Background: Diabetes mellitus (DM) is a common endocrine disorder worldwide, causing multisystem comorbidities, which compromise organ functions including musculoskeletal complications that affect the quality of life up to handicapping. Ultrasound is a very sensitive tool and a strong predictor of a DM musculoskeletal (MSK) changes, aiding in early management and control of disease parameters preventing subsequent comorbidities. Objective: This study aimed to evaluate if there is a relation between sonographic musculo-tendinous structural changes and diabetes and to correlate them with both clinical and laboratory parameters. Patient and Methods: 40 diabetic patients and 25 healthy subjects were involved in this work. All participants underwent history taking, general and musculoskeletal examination and laboratory and ultrasonographic evaluation. Results: 28 diabetic females and 12 diabetic males with mean age of 49.8± 13.7 years, showed statistically significant tendinous changes mainly tendon thickness compared to controls (p < 0.05), there were statistically significant correlations between these variations and disease duration, HA1c P (0.008, <0.001) respectively. Conclusion: Chronic diabetes is linked to the destruction of collagen fibres, and biomechanical decline of tendons. Ultrasound is sensitive and accurate dedicated, simple and noninvasive screening method for the detection of musculoskeletal changes related to diabetes. This could serve as strong screening tool of underserved, asymptomatic diabetic individuals.