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Background: Diabetes mellitus (DM) affects connective tissues in many ways and causes different alterations in periarticular and skeletal systems. Methods: A cross-sectional study was conducted by interviewing and examining 402 consecutive diabetic patients followed at Tikur Anbessa Hospital OPD. Evaluation was performed according to the Short Musculoskeletal Function Assessment Questionnaire (SMFA). The diagnoses were established by Consultant Orthopedic Surgeon. Results: Average duration of diabetes is 143 months (12 Years) and majority, 66.7% (268/402) of them are currently on insulin therapy. Mean current FBS is 245mg%. Excluding OA (47, 11.7%) and CLBP (78, 19.4%), overall prevalence of 1 or more of musculoskeletal Diseases (MSD) is 41.5 %. Hands were the most affected (74, 18.5 %). Five had amputation. Hand involvement and sex of the patient and Type of diabetes is significantly associated, Duration of DM and shoulder involvement are significantly related. Conclusions: Musculoskeletal manifestations are very high in adult diabetic patients at the centre and need multidisciplinary clinical attention. Physicians should always consider examining the periarticular regions of the joints in the hands and feet. Duration of diabetes is associated with development of shoulder complications. Recommendations: Routine MSD screening, establishing a foot care clinic and strengthening diabetic education may prevent development or worsening of MSD. https://dx.doi.org/10.4314/ecajs.v22i2.6 This work is licensed under a Creative Commons Attribution 4.0 International License, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source (including a link to the formal publication), provide a link to the Creative Commons license, and indicate if changes were made.