This retrospective cohort study aimed to assess the clinical and radiological outcomes of utilizing a suprapatellar approach for intramedullary tibial nailing in the semi-extended knee position to manage proximal tibia fractures in patients with diabetes. Proximal tibia fractures, common in the knee joint, can significantly impact the quality of life, occurring frequently in women as they age and resulting from high-energy trauma in younger patients or low-energy fractures in the elderly. Diabetes, a known cause of delayed bone healing and soft tissue repair, can lead to diabetic dermopathy, reducing blood flow and sensation in the skin, making wound healing challenging. Additionally, high blood sugar levels in diabetes impair the immune response, increasing infection risk and further delaying healing. The study, conducted at the Department of Orthopedics in RGMC & CSMH Kalwa Thane over 18 months, included 30 patients with proximal 1/3rd Tibial fractures and mean HbA1c of 7.1, while excluding those with pathological fractures, periprosthetic fractures, deformities in the same limb, severe knee osteoarthritis, Gustilo Grade 3C open Tibial fractures, or severe soft tissue lacerations, contamination, and suprapatellar area infection. The suprapatellar approach in the semi-extended knee position offered an alternative to traditional methods, facilitating fracture reduction, especially for proximal third tibial and diaphyseal fractures, and yielding excellent functional outcomes with early radiological recovery and no postoperative anterior knee pain or malalignment. This approach appears safe, with minimal complications compared to conventional methods, making it a valuable option for managing proximal tibia fractures in diabetic patients, potentially improving fracture management and patient outcomes