic patients and hence demands proper screening and follow-up.

Background: Diabetes mellitus is a global health concern that significantly impacts the quality of life due to its systemic and wide-ranging complications. Among these, neuromuscular and musculoskeletal disorders are increasingly recognized for their debilitating effects on individuals with chronic diabetes, contributing to decreased mobility, pain, and overall functional impairment. Objective: The aim of this study was to determine the prevalence of neuromuscular and musculoskeletal complications among chronic diabetic patients in Gujranwala and to elucidate the nature and frequency of these complications. Methods: This observational cross-sectional study employed a non-probability convenient sampling technique to recruit 260 chronic diabetic patients from the District Head Quarters (DHQ) in Gujranwala. Inclusion criteria comprised both genders with a minimum diabetes duration of 10 years and the presence of chronic diabetes alongside neuromuscular and musculoskeletal complications. Exclusion criteria included patients with systemic diseases or any form of disability unrelated to diabetes. Data were collected through a self-administered questionnaire, focusing on demographic information and the presence of musculoskeletal disorders. SPSS version 25 was utilized for data analysis, presenting findings through descriptive statistics and bar charts. Results: Among the participants, 63.08% were female and 36.92% male, with a significant portion (68.46%) having a positive family history of diabetes mellitus. The most prevalent musculoskeletal complications observed were adhesive capsulitis (77.31%), fibromyalgia and osteoarthritis (each affecting 60% of the patients), and flexor tenosynovitis (57.31%). Other noted complications included carpal tunnel syndrome, Dupuytren’s contracture, and peripheral neuropathies, highlighting a diverse range of musculoskeletal issues affecting the diabetic population. Conclusion: The study underscores a high prevalence of neuromuscular and musculoskeletal complications among chronic diabetic patients, with adhesive capsulitis, fibromyalgia, and osteoarthritis being the most common. These findings highlight the need for healthcare professionals to adopt a multidisciplinary approach in managing diabetic patients, considering the significant impact of these complications on their quality of life.

The musculoskeletal complications of diabetes mellitus (DM), which are the most common endocrine arthropathy, have been generally ignored and poorly treated compared with other complications such as neuropathy, retinopathy and nephropathy. Like other quality of life issues, the musculoskeletal disability of DM has not been investigated effectively. The incidence of diabetic foot has decreased thanks to excellent foot care, but the hand is still an important target for diabetic complications. The aim of this study was to investigate early diabetic musculoskeletal complications on the basis of a collaborative multidisciplinary study design. For this purpose 78 patients (mean age 57.8 +/- 11.9 years, 55 women and 23 men) who had type II DM for 15 years maximally and 37 non-diabetic controls (mean age: 55.7 +/- 11.5, 27 women and 10 men) were randomly selected for inclusion in the study. All patients were evaluated by the Rheumatology, Orthopedic Rehabilitation and Hand Rehabilitation Divisions. Dupuytren's disease was present in 17 (21.8%) of 78 diabetic subjects as the most frequent and statistically significant complication of the musculoskeletal system. In correlation and logistic regression analysis, only retinopathy was significantly associated with duration of diabetes and diabetic foot. Long-term prospective randomised controlled trials on the effects of exercise in preventing musculoskeletal complications and disability in diabetics are needed.

Background. Diabetes mellitus (DM) is a global epidemic. According to the experts, by 2045 the number of patients with diabetes will rise by 48 %. Patients with diabetes are characterized by the high cardiovascular mortality and a significant reduction in life expectancy. Almost half of the deaths associated with diabetes are due to cardiovascular diseases (CVD). Patients with diabetes often have concomitant pathology (hypertension, dyslipidemia, obesity), which increases the cardiovascular risk.
 Objective. To describe microcirculation disorders in patients with comorbid conditions.
 Materials and methods. Analysis of literature sources on this topic.
 Results and discussion. Type 2 diabetes (DM2) is a multifaceted disease that has a number of cardiovascular, metabolic and renal complications. The links of the pathogenesis of cardiovascular complications of DM2 include dyslipidemia, systemic inflammation, insulin resistance, autonomic imbalance, and endothelial dysfunction (ED). ED leads to vasoconstriction, increased chronic inflammation, increased vascular permeability and hypercoagulation, which ultimately causes micro- and macroangiopathy. Neurological complications of diabetes are also mediated by ED and microangiopathies, which lead to nerve hypoxia with a decrease in conductivity velocity. In recent years, the literature has been actively discussing the syndrome of early vascular aging – premature and accelerated development of structural and functional age-related changes in blood vessels. Microcirculation disorders that accompany diabetes, CVD and their complications are mediated by nitric oxide (NO) imbalance. NO reduces the contractility and proliferation of smooth muscle cells, platelet aggregation, endothelin production, adhesion of monocytes and platelets, and oxidation of low-density lipoproteins. In humans, NO is produced from L-arginine. Increased L-arginase activity and decreased NO-synthase activity lead to a decrease in NO content and to the development of ED, atherosclerosis, and decreased insulin sensitivity. L-arginine as a substrate of NO improves the functional state of the endothelium, reduces the manifestations of oxidative stress, reduces the level of pro-inflammatory cytokines and adhesion molecules, inhibits platelet aggregation, reduces insulin resistance. It should be noted that the administration of 4.2 g of L-arginine in DM is not enough. In clinical studies, doses of 6.4-9 g per day were found to be effective in diabetes and obesity. Therefore, it is advisable to use Tivortin-200 (“Yuria-Pharm”), which contains 8.4 g of L-arginine in one vial.
 Conclusions. 1. Patients with diabetes are characterized by the high cardiovascular mortality and a significant reduction in life expectancy. 2. The links of the pathogenesis of cardiovascular complications of DM2 include dyslipidemia, systemic inflammation, insulin resistance, autonomic imbalance, and ED. 3. Disorders of microcirculation that accompany diabetes, CVD and their complications, are mediated by NO imbalance. 4. L-arginine as a substrate of NO improves the functional state of the endothelium, reduces the manifestations of oxidative stress, reduces the level of pro-inflammatory cytokines and adhesion molecules, inhibits platelet aggregation, reduces insulin resistance. 5. In diabetes and obesity, it is advisable to use Tivortin-200, which contains 8.4 g of L-arginine in one vial.

Type 2 diabetes mellitus (DM) remains the most common type of DM and is associat-ed with disabling complications, reduced quality of life and reduced life expectancy. Satisfactory control of carbohydrate metabolism remains the key way to manage them. To perform a retrospective analysis of carbohydrate metabolism (in terms of glycated hemoglobin - HbA1c), the prevalence of complications, and features of hypoglycemic and concomitant therapy in patients with type 2 DM. The analysis of sex and age characteristics, achieved level of HbA1c, diabetes complications, sugar-reducing and concomitant therapy according to the data of outpatient records of the patients who are on dispensary registration with an endocrinologist in the Endocrinology Department of the Consultative and Diagnostic Polyclinic of the Tomsk Regional Clinical Hospital in Tomsk was carried out. 546 outpatient medical records of patients with type 2 DM were analysed, among which there were 39.6% men (n=216) with a history of type 2 DM 8.0 years [3.0; 13.0] , median age 64.0 years [54.5; 71.0] and 60.4% women (n=330), history of type 2 DM 10.0 years [5.0; 15.0], median age 70.0 years [63.0; 75.0]. The achieved HbA1c level in men was 7.6% [6.3; 9.0] and in women 7.4% [6.4; 9.1]. 19.4% of men and 13.6% of women had an aggravated history of type 2 DM. According to the history, 6.5% of men (n=14) and 3% of women (n=10) with type 2 DM had a history of stroke, and myocardial infarction 12% (n=26) and 1.5% (n=5), respectively. Among the analysed outpatient records of type 2 DM patients, 18.5% of men (n=40) and 12.4% of women (n=41) were found to have diabetic nephropathy. Diabetic retinopathy was reported in 9.3% (n=20) of men and 4.2% (n=14) of women. Diabetic macroangiopathies were detected in 29.6% (n=64) of males and 9.7% (n=32) of females. Among other chronic complications of DM, diabetic neuroosteoarthropathy was recorded in 1% (n=2) of males and 3% (n=10) of females, diabetic polyneuropathy in 25% (n=54) and 21.5% (n=71), respectively. Diabetic foot was diagnosed in 1.9% (n=4) of men and 1.8% (n=6) of women. Among comorbid pathology, obesity was diagnosed in 45.4% (n=88) of men and 69.1% (n=228) of women, dyslipidaemia in 10.2% (n=22) and 10.6% (n=35) respectively, hypertension in 39.8% (n=86) and 32.6% (n=108) of cases. The diagnosis of non-alcoholic fatty liver disease was verified in 3.7% of men (n=7) and 1.8% of women (n=6), chronic heart failure in 7.4% of men (n=16) and 2.4% of women (n=8) registered for type 2 DM. According to the analysed outpatient records, 4.1% (n=23) of patients received diet therapy, 48.3% (n=263) received monotherapy and 47.6% (n=260) received combination therapy for type 2 DM. Metformin was the most commonly used monotherapy for type 2 DM 36.1% (n=197), followed by insulin 6.9% (n=38), sulfonylurea derivatives - 2.7% (n=15). Combination of metformin and dipeptidyl peptidase-4 inhibitors (13.9%) was the most commonly used combination therapy. Analysis of the current situation in the diabetology service will help to identify weaknesses and strengths, which is necessary to optimise existing therapeutic approaches in accordance with current clinical recommendations.

Background: Musculoskeletal complications of diabetes have been generally ignored and poorly treated as comparedto other complications. Hence we carried out this study to find the prevalence of musculoskeletal manifestations indiabetes mellitus and its relation with age, gender and control of diabetes. Materials and methods: In the present study 100 patients of Diabetes Mellitus (DM) were studied. This was a cross sectional observational study carried out in Physical medicine and Rehabilitation Out Patient Department (OPD) of Chattagram Maa-OShishu Hospital Medical College between October 2020 to March 2021. P urposive sampling was done. Duration of diabetes, control of diabetes and any musculoskeletal complaints were noted. Correlation of musculoskeletal manifestations with age, occupation, duration of diabetes, and control of diabetes was evaluated and statistical analysis was done. After collection of all data those were analyzed by SPSS 20. Results: Among the 100 patients of DM more patients were female (72%) and most were at age group 41 to 50 years (45%). Duration of DM showed 35% patients were suffering from DM for 11- 15 years and 21% were suffering from DM for 16 -20 years. Regarding different musculoskeletal complications among DM patients adhesive capsulitis was (11%), curpal tunnel syndrome was (6%), OA knee was (10%) and planter fasciitis was (8%). Other less common complications were also found . Different complications in relation with age, gender differences and control status of DM were not significant. Conclusions: Musculoskeletal manifestations are frequent in diabetis mellitusand common complications are more among patients with higher age and findings are not related with control of diabetes. Chatt Maa Shi Hosp Med Coll J; Vol.23 (2); July 2024; Page 79-83

Diabetes mellitus (DM) is a syndrome of chronic hyperglycaemia due to relative insulin deficiency, resistance, or both. It affects more than 120 million people world-wide, and it is estimated that it will affect 370 million by the year 2030. Diabetes is usually irreversible and, although patients can have a reasonably normal lifestyle, its late complications result in reduced life expectancy and major health costs. These include macrovascular disease, leading to an increased prevalence of coronary artery disease, peripheral vascular disease and stroke, and microvascular damage causing diabetic retinopathy and nephropathy. Neuropathy is another major complication.[1] A facility and community - based descriptive case study will be conducted in Dahda area and the Primary Health Care Center that related to this area to determine the risk factors of diabetes mellitus among people above 40 years old . Purposive and selective non-probability sampling techniques will be using for the selection of 55 diabetic patients. These include male and female Saudi. The data will be collected by questionnaires, the check lists, and interview interviews. The combined data revealed that the family history has a relationship with diabetes mellitus as it affect72.72% of diabetic patients and just 27.28% are not affected, the obesity is absent in 63.64 %, but it is present in 36.36%, the physical inactivity lead to the diabetes mellitus in 81.81% while 18.19 is not affected, The pregnancy affects 12.72% and not affects 87.28% of the diabetic women and effect of hypertension on diabetes mellitus in Dahda is 16.36% while 83.64% not affected. In this study we recommended that people must practice the sports at least one hour each day to control the diabetes mellitus or to prevent occurrence of diseases. In addition, they must eat the healthy diet and avoid the fatty food while they should reduce their weights if they are obese. Also, they are in a need to consult a physician to control their diabetes.

Background: Patients with diabetes mellitus (DM) are known to have reduced life expectancy and be at increased risk for multiple morbidities including serious infection. However, published data on DM outcomes after left ventricular assist device (LVAD) implantation are sparse, inconsistent and individual studies are small with limited power. We conducted a systematic review and meta-analysis to compare survival and adverse events post-LVAD in DM versus non-DM (NDM) patients. Methods: Medline, Scopus and Cochrane Central databases were searched for studies comparing outcomes in DM and NDM patients undergoing LVAD implantation for advanced heart failure (HF) from inception-February 2018. Outcomes included all-cause mortality (30-day and one-year), device-related infection, ischemic stroke, hemorrhagic stroke and major bleeding. Results were reported as random effect risk ratios (RR) with 95 % confidence intervals. Results: We identified 5 retrospective cohort studies, at low risk of bias, reporting on 1,351 patients (n=488 DM). There was a borderline significant, increased 30-day mortality (RR: 1.57 [1.00, 2.47]; p=0.05; I 2 =0%) among DM vs. NDM. The DM and NDM groups did not differ significantly in terms of 1-year mortality (RR: 1.15 [0.98, 1.35]; p=0.08; I 2 =39%), device-related infection (RR: 1.05 [0.92, 1.19]; p=0.88; I 2 =0%), ischemic stroke (RR: 1.29 [0.91, 1.83]; p=0.69; I 2 =0%), hemorrhagic stroke (RR: 1.10 [0.42, 2.83]; p=0.85; I 2 =69%), and bleeding (RR: 1.06 [0.80, 1.40]; p=0.70; I 2 =27%). Conclusion: Following LVAD implantation, patients with DM, versus patients without, have a modestly elevated 30-day mortality rate. However, 1-year mortality rates, device related infection, and bleeding rates were not different.

Diabetes mellitus is a major public health issue globally, and type-2 diabetes mellitus is the most prevalent form of this disease. Due to multiple factors, most diabetic patients develop functional disabilities including musculoskeletal complications. To determine the frequency of musculoskeletal complications, the relationship between these complications and different potential variables, and the status of pharmacotherapy management to treat these complications among patients with type-2 diabetes mellitus. It was a cross-sectional study and data was collected through self-administered, face-validated pro forma in the English language in outpatient clinics of two tertiary care hospitals of Multan, Pakistan. Total n = 270 type-2 diabetic patients of both genders were assessed for musculoskeletal complications; n = 126 (46.7%) patients had at least one musculoskeletal complication. The most common manifestations were shoulder capsulitis or frozen shoulder (20.7%), flexor tenosynovitis (10.4%), hand stiffness syndrome (10%), and limited joint mobility (9.6%). A statistically significant association was found between frozen shoulder, limited joint mobility, and hand stiffness syndrome with the duration of diabetes (p value = 0.003, 0.0001), and overall glycemic control (p value = 0.004, 0.001) respectively. Out of 254 complaints, only 42.9% of complaints were receiving pharmacotherapy management. Main outcome measure: overall prevalence of musculoskeletal complications among patients of type-2 diabetes and level of pharmacotherapy management for them. Periarticular region of the joints in the hands and shoulders should be examined whenever diabetic patients present with uncontrolled diabetes, and pharmacotherapy management should be planned for these patients who will improve their quality of life.

The prevalence of cardiometabolic multimorbidity is increasing. To estimate reductions in life expectancy associated with cardiometabolic multimorbidity. Age- and sex-adjusted mortality rates and hazard ratios (HRs) were calculated using individual participant data from the Emerging Risk Factors Collaboration (689,300 participants; 91 cohorts; years of baseline surveys: 1960-2007; latest mortality follow-up: April 2013; 128,843 deaths). The HRs from the Emerging Risk Factors Collaboration were compared with those from the UK Biobank (499,808 participants; years of baseline surveys: 2006-2010; latest mortality follow-up: November 2013; 7995 deaths). Cumulative survival was estimated by applying calculated age-specific HRs for mortality to contemporary US age-specific death rates. A history of 2 or more of the following: diabetes mellitus, stroke, myocardial infarction (MI). All-cause mortality and estimated reductions in life expectancy. In participants in the Emerging Risk Factors Collaboration without a history of diabetes, stroke, or MI at baseline (reference group), the all-cause mortality rate adjusted to the age of 60 years was 6.8 per 1000 person-years. Mortality rates per 1000 person-years were 15.6 in participants with a history of diabetes, 16.1 in those with stroke, 16.8 in those with MI, 32.0 in those with both diabetes and MI, 32.5 in those with both diabetes and stroke, 32.8 in those with both stroke and MI, and 59.5 in those with diabetes, stroke, and MI. Compared with the reference group, the HRs for all-cause mortality were 1.9 (95% CI, 1.8-2.0) in participants with a history of diabetes, 2.1 (95% CI, 2.0-2.2) in those with stroke, 2.0 (95% CI, 1.9-2.2) in those with MI, 3.7 (95% CI, 3.3-4.1) in those with both diabetes and MI, 3.8 (95% CI, 3.5-4.2) in those with both diabetes and stroke, 3.5 (95% CI, 3.1-4.0) in those with both stroke and MI, and 6.9 (95% CI, 5.7-8.3) in those with diabetes, stroke, and MI. The HRs from the Emerging Risk Factors Collaboration were similar to those from the more recently recruited UK Biobank. The HRs were little changed after further adjustment for markers of established intermediate pathways (eg, levels of lipids and blood pressure) and lifestyle factors (eg, smoking, diet). At the age of 60 years, a history of any 2 of these conditions was associated with 12 years of reduced life expectancy and a history of all 3 of these conditions was associated with 15 years of reduced life expectancy. Mortality associated with a history of diabetes, stroke, or MI was similar for each condition. Because any combination of these conditions was associated with multiplicative mortality risk, life expectancy was substantially lower in people with multimorbidity.

ObjectivesTo determine the life expectancy and mortality rates in patients with type 2 diabetes mellitus when compared with the UK general population; to measure the years of life lost.DesignLongitudinal and...