"It's a chronic, vicious, cycle": diabetes health professionals' perceptions of the impact of knee osteoarthritis on type 2 diabetes management.

Background: Type 2 diabetes (T2D) and knee osteoarthritis (OA) frequently co-occur, and concomitant knee OA increases risk for diabetes complications. Despite this, OA is frequently undertreated. Diabetes health professionals' (HPs') perceptions of the impact of knee OA in people with T2D may impact how it is addressed in clinical practice. We aimed to understand how diabetes HPs perceive the impact of knee OA on diabetes management and outcomes.

Methods: In this qualitative study we performed a secondary analysis of semi-structured interviews with 18 diabetes HPs (primary care providers, endocrinologists, and diabetes educators) in Ontario, Canada. Transcripts were inductively coded and thematically analyzed.

Results: We developed three themes: 1) Patients commonly raise OA-related concerns during diabetes appointments; 2) Impact of OA on diabetes management; and 3) Conscious disconnect between perceived patient and HP priorities. Diabetes HPs recognized that knee OA commonly co-occurred in their patients. Most HPs perceived that OA has deleterious effects on diabetes management through physical inactivity, as well as other mechanisms. Despite observing OA's impact on their patients, most participants did not address OA due to the focused structure of diabetes appointments, "single problem" appointments, and culture of siloed care.

Conclusions: Diabetes HPs recognized the high prevalence of knee OA in their patients and its deleterious effects on diabetes management, though OA management was usually not prioritized. This highlights a missed opportunity in optimizing care for persons with T2D. Implementing strategies to promote OA care during diabetes visits may improve disease outcomes for both conditions.