Background: To examine the incidence of traumatic and overuse 
Musculoskeletal Injuries (MSI) in children and adolescents with 
diagnosed diabetes mellitus, which has been understudied. 
Methods: Using a population-based, retrospective cohort design 
and South Carolina’s (USA) Medicaid claims dataset covering 
outpatient and inpatient medical services, and medication 
prescriptions over an 11-year period for patients < 17 years of age 
with > 2 visits for ICD-9 diagnostic codes for diabetes mellitus, a 
cohort of 5448 cases was identified and analyzed using logistic 
regression to compare risk factors for those who sustained MSIs 
with those who did not. 
Results: Incident joint, back, or muscle pain, contracture, spasms, 
or swelling were diagnosed, in addition to upper limb fractures 
and sprains, costochondritis, and stress fractures, usually in 
adolescence. Comorbid obesity (30.6%), dyslipidemia (22.9%), 
primary hypertension (18.7%), substance use disorder (7.4%), and 
arrhythmia (5.6%) were diagnosed in the cohort as were 
peripheral neuropathy (2.7%) and early cardiovascular disease 
(5.5%). While traumatic fractures and concussions were more 
closely associated with cardiovascular conditions and substance 
abuse, sprains, dislocations, and all micro-traumatic, overuse 
injuries were associated with comorbid obesity, dyslipidemia, and 
hypertension, as well as with less-frequent incident arrhythmia, 
and the cardiovascular and peripheral neuropathy complications 
of diabetes. 
Conclusions: These findings add to the existing, primarily adult, 
literature regarding the musculoskeletal manifestations of diabetes 
and cardio-metabolic disorders in youth and update the knowledge base of pediatric practitioners to enable them to better 
anticipate the clinical care needs of such patients and provide 
them more effective care.