OBJECTIVE:Diabetes mellitus (DM) appears to increase osteoarthritic knee pain, which may be related to greater adiposity and more advanced disease status often observed in individuals with osteoarthritis (OA) and DM. We aimed to assess whether OA knee pain and health status are worse in individuals with OA and DM, independent of these potential confounders. METHODS:We included 202 OA participants with DM and 2,279 without DM from the Osteoarthritis Initiative. Knee pain was evaluated using Knee injury and Osteoarthritis Outcome Score (KOOS) and numerical rating scale (NRS). Physical and mental status were assessed by Medical Outcomes Study Short Form 12 (SF-12 physical, SF-12 mental) and Center for Epidemiological Studies-Depression Scale (CES-D). Linear regression models assessed the influence of DM, adjusted for age, sex, body mass index (BMI) and radiographic severity. RESULTS:OA participants with DM reported worse knee pain and greater physical and mental issues compared with participants without DM. Individuals with DM had worse KOOS-pain (β=-4.72 [-7.22, -2.23]), and worse NRS-pain (β=0.42 [0.04, 0.80]) independent of BMI, OA severity, age and sex. The negative influence of DM was also apparent for SF-12 PCS (β=-3.49 [-4.73, -2.25]), SF-12 MCS (β=-1.42 [-2.57, -0.26]) and CES-D (β=1.08 [0.08, 2.08]). CONCLUSION:Individuals with knee OA experience on average higher pain intensity and a worse physical and mental health status if they suffer from DM. Linear regression models show that DM is a risk factor for higher pain, in addition and independent of greater BMI and radiographic OA severity.