Expert Tips for Living With Arthritis & Diabetes 

Released Sept. 1, 2026 

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Stacy Courtney: Hello and welcome to the Live Yes With Arthritis podcast. My name is Stacy Courtney, and I'm happy to be hosting today our episode around diabetes and arthritis. Type two diabetes and osteoarthritis are among the top (if not the top) two chronic conditions affecting people in the U.S. As many as half of the people with osteoarthritis have type two diabetes, and that's not the only overlap between different types of arthritis and both type one and type two diabetes. Today, we're speaking with Dr. Amy Warriner of the University of Alabama at Birmingham Medicine to learn how they're related and what people can do to best manage these diseases together. So, I'd like to welcome Dr. Amy Warriner. If you don't mind telling us a little bit about yourself and your area of specialty. 

Dr. Amy Warriner: I'm Amy Warriner. I'm an endocrinologist by training. I completed internal medicine residency and then endocrinology fellowship. I'm currently the director of both our UAB weight loss medicine clinic and our UAB osteoporosis prevention and treatment clinic, as well as the program director for the endocrinology fellowship program. 

Stacy Courtney: Well, thank you so much for joining us today. I'm anxious to pick your brain about diabetes and arthritis, so let's just jump right into it. Can you tell us the difference between type one and type two diabetes? 

Dr. Amy Warriner: I think when most people think about diabetes, they're thinking about type two diabetes. Approximately 90% of people who have diabetes have type two diabetes. Type two diabetes is much more common, especially in the United States. Type one diabetes is less common. It is an autoimmune process in which the pancreas is attacked, and or people with type one diabetes become incapable of making insulin. It's a disease of insulin deficiency and requires insulin to be given for life protection. 

Type two diabetes is a slower onset disease. It is a disease that typically starts with what we think of as insulin resistance, where it takes more insulin to do the action that insulin is required for, and that's pushing glucose from the bloodstream into the cells. As the body becomes less sensitive to insulin and the body has to make more insulin from the pancreas, that's what we call insulin resistance. And over time, the body's not able to keep up with the insulin demands. Blood sugars go up, and that leads to the diagnosis of type two diabetes, which is diagnosed based on elevated blood sugars. 

Stacy Courtney: And so, people with type two diabetes, are they more likely than general population to develop osteoarthritis? 

Dr. Amy Warriner: Yes, for direct and indirect reasons. Type two diabetes is more common with overweight. So, as we gain weight, the increase in weight leads to increased insulin requirements and puts one at higher risk of developing type two diabetes. That increased weight also puts more load on our joints and increases our risk of developing osteoarthritis, especially of the weight-bearing joints, like our hips and our knees. Other ways that we think that they're related is that, as our blood sugars rise, it leads to inflammation in our body. And that inflammation could increase the risk of inflammation in the joints as well, and increase the destruction of joints, issues with collagen, that could also contribute to the development of osteoarthritis. 

Stacy Courtney: Can you tell me a little bit about how psoriatic arthritis is associated with overweight and with people that are overweight and obesity? And is it more likely with people with type two diabetes? 

Dr. Amy Warriner: Psoriatic arthritis, rheumatoid arthritis are subtypes of arthritis. Osteoarthritis is what we think of as our wear and tear arthritis. Psoriatic arthritis is a process that goes along with psoriasis, the skin disease. And people with psoriatic arthritis have more of a destructive component in their joints related to the same process that causes the skin reaction in psoriasis. Rheumatoid arthritis, similarly, is another autoimmune process where there's destruction of the joints from the antibodies attacking specific joints. Psoriatic arthritis, rheumatoid arthritis are different because they have specific inflammatory processes that lead to those disease states versus osteoarthritis, we generally think of as being a wear and tear disease. 

Stacy Courtney: I have rheumatoid arthritis, and I'm wondering for someone like myself who has an autoimmune disease, we're more likely to develop another autoimmune disease. Is that the main reason why having type one can make you more likely to develop an autoimmune form of arthritis? 

Dr. Amy Warriner: Yes. For reasons that we're still trying to understand, once we have one autoimmune process, we are at higher risk of other autoimmune processes. Type one diabetes is most commonly diagnosed in children. There are some people who develop type one diabetes or a similar state later in life, whereas rheumatoid arthritis more commonly starts later than what we would expect with type one diabetes. But they can go hand in hand. 

Stacy Courtney: Generally, what comes first? Is it arthritis and diabetes or diabetes and arthritis? 

Dr. Amy Warriner: With regards to osteoarthritis, that's a very good question. And we don't know. It's very curious: In the world of obesity, for example, that we can have people who have abnormal weight who have no complications at all. They have no joint pain. They have no arthritis. They have no evidence of insulin resistance or diabetes. Whereas other people who have the same amount of excess weight have significant debilitating osteoarthritis and severe type two diabetes. So, we can't always say that arthritis develops first and diabetes develops second. It can happen differently in each individual. Similarly, rheumatoid arthritis and type one diabetes can develop at different times within people with autoimmune processes. So, there's not a single representation that we see in all people. 

Stacy Courtney: OK. There are certain arthritis medications that can affect diabetes. Can you discuss some of those? 

Dr. Amy Warriner: Yeah. The most common one would be our glucocorticoids, our steroids. Steroids are very effective anti-inflammatory medications and are used commonly if someone especially is having a flare of arthritis, because it will help reduce the inflammation and the pain much more rapidly than some of our other medications. But at the same time, steroids cause very significant elevations in blood glucoses or blood sugars in a lot of people. And so, it can very rapidly worsen diabetes or even cause diabetes to present if steroids are used at very high doses or for long periods of time. 

Other medications that are frequently used for arthritis include NSAIDs, which are non-steroidal anti-inflammatory drugs. These are medications like ibuprofen or Advil, and medicines like Naproxen or Aleve. These medications don't have the same blood sugar elevation issues that steroids do. But they can also damage kidneys like elevated blood sugars can. Or people with diabetes are at risk of developing… They can also irritate the stomach lining. So, there are risks with multiple osteoarthritis medications with regards to diabetes and elevated blood sugars. 

Stacy Courtney: Whenever I have a flare, I always say I wish I could live on steroids because they're a magic pill, but I know you can't stay on them forever. 

Dr. Amy Warriner: Yeah. They're magic for the inflammation. They're horrible on our other body systems. 

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Stacy Courtney: Diabetes can cause nerve pain, especially in the joints. And how does that differ from arthritis joint pain? Or is it different? 

Dr. Amy Warriner: Yeah, nerve pain, what we think of as the most common form of nerve damage with diabetes, is something called diabetic polyneuropathy. This is where there's gradual damage to the nerves, likely due to a process similar to what we see with arthritis in diabetes, where there's inflammation, that chronic inflammation from fluctuating blood sugars, that leads to damage of the nerves. Most common with diabetic polyneuropathy: The longest nerves are affected first. So, we start having symptoms in the feet followed by hands because those nerves are the longest, having to travel all the way down the spinal canal from the brain to the feet and hands. So, numbness, tingling, burning pain in the feet is the most common initial presentation of neuropathy and diabetes, which is going to be different from the specific joint pain that we see. But it can be confused. Many people with osteoarthritis, for example, will first present with pain in the feet and hands as their initial joints that are affected by osteoarthritis. So, it can be confusing for some people with diabetes: trying to differentiate osteoarthritis versus neuropathy. 

Stacy Courtney: And I think that goes with any autoimmune disease. It's not easily diagnosed. It takes a long time from symptoms to actually get your diagnosis. And I know that's something that I hear from a lot of other arthritis patients: that you don't go to the doctor and get the diagnosis right away. It takes a lot of investigation. 

Dr. Amy Warriner: It takes time and it's autoimmune processes tend to be fairly slow in onset. 

Stacy Courtney: What are some comorbidities that overlap with type one and type two diabetes? 

Dr. Amy Warriner: Type one diabetes is going to be your autoimmune processes. So, in the endocrine world, it's very common for us to see type one diabetes with hypothyroidism, for example. Type two, because it's more common — and that's what most people are going to be dealing with — can overlap with other disease states that are associated with blood sugar variability and with obesity, since many people who struggle with type two diabetes also struggle with overweight or obesity. And so those issues include comorbidities associated with the excess weight, like arthritis, like gastroesophageal reflux, like obstructive sleep apnea. And other issues more related to the blood sugar variability would be kidney damage, damage to our eyes, damage to the nerves that we already talked about. And then importantly, cardiovascular risk. So, increased risk of not only heart attacks and heart failure, but also an increased risk of stroke. 

Stacy Courtney: OK. So, Dr. Warriner, can you tell me a little bit about complications? Diabetes can have some really serious side effects. And do they also overlap with arthritis complications? 

Dr. Amy Warriner: The complications of arthritis are frequently reduced mobility and considering the need for surgery. The complications associated with diabetes are going to more commonly occur to other organ systems, like the kidneys, the heart, the eyes, the nerves. So, not clear overlap, but progression of diabetes, worsening diabetes, can increase the risk of developing osteoarthritis. 

Stacy Courtney: And if someone has arthritis, how can they tell if they are developing diabetes? 

Dr. Amy Warriner: Diabetes is a slow progression, and the symptoms of diabetes are frequently overlooked. It can be a silent disease for a long time. And keeping regular checkups with your doctor is probably the best way to be screened and monitored for signs of early diabetes. And that's something important for us to think about. With regards to symptoms: The typical symptoms that we think of for elevated blood sugars are increased thirst, increased urination, increased hunger and weight loss. So, if our blood sugars get very high, our body's going to try to get rid of that extra sugar by peeing it out. We'll have increased urination that leads to increased thirst. And because you're peeing out so much sugar, you actually can be at risk of developing weight loss as well. 

The challenge for type two diabetes especially is that if we wait until we've already developed diabetes, the chances of us reversing the diabetes is much lower than if we identify pre-diabetes or early type two diabetes, then we have a much greater chance of reversing it before it becomes more progressed or requiring medications, especially requiring insulin. The challenge, especially for those with arthritis, is that the best way that we have to prevent progression of pre-diabetes to diabetes is actually through diet and exercise. And exercise becomes very challenging if we're already suffering from symptoms from either osteoarthritis or the other types of arthritis, like rheumatoid arthritis or psoriatic arthritis. 

Stacy Courtney: And on the flip side, what about somebody with diabetes? How can they tell if they might be developing arthritis? 

Dr. Amy Warriner: Most common would be pain, right? Osteoarthritis is a painful condition in the joints. It can present first with pain in our hands, pain in our feet. The other autoimmune types of arthritis might present first with significant swelling in our joints and increased pain, especially in the morning, that can get better with activity through the day. But, significant early morning stiffness, swelling of the joints, would be something that would be concerning for a possible autoimmune arthritis. 

Stacy Courtney: There are some very good medications that can slow or stop disease process and autoimmune forms of arthritis, but no cures for any form of arthritis. What about for diabetes? 

Dr. Amy Warriner: We're still working on that. We don't have any specific cures. We're very excited about the newer treatments that are not only recently available for type two diabetes, but some of the other medications on the horizon for type two diabetes. And these are medications that are very popular in the media right now. 

Medicines like Ozempic and Mounjaro that do things that none of our other previous diabetes medications do. And that includes improving blood sugars; but it also includes weight loss, reduced heart disease, which we've never seen with any of our diabetes medications before. And reduced pain, which is interesting. We're seeing many people who take these medications have reduction in arthritis pain. And that's something that we're still trying to understand. As far as type one diabetes, sadly, we don't have any medications at this point that will reverse type one diabetes. Once someone develops type one diabetes and requires insulin, they need to be on insulin for the rest of their lives at this point. Hopefully in my lifetime, we'll see a cure. 

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Stacy Courtney: Let's go back to the GLPs that you just referenced, which is the hot topic in the weight loss world. But also how these drugs can help other conditions, such as arthritis or diabetes. Can you tell me a little bit more about that? 

Dr. Amy Warriner: I think it's a little challenging for me to convey how important GLP medications have been for the field of endocrinology. As I mentioned before, diabetes is very strongly associated with an increased risk of cardiovascular disease, heart attacks, heart failure, stroke. And before we had our first GLP medication, nothing that we did as endocrinologists to improve blood sugar control led to significant improvement in cardiovascular outcomes until we had access to these medications. And no medicine that we had before these medications led to significantly more weight loss than we could achieve with diet and exercise. So, we have very good studies where we were very aggressive with diet and exercise and tried to help people lose weight with interventions using dieticians, exercise behaviorists, even sometimes our old weight loss medications. And with all of that effort, over a year's time, we are only able to achieve on average about 5% total body weight loss. 

So, for someone coming in 200 pounds: That would be approximately 10 pounds of weight loss. And when my patients come in and see me, and they say, "Dr. Warriner, I'm 200 pounds, and I want to be 150 pounds," that's very challenging. Because I know based on this evidence that it's very unlikely that they would be able to achieve that weight and sustain that weight with diet and exercise alone. But with these newer medications, we're able to achieve weight loss in the range of 15% to 20% total body weight loss, which is almost double what we could ever see with any of our previous medications. And it's not just the weight loss: It's the improvement in their overall health outcomes. So along with the weight loss, we see reductions in pain. We see increased mobility. We see the reduced cardiovascular disease, but we also see reversal of diabetes. 

And that's a huge outcome. And I think we're still trying to understand what this means in the long run. The first GLP medication came out around 2005. So, we've had access to these medications for approximately 20 years. But when you think of science, and when you think about looking at long-term disease states, like osteoarthritis, like type two diabetes, it's going to take longer than 20 years for us to really understand what's happening at the cell level. And what these medications are going to mean long term, for our patients. 

Stacy Courtney: So just to clarify, you said that GLPs can reverse some signs of diabetes? 

Dr. Amy Warriner: They can. Because these medications are not only good at helping reduce hunger, which is the most common thing that we hear about in the media, right? But these medications are very good at also helping improve blood sugar control by helping the pancreas make appropriate amounts of insulin around the time that we're eating. And probably through the weight loss effects as well, because some of type two diabetes is related to weight gain. When we lose weight, we improve that insulin resistance that we talked about earlier, and that leads to improved blood sugar control as well. And so, we're seeing reversal of diabetes better with these medications than we can achieve with some of our other medications. 

Stacy Courtney: That's exciting. 

Dr. Amy Warriner: It is. It's exciting to have medications that not only help control blood sugar but have all of these other positive effects on the overall health of our patients. 

Stacy Courtney: What advice do you have for someone living with both diabetes and arthritis? 

Dr. Amy Warriner: Multiple things. I think when we think about the disease of diabetes, understanding that, not only improving our A1C, which is the blood test that we use to estimate an average blood sugar over the past three months, but improving the variability of our blood sugars is very important in reducing the risk of negative outcomes, including arthritis. And arthritis is also benefited by weight loss, because there's less pressure on the joints and especially increased activity, which is easier if we're able to achieve some weight loss. 

I think the challenge with these medications is they get a lot of negative media around them, because some people are going to view them as an easy way out. Some of them are going to be fearful of the negative side effects that can sometimes be seen in some people, especially if the medications are used inappropriately. For example, if we start at too high of a dose of medication, or we increase the medication too rapidly, we're at more risk of some of the serious side effects associated with these medications. But if we have access to a good doctor who recommends considering these medications because of the positive side effects, I think it is worth a trial of the medications in many of our patients with type two diabetes and with arthritis. 

Stacy Courtney: And if you start a GLP-1, is it going to be a lifelong medication? 

Dr. Amy Warriner: That is the question I get almost every day. The way that I answer it in most cases is: I don't know. I think it's important for us to look at each individual one at a time. And I always tell my patients, "If we start this medication, we're not committing you to being on it. If you try it and you don't like how you feel on it, then we stop it. There's no harm in starting and stopping." The truth is that the majority of people that get started on these medications notice the positive effects from taking these medications and want to continue on the medications. Where we're at right now in the field of GLP medications is that we don't know if there's a certain amount of time that we need to be on the medications before we can stop them and still maintain the benefits of the medications. And I think that's a question that we're going to need more time to answer. But more importantly, there are new medications on the horizon that are likely to have some of that sustained benefit, even after potentially stopping the medications. So, my short answer is: Let's see how you feel first. And then we'll decide if we want to continue the medication. And let's see where the field is going with regards to new medications that are coming out. 

Stacy Courtney: What can people do for self-management of both diseases? 

Dr. Amy Warriner: There is a lot that we can do without medications. Focusing on healthy lifestyle is really important. So, making sure that we're getting proper nutrition through lean proteins, healthy vegetables and fruits in our diet, eliminating highly processed foods — especially things like foods that contain saturated fats or trans fats, like our cookies, crackers and processed meats like sausages, bacon and ham — will lead to improvements in a lot of health outcomes by reducing some of the inflammation in our body, but also helping expose our body to antioxidants in our foods. 

I think the challenge there is we all want instant results. And leading a healthy lifestyle doesn't lead to instant results. It's something that will prove itself over time. And so encouraging, focusing on things other than the scale, focusing on making healthy choices for you, and not worrying so much about other outcomes such as weight. 

And then increased activity. There is a lot of evidence that the more that we can move, the lower the chances of progression of osteoarthritis, lower progression of prediabetes to diabetes. And so, movement is very important. If our knees are hurting, there's other ways for us to move. And I think finding ways to move, regardless of our limitations, is important. 

Stacy Courtney: Absolutely. I have found with my rheumatoid arthritis that Pilates has been the way to go for me. I mean, just… It's for the mind, the body, the soul, all of it. Even if I'm having a flare-up, I can still manage to do Pilates, which has been great for me. 

Dr. Amy Warriner: There's so many things. One of my favorite studies that my residents, students and fellows hear me quote all the time is a study done way back in the 1970s that showed pregnant women who did old-fashioned arm circles, like we did in PE class when we were children, was better than some of the diabetes medications that we use for gestational diabetes. So, even if we can sit in our chair and move our arms, we're going to get benefit. 

Stacy Courtney: That's funny. 

Dr. Amy Warriner: I think the main challenge that people who have both diabetes and arthritis have, that people with just diabetes don't have, is challenges with mobility and getting from place to place. Arthritis can be very debilitating and lead to challenges, even getting to a doctor's appointment, for example. So, there are some good resources that can be found at home that can be helpful to patients. And there's so much on the internet right now. Finding reliable resources is very important. I know that the Arthritis Foundation has information, but the American Diabetes Association has a wonderful website specifically for patients that has not only information about the disease of diabetes and the medications that we use for diabetes, but it has amazing information about activity and especially about diet, including recipes, and instruction on how to live a healthy lifestyle. 

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Stacy Courtney: Dr. Warriner, would you like to offer our audience the top three takeaways that you would recommend if you're dealing with type one or type two diabetes, as well as osteoarthritis? 

Dr. Amy Warriner: The top three takeaways are: Number one, recognizing that improving blood sugar control is very important to reducing the risk of complications related to diabetes, including osteoarthritis. Number two, newer medications for the treatment of diabetes are exciting for many reasons, not only because of the benefit that they have in improving blood sugar control, but also the potential benefit in reducing the risk of developing or reducing existing osteoarthritis, improving mobility, improving function overall. And so, if these medications are affordable and an option, they can be very helpful medications for people who are struggling with diabetes and arthritis. And thirdly, not forgetting that regardless of medications, a healthy lifestyle is very important to all of us. And that would include making sure we're finding lean proteins, whether that's animal proteins or plant-based proteins, loading our diet up with lots of healthy vegetables and fruits, and finding ways to remain physically active. 

Stacy Courtney: Very similar to my three takeaways. I was going to say, of course, having a healthy diet. As always, the movement piece of it is very important. And when I'm having a flare-up, a lot of times the last thing I'm going to do is move, but that's what I really need to do. And then lastly, the exciting research from the GLPs. Like you said, it's not just for the weight loss, but all the other positive benefits that go along with that. So, that's exciting research and medications and hopefully we continue to find the benefits for other diseases, like not just diabetes or arthritis, but I'm sure we'll find how it's helping in many other ways for many other chronic conditions. 

Dr. Amy Warriner: Agree. 

Stacy Courtney: So, Dr. Warriner, thank you so much for joining us today about this very important discussion around diabetes and arthritis. And thank you to our listeners. We would love to hear from you about our podcast. If you have any ideas that you'd like to share, please just email us at [email protected] And thank you again for joining us today. 

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