INS and diabetes mellitus: Despite evidence of the mechanical impact of being overweight/obese in elucidating lower limb OA in obese subjects with diabetes, their association in hand OA supports the role of diabetes in OA pathogenesis through two major pathways: oxidative stress resulting from chronic hyperglycemia, leading to the overproduction of pro-inflammatory cytokines and AGEs in joint tissue; insulin resistance, which may impact both local and systemic low-grade chronic inflammation.