Graduation Year


Document Type




Degree Name

MS in Public Health (M.S.P.H.)

Degree Granting Department

Public Health

Major Professor

Alfred Mbah, Ph.D.

Committee Member

Rachel Williams, M.D., M.S.P.H.

Committee Member

Jared Jeffries, M.D., M.S.P.H.


BMI, diabetes, inflammation, insulin, metformin, obesity


Obesity is a major risk factor for osteoarthritis (OA). There is evidence that diabetes also increases risk. Our hypothesis is that A1C is a predictor of OA severity. The aim is to investigate the association between A1C, BMI, and knee and hip OA severity. This is a cross-sectional study within the Veterans Health Administration (VHA) database containing 818 patients with diagnosed diabetes. Patients at one VHA facility with recorded diabetes in fiscal year 2020 were identified. A1C and BMI data was obtained from the electronic health record. Chart reviews were performed to collect data on imaging reports of weight-bearing joints in order to assign an OA severity level. The exposure was BMI and A1C. The outcome was the presence and/or severity of OA in the record. Participants who used nicotine and/or were missing an A1C in the past 12 months, as well as those without weight-bearing imaging, were excluded. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated as a function of A1C and BMI with logistic regression analysis. 220 participants (white, non-Hispanic/Latino males, aged 55-64 years) with weight-bearing imaging were included. Participants with OA did not have a significantly different BMI or A1C than participants without OA. There was no association between BMI and OA severity (OR: 1.00, 95% CI: 0.94-1.07). There was a non-statistically significant inverse association between A1C and OA severity (OR: 0.92, 95% CI: 0.77-1.11). In diabetic patients, BMI does not seem to be predictive of OA severity, whereas better glucose control (lower A1C) is associated with increasing severity of OA, although this was not statistically significant. This is supported by literature that shows the pro-inflammatory nature of insulin and means that tight control of A1C could negatively impact OA. Future research should focus on treating patients with T2DM and OA with exercise and other therapies aimed at improving insulin resistance.

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