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Despite the problem of DM-related tendon complications, treatment guidelines specific to this population of individuals are lacking. DM impairs tendon structure, function, and healing capacity in tendons throughout the body, but the Achilles tendon is of particular concern and most studied in the diabetic foot. At macroscopic levels, asymptomatic, diabetic Achilles tendons may show morphological abnormalities such as thickening, collagen disorganization, and\/or calcific changes at the tendon enthesis. At smaller length scales, DM affects collagen sliding and discrete plasticity due to glycation of collagen. However, how these alterations translate to mechanical deficits observed at larger length scales is an area of continued investigation. In addition to dysfunction of the extracellular matrix, tendon cells such as tenocytes and tendon stem\/progenitor cells show significant abnormalities in proliferation, apoptosis, and remodeling capacity in the presence of hyperglycemia and advanced glycation end-products, thus contributing to the disruption of tendon homeostasis and healing. Improving our understanding of the effects of DM on tendons\u2014from molecular pathways to patients\u2014will progress toward targeted therapies in this group at high risk of foot and ankle morbidity.<\/jats:p>","DOI":"10.1177\/19322968221100842","type":"journal-article","created":{"date-parts":[[2022,6,2]],"date-time":"2022-06-02T09:18:37Z","timestamp":1654161517000},"page":"89-98","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":41,"title":["Effect of Diabetes on Tendon Structure and Function: Not Limited to Collagen Crosslinking"],"prefix":"10.1177","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6120-5056","authenticated-orcid":false,"given":"Rachana","family":"Vaidya","sequence":"first","affiliation":[{"name":"Washington University School of Medicine, St. Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Spencer P.","family":"Lake","sequence":"additional","affiliation":[{"name":"Washington University, St. Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0601-1355","authenticated-orcid":false,"given":"Jennifer A.","family":"Zellers","sequence":"additional","affiliation":[{"name":"Washington University School of Medicine, St. Louis, MO, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,6,2]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107954"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12963-018-0166-4"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107843"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1136\/bjsports-2015-094735"},{"key":"e_1_3_3_6_2","unstructured":"Sapra A Bhandari P. 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