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Background and objective Musculoskeletal pain (MSKP) is a common but frequently underrecognized complication among patients with type 2 diabetes mellitus (T2DM). Chronic hyperglycemia, obesity, peripheral neuropathy, reduced physical activity, microvascular complications, and altered biomechanics have all been implicated in the development of musculoskeletal disorders affecting the spine, shoulder, knee, hand, and foot. The objective of this study is to determine the frequency, anatomical pattern, and severity of MSKP and to identify the clinical factors associated with MSKP among patients with T2DM. Methods A descriptive cross-sectional study was conducted among 230 consecutive adult patients with T2DM attending the outpatient diabetes clinic of Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan. Demographic characteristics, duration of diabetes, body mass index (BMI), glycemic control (HbA1c), diabetic complications, physical activity, and MSKP characteristics were recorded using a structured interviewer-administered questionnaire and review of medical records. Pain was assessed across eight anatomical regions using a structured body-region questionnaire, and pain severity was graded using the 11-point Numerical Rating Scale (NRS). Data were analyzed using descriptive statistics and the chi-square test, with a p-value <0.05 considered statistically significant. Results The prevalence of MSKP was 73.0% (168/230). The mean age of participants was 55.8 ± 10.6 years, and 129 (56.1%) were female. The lower back was the most frequently affected site (101, 43.9%), followed by the shoulder (83, 36.1%), knee (76, 33.0%), neck (58, 25.2%), hand/wrist (48, 20.9%), ankle/foot (42, 18.3%), hip (34, 14.8%), and elbow (20, 8.7%). Multiple-site pain was reported by 97 (57.7%) patients with MSKP, while moderate pain was the most common severity category (96, 41.7%). MSKP was significantly associated with female sex, longer duration of diabetes (>10 years), obesity, poor glycemic control (HbA1c ≥8%), peripheral neuropathy, and low physical activity (all p < 0.05). Conclusion MSKP is highly prevalent among patients with T2DM, with the lower back, shoulder, and knee being the most commonly affected anatomical sites. Female sex, longer diabetes duration, obesity, poor glycemic control, peripheral neuropathy, and low physical activity were significantly associated with MSKP. Routine musculoskeletal assessment should be integrated into comprehensive diabetes care to facilitate early identification, multidisciplinary management, and improved physical function and quality of life.