Prevalence and pattern of hand soft-tissue changes in type 2 diabetes mellitus

A systematic review and meta-analysis on effect of different exercise training on grip strength and upper extremity muscle strength in patients with type 2 diabetes mellitus

BACKGROUND

Individuals with type 2 diabetes mellitus (T2DM) are prone to musculoskeletal complications, particularly in the upper extremities (UE), which can significantly impair their grip strength and UE muscle strength. This review will provide valuable insights for developing optimized exercise interventions aimed at enhancing upper limb functionality and improving patient outcomes.

AIM

To determine the effect of different exercise training on grip strength & UE muscle strength in patients suffering from T2DM.

METHODOLOGY

A comprehensive search from electronic databases was performed based on the selection criteria and 13 randomized controlled trials (RCT's) were included in the study. Mean changes in grip strength and UE muscle strength were the primary outcome measures. Included studies ranked high on the PEDro rating scale and eta-analysis was performed by Rev Man 5.4 software.

RESULTS

Meta-analysis results indicated that there was a statistically significant improvement in UE muscle strength of experimental group when compared to control group (mean differences [MD] = 2.91, 95% confidence interval = 0.12, 5.71; p = 0.04) with moderate heterogeneity (I2 = 49%, p < 0.07). Grip strength improved significantly in the experimental group when compared to the control group with (MD = 2.93, 95% CL = -0.00, 5.86; p = 0.05) and moderate heterogeneity (I2 = 66%, p < 0.08).

CONCLUSION

This review indicated a positive role of supervised resistance & aerobic exercises on UE muscle strength in patients with T2DM. Due to lack of RCT's, grip strength needs to be explored by further investigations in these patients.

Warning Signs: Occult Diabetes and Dysglycemia in the Hand Surgery Patient Population

BACKGROUND

Diabetes mellitus often exists for many years prior to diagnosis, and very little is known about the role of the prediagnosis stage of metabolic impairment in contributing to hand and upper-extremity pathology. The goal of this study is to determine the prevalence of undiagnosed glucose dysregulation in patients presenting with the 2 most commonly treated conditions of the hand and wrist.

METHODS

A retrospective study was performed of hand surgery patients with no established diagnosis of prediabetes or diabetes referred for a 2-hour glucose tolerance test according to American Diabetes Association criteria. Patients were divided into 3 groups: peripheral neuropathies, trigger finger, and controls with various upper-extremity diagnoses. Rates of undiagnosed prediabetes and diabetes were compared between groups, including subgroup analysis of patients based on unilateral or bilateral presentation. Binary logistic regression analysis was also used to calculate odds ratios for multiple variables.

RESULTS

Patients with neuropathy had a significantly higher incidence of undiagnosed dysglycemia compared with the control group. Of those patients, 51.3% were prediabetic and 12.8% were diabetic. The control group had significantly lower rates. Within the bilateral neuropathy patients, 59.6% had prediabetes and 15.4% had diabetes, versus 34.6% with prediabetes and 7.7% with diabetes in the unilateral group.

CONCLUSIONS

Hand surgeons encounter a patient population with high rates of undiagnosed prediabetes and diabetes, with some presentations as much as 6 times higher than the general population. Certain patient presentations should prompt appropriate diagnostic testing and referral, especially those presenting with bilateral compression neuropathy and elevated body mass index.

Khachatryan L, Mohammadian-Hafshejani A. Investigating the association between diabetes and carpal tunnel syndrome: A systematic review and meta-analysis approach

INTRODUCTION

In recent years, several studies have reported on the relationship between diabetes and carpal tunnel syndrome (CTS). However, due to their contradictory results, a systematic review and meta-analysis were conducted to investigate this subject.

METHODS

This study is a systematic review and meta-analysis of studies published in ISI Web of Science, Scopus, PubMed, Cochrane, Google Scholar, and Embase databases. Heterogeneity in the studies included in the meta-analysis was evaluated using statistical tests such as the Chi-square test, I2, and forest plots. Publication bias was assessed using Begg's and Egger's tests.

RESULTS

This investigation analyzed data from 42 studies conducted between 1985 and 2022, with a total of 3,377,816 participants. The meta-analysis demonstrated that the odds ratio (OR) of CTS in participants with a history of diabetes compared to those without was 1.90 (95% CI: 1.64-2.21; P-value < 0.001). Given that publication bias was observed in this study (Begg's test P-value = 0.01), the modified OR was calculated with consideration of missed studies, which was 1.68 (95% CI: 1.45-1.94; P-value < 0.001).

CONCLUSION

The results of this study suggest that diabetic patients have 90% higher odds of developing CTS compared to non-diabetic individuals, which is statistically significant.

Musculoskeletal Comorbidities among known Diabetes Patients, their Quality of Life, and Healthcare Costs: A Comparative Study From a Tertiary Care Hospital in Uttarakhand

Introduction

Diabetes is a chronic disorder with long-term sequelae and multisystem manifestation. Burden of diabetes in on the rise. Presence of other morbidities can not only have a detrimental effect on the disease treatment and recovery course, but also on the financial burden and quality of life. Present study aims to investigate how musculoskeletal conditions affect individuals with diabetes compared to those without the condition.

Material and Methods

A comparative study was conducted among patients attending the outpatient department of a tertiary care hospital in North India to assess the burden of musculoskeletal disorders in people with and without diabetes. A total of 195 diabetes patients and an equal number of individuals without diabetes were sequentially enrolled from the outpatient department (OPD).

Results

Burden of musculoskeletal comorbidities was significantly higher (46.2%) among people with diabetes than the comparison group (25.1%). The overall odds ratio (OR) for comorbidities of musculoskeletal system was 2.5 times higher in diabetes cases as compared to individuals without diabetes. The OR for rheumatoid arthritis, chronic backache, and osteoarthritis was found to be 3.6, 2.9, and 1.7 respectively. Poor quality of life and higher direct cost of treatment were found among diabetes cases with musculoskeletal comorbidities as against those without these comorbidities.

Conclusion

Presence of musculoskeletal comorbidity is high among diabetes patients, and it has an impact on the quality of life and treatment cost. Screening for musculoskeletal comorbidities should be included as part of the diabetes complication assessment to allow for early detection and treatment.

An analysis of the relationship between dietary pattern changes and temporomandibular joint inflammation in diabetic rats

Background

The temporomandibular joint (TMJ) is the most commonly used joint in the human body. Recent studies have shown pathologic relationships between inflammation, diabetes, and musculoskeletal disorders (MSDs). Chewing disorder is a significant sign of dysfunction in the masticatory system. This study investigated dietary pattern changes in response to TMJ inflammation in diabetic rats.

Methods

This experimental study was carried out on 30 male rats. The rats were fed concentrated 20-mg dietary tablets. Complete Freund's adjuvant (CFA) was used to induce TMJ inflammation and streptozotocin (STZ) was used to induce diabetes. The animals were randomly divided into three groups (n=10), including group I (CFA+STZ), group II (healthy rats+CFA), and group III (healthy rats, no injection). Parameters such as overall food intake, food intake duration, food intake frequency, and the interval between meals were recorded in a checklist and analyzed by Mann-Whitney and Kruskal-Wallis tests (P<0.05).

Results

The results showed no significant difference between groups in overall food intake and food intake frequency on days 0 and 1, but this difference was significant from day 2 to day 7. Regarding the time and end of food intake, there was a significant difference between the three groups from day 1 to day 7, but this difference was not significant on day zero.

Conclusion

Dietary pattern changes were similar in the diabetic TMJ inflammation and TMJ inflammation groups. These changes can be used as a behavioral marker for TMJ inflammation in rats.

The Association of Diabetic Cheiroarthropathy With Microvascular Complications of Type 2 Diabetes Mellitus: A Cross-Sectional Study

Introduction Diabetic cheiroarthropathy (DCA), also known as the syndrome of limited joint mobility (LJM), is among the most underdiagnosed complications of diabetes mellitus (DM). Although not severe, it can hamper the day-to-day activities of the patient and significantly reduce the quality of life. It is hypothesized to be due to increased glycation of collagen around joints. The objective of our study was to examine the association of diabetic cheiroarthropathy with microvascular complications of type 2 diabetes mellitus. Methods The study was conducted on 251 previously diagnosed cases of type 2 DM. Patients with previous contractures due to any other cause, who are diagnosed cases of rheumatoid arthritis and scleroderma, and other risk factors such as cardiac or renal disease were excluded from the study. All subjects were subjected to a detailed clinical history including a past history, thorough physical examination, prayer test, tabletop sign, and passive extension of fingers. Patients who are diagnosed with diabetic cheiroarthropathy were then screened for microalbuminuria, fundus examination, and monofilament test and clinical examination to look for the presence of microvascular complications. Results Out of the 251 patients, 46 (18.3%) were found to have diabetic cheiroarthropathy. Fifteen (34.9%) cheiroarthropathy patients had neuropathy compared to 14.9% without diabetic cheiroarthropathy, which was statistically significant. We found that there was an increased incidence of diabetic neuropathy in subjects with cheiroarthropathy. Thirty (35.7%) patients with diabetic cheiroarthropathy had diabetic retinopathy compared to 9.6% without diabetic cheiroarthropathy. Twenty-six (26.8%) patients with diabetic cheiroarthropathy had diabetic nephropathy compared to 13% without diabetic cheiroarthropathy. We identified from our study that patients with diabetic cheiroarthropathy had an increased risk of developing microvascular complications. Conclusion There is an increased prevalence of diabetic nephropathy, diabetic neuropathy, and diabetic retinopathy in patients with diabetic cheiroarthropathy. The presence of diabetic cheiroarthropathy hence warrants better control of the patient's glycemic status to prevent further deterioration of diabetes-related complications.

Type 2 diabetes and the risk of synovitis-tenosynovitis: a two-sample Mendelian randomization study

Introduction

It has been shown that people with type 2 diabetes have a higher risk of synovitis and tenosynovitis, but previous studies were mainly observational, which may be biased and does not allow for a cause-and-effect relationship. Therefore, we conducted a two-sample Mendelian randomization (MR) study to investigate the causal relationship.

Method

We obtained data on "type 2 diabetes" and "synovitis, tenosynovitis" from published large-scale genome-wide association studies (GWAS). The data were obtained from the FinnGen consortium and UK Biobank, both from European population samples. We used three methods to perform a two-sample MR analysis and also performed sensitivity analysis.

Results

The results of all three MR methods we used for the analysis illustrated that T2DM increases the risk factor for the development of synovitis and tenosynovitis. Specifically, for the IVW method as the primary analysis outcome, OR = 1.0015 (95% CI, 1.0005 to 1.0026), P = 0.0047; for the MR Egger method as the supplementary analysis outcome, OR = 1.0032 (95% CI, 1.0007 to 1.0056), P = 0.0161; for the weighted median method, OR = 1.0022 (95% CI, 1.0008 to 1.0037), p = 0.0018. In addition, the results of our sensitivity analysis suggest the absence of heterogeneity and pleiotropy in our MR analysis.

Conclusion

In conclusion, the results of our MR analysis suggest that T2DM is an independent risk factor for increased synovitis and tenosynovitis.

Magnitude and factors associated with musculoskeletal disorder among patients with diabetes attending chronic care at Arba Minch General Hospital, Arba Minch, southern Ethiopia, 2021: a cross-sectional study

OBJECTIVE

This study aimed to assess the prevalence and determinants of musculoskeletal disorders (MSDs) among patients with diabetes in southern Ethiopia.

DESIGN

Facility-based cross-sectional study.

SETTING

Data collected from 1 March 2021 to 30 August 2021 at Arba Minch General Hospital.

PARTICIPANTS

Three hundred and sixty-five patients with diabetes attending care at Arba Minch General Hospital.

MAIN OUTCOME MEASURES

The magnitude and determinants of the MSDs.

RESULTS

The prevalence of MSDs among patients with diabetes was 23.29% (95% CI 19.00 to 27.76). The likelihood of developing MSDs was 6.8 times higher among women than men (AOR=6.787, 95% CI 2.08 to 22.19). Rural participants were about 2.4 times (AOR=2.38, 95% CI 1.06 to 5.33) more likely to develop MSDs as compared with urban participants. Participants aged &gt;50 years were 5.9 times more likely to develop MSDs as compared with those aged ≤50 years (AOR=5.864, 95% CI 2.663 to 12.914). The odds of developing MSDs was 6.2 times (AOR=6.247, 95% CI 1.158 to 33.702) and 5.5 times (AOR=5.451 95% CI 1.174 to 25.312) higher among participants who attended primary and secondary education as compared with those who attended college and above, respectively. Participants with cardiovascular disease were 3.9 times more likely to develop MSDs as compared with their counterparts (AOR=3.854, 95% CI 1.843 to 8.063).

CONCLUSIONS

This study showed that age, sex, educational status, place of residence and cardiovascular disease were found to be determinants of MSDs. Thus, clinical and public health interventions working on diabetes mellitus should consider these determinants.

Diabetes mellitus tendino-myopathy: epidemiology, clinical features, diagnosis and management of an overlooked diabetic complication

Tendino-myopathy, an unexplored niche, is a non-vascular unstated T2DM complication, which is largely disregarded in clinical practice, thus, we aim to explore it in this review. Literature search using published data from different online resources. Epidemiologically, reported prevalence varies around 10-90%, which is marked variable and unreliable. Clinically, diabetic tendino-myopathy is typified by restriction of movement, pain/tenderness, cramps and decreased functions. Moreover, myopathy is characterized by muscle atrophy, weakness and ischemia, and tendinopathy by deformities and reduced functions/precision. In tendonapthy, the three most affected regions are: the hand (cheiroarthropathy, Dupuytren's contracture, flexor tenosynovitis and carpel tunnel syndrome), shoulder (adhesive capsulitis, rotator cuff tendinopathy and tenosynovitis) and foot (Achilles tendinopathy with the risk of tear/rupture), in addition to diffuse idiopathic skeletal hyperostosis. Pathologically, it is characterized by decreased muscle fiber mass and increased fibrosis, with marked extracellular matrix remodeling and deposition of collagens. The tendon changes include decreased collagen fibril diameter, changed morphology, increased packing and disorganization, with overall thickening, and calcification. Diagnosis is basically clinical and radiological, while diagnostic biomarkers are awaited. Management is done by diabetes control, special nutrition and physiotherapy, while analgesics, steroids and surgery are used in tendinopathy. Several antisarcopenic drugs are in the pipeline. This review aims to bridge clinical practice with research and update routine diabetic checkup by inclusion of tendino-myopathies in the list with an emphasis on management.

Circulating inflammatory cytokines alter transcriptional activity within fibrotic tissue of Dupuytren's disease patients

Dupuytren's disease is a benign fibroproliferative disorder of the hand that results in disabling digital contractures that impair function and diminish the quality of life. The incidence of this disease has been correlated with chronic inflammatory states, but any direct association between inflammatory cytokines and Dupuytren's disease is not known. We hypothesized that advanced fibroproliferation is associated with increased levels of circulating inflammatory cytokines. Blood and fibrotic cord tissue were collected preoperatively from patients with severe contracture and control patients. Blood plasma concentrations of known inflammatory cytokines were evaluated using a multiplex immunoassay. Proteins from the cord tissue were analyzed by RNA sequencing and immunohistochemistry. Moreover, collagen-rich cords were analyzed using Fourier-transform infrared spectroscopy. The results indicate that patients exhibited significantly elevated circulating inflammatory cytokines, including tumor necrosis factor-α (TNF-α), interleukin (IL)-2, and IL-12p70, as compared with controls. Similarly, IL-4 and IL-13 were detected significantly more frequently in Dupuytren's disease as compared with control. RNA sequencing revealed 5311 differentially expressed genes and distinct clustering between diseased and control samples. In addition to increased expression of genes associated with fibroproliferation, we also observed upregulation of transcripts activated by inflammatory cytokines, including prolactin inducible protein and keratin intermediate filaments. IL-2, but not TNF-α, was detected in fibrotic cord tissue by immunohistochemistry. Finally, spectroscopic assays revealed a significant reduction of the collagen content and alterations of collagen cross-linking within the Dupuytren's disease tissues. In total, our results illustrate that patients with severe Dupuytren's disease exhibit substantially elevated circulating inflammatory cytokines that may drive fibroproliferation. Clinical Significance: The results from this study establish the basis for a specific cytokine profile that may be useful for diagnostic testing and therapeutic intervention in Dupuytren's disease.

Trigger finger is associated with risk of incident cardiovascular disease in individuals with type 2 diabetes: a retrospective cohort study

INTRODUCTION

Trigger finger is one of the complications affecting the upper extremity in patients with diabetes. Diabetes is also a well-known risk factor that predisposes individuals to cardiovascular diseases (CVDs). This retrospective cohort study aimed to establish the association between trigger finger and the patients with incident CVD with type 2 diabetes.

MATERIALS AND METHODS

Trigger finger was diagnosed by palpating a thickened tendon during flexion or on the manifestation of a locking phenomenon during extension or flexion of either finger. The relationship between trigger finger and other clinical parameters or complications of diabetes was examined by a comparative analysis. Cox regression analysis was used to evaluate the association between trigger finger and incidence of CVD. We calculated the propensity scores using sex, body mass index, age, smoking status, duration of diabetes, estimated glomerular filtration rate, hypertension, dyslipidemia, and hemoglobin A1c as the number of patients with incident CVD during the follow-up period was low.

RESULTS

Among the 399 patients with type 2 diabetes, 54 patients had trigger finger. Patients with trigger finger were significantly older in age and had been suffering from diabetes for a longer duration. They also displayed worse renal function and glycemic control, along with a higher incidence of hypertension, neuropathy and nephropathy. During the average 5.66±1.12 years of follow-up, a total of 18 incidents occurred. According to the Cox regression analysis, trigger finger was shown to be associated with enhanced risk of the incidence of CVD after adjustment for the covariates (adjusted HR=3.33 (95% CI 1.25 to 8.66), p=0.017).

CONCLUSIONS

Trigger finger is associated with the risk of incident CVD in patients with type 2 diabetes. Thus, clinicians must consider these factors at the time of diagnosis of such patients.

Functional outcomes of trigger finger release in non-diabetic and diabetic patients

We compared the functional outcomes, health-related quality of life, and satisfaction in diabetic and non-diabetic patients undergoing A1 pulley release for trigger finger in 192 patients. Preoperative and postoperative Quick Disabilities of the Arm, Shoulder and Hand questionnaire (Quick DASH), EuroQol-5 dimensions, and satisfaction scores were collected prospectively over a 6-year period. These patients had a mean follow-up of 14 months (range 11-40) after surgery. There were 143 patients (143 trigger fingers) without diabetes and 49 patients (49 trigger fingers) with diabetes. We found overall QuickDASH improvement was the same in both groups (-4.5 points). Patient satisfaction rates were comparable in both groups (90% versus 96%), and no significant difference in postoperative health-related quality of life was observed. No complications were reported in either group. We conclude from this study that A1 pulley release leads to similar functional improvement and high patient satisfaction at one year postoperatively in diabetic and non-diabetic patients.Level of evidence: III.

The worldwide prevalence of the Dupuytren disease: a comprehensive systematic review and meta-analysis

Background

The Dupuytren disease is a benign fibroproliferative disorder that leads to the formation of the collagen knots and fibres in the palmar fascia. The previous studies reveal different levels of Dupuytren’s prevalence worldwide; hence, this study uses meta-analysis to approximate the prevalence of Dupuytren globally.

Methods

In this study, systematic review and meta-analysis have been conducted on the previous studies focused on the prevalence of the Dupuytren disease. The search keywords were Prevalence, Prevalent, Epidemiology, Dupuytren Contracture, Dupuytren and Incidence. Subsequently, SID, MagIran, ScienceDirect, Embase, Scopus, PubMed and Web of Science databases and Google Scholar search engine were searched without a lower time limit and until June 2020. In order to analyse reliable studies, the stochastic effects model was used and the I² index was applied to test the heterogeneity of the selected studies. Data analysis was performed within the Comprehensive Meta-Analysis Software version 2.0.

Results

By evaluating 85 studies (10 in Asia, 56 in Europe, 2 in Africa and 17 studies in America) with a total sample size of 6628506 individuals, the prevalence of Dupuytren disease in the world is found as 8.2% (95% CI 5.7–11.7%). The highest prevalence rate is reported in Africa with 17.2% (95% CI 13–22.3%). According to the subgroup analysis, in terms of underlying diseases, the highest prevalence was obtained in patients with type 1 diabetes with 34.1% (95% CI 25–44.6%). The results of meta-regression revealed a decreasing trend in the prevalence of Dupuytren disease by increasing the sample size and the research year (P < 0.05).

Conclusion

The results of this study show that the prevalence of Dupuytren disease is particularly higher in alcoholic patients with diabetes. Therefore, the officials of the World Health Organization should design measures for the prevention and treatment of this disease.

Limited joint mobility of the hand correlates incident hospitalisation with infection in patients with type 2 diabetes

AIM

Limited joint mobility (LJM) of the hand is one of the important complications of diabetes. Diabetes is a risk factor for hospitalisation with infection. This study investigated the relationship between LJM of the hand and the incidence of hospitalisation with infection in type 2 diabetic patients.

MATERIALS AND METHODS

LJM of hand was defined as the 'prayer sign' or 'table test'. The association between LJM of the hand and incident hospitalisations was evaluated using Cox regression analysis. The number of incident hospitalisations was small over the course of the study, which we compensated for by calculating propensity scores using age, body mass index, sex, duration of diabetes, creatinine, smoking status, haemoglobin A1c and dyslipidaemia.

RESULTS

In this retrospective cohort study of 502 patients with type 2 diabetes, 102 patients had LJM of the hand. These patients were, on average, older and had worse renal function and glycaemic control, and a higher proportion of microangiopathy significantly. During the study period, 56 patients were hospitalised with infection. A Cox regression analysis showed that LJM of the hand was associated with an increased probability of incident hospitalisation with infection after adjustment for covariates (HR = 1.65 [95% CI 1.60-1.70], p < 0.001).

CONCLUSIONS

Our results reveal that LJM of the hand is associated with incident of hospitalisation with infection. A diagnosis of LJM of the hand might, therefore, be a useful indicator for assessing the risk of hospitalisation with infection in type 2 diabetic patients.

Not a Painless Condition: Rheumatological and Musculoskeletal Symptoms in Type 2 Diabetes, and the Implications for Exercise Participation

OBJECTIVES

People with type 2 diabetes (T2D) are more likely to develop a range of rheumatological and musculoskeletal symptoms (RMS), and experience both chronic and widespread pain, compared with the general population. However, these symptoms are not commonly acknowledged by researchers, which hampers our understanding of the impact on this population. Since exercise is a key lifestyle management strategy for T2D and participation levels are typically low, understanding the potential impact of RMS on exercise participation is critical. The aim of this review is to summarise the literature regarding the prevalence and pathophysiology of RMS in T2D, the evidence for the benefits and risks associated with exercise on RMS, and the currently available tools for the reporting of RMS in both research studies and community settings.

METHODS

A narrative review.

RESULTS

There are numerous exercise trials in T2D, but few have sufficiently reported pain-related adverse events and even fewer have investigated the effects of exercise on RMS and chronic pain.

DISCUSSION

Recommendations for future research are provided.

Awareness of limited joint mobility in type 2 diabetes in general practice in the Netherlands: an online questionnaire survey

BACKGROUND

Next to the well-known micro- and macrovascular complications, type 2 diabetes mellitus (T2DM) is associated with musculoskeletal disorders of the upper extremities referred to as limited joint mobility (LJM), e.g. carpal tunnel syndrome (CTS) and adhesive capsulitis. Unrecognized and untreated LJM can lead to poor quality of life and non-compliance to diabetes treatment which aggravates LJM. Despite its reported higher prevalence in international prevalence studies, examination of the upper extremities is still no part of the regular diabetes mellitus (DM) check-ups. The primary aim of this study was therefore to evaluate the awareness of Dutch GPs and nurse practitioners concerning LJM. Secondary aims were to evaluate the current management of a patient with LJM, and to assess opinions regarding the question of who should screen for LJM if this is done in the near future.

METHODS

An online survey was conducted among 390 general practitioners (GPs) and 245 nurse practitioners (NPs) of three diabetes care groups in The Netherlands to assess their awareness of the association between DM and LJM.

RESULTS

Most GPs are not aware that LJM is a DM complication, with an unawareness for specific upper extremity disorders ranging from 59 to 73%. Of the NPs, 76% is not aware either. Only 41% of GPs would advise the most optimal treatment for diabetes patient with CTS. Finally, only 25% of the GPs believe that screening for LJM should be performed during the regular diabetes check-up compared to 63% of the NPs.

CONCLUSION

The majority of GPs and NPs are not aware of LJM as a T2DM complication. In contrast to NPs, most GPs do not believe that screening for LJM should be performed during the regular diabetes check-up.

Prevalence of musculoskeletal disorders in patients with diabetes mellitus: A systematic review and meta-analysis

BACKGROUND

Diabetes mellitus (DM) is associated with musculoskeletal disorders (MSDs) and is often not clinically diagnosed and managed. There are also no systematic reviews of literature relating to the prevalence of MSDs among people with diabetes.

OBJECTIVE

To determine the prevalence and areas of the body affected by MSDs in diabetic patients.

METHODS

A literature search of the electronic databases of CINAH, PubMed, Web of Science and Google Scholar using the keywords of "MSDs and DM" as the search term was conducted. Pooled estimates were calculated using a meta-analysis of proportion.

RESULTS

Five thousand and eighty-eight studies were identified from the databases; 21 studies fulfilled the inclusion criteria and were included in the review. Five studies were of high quality, 13 were of moderate quality and three were of low quality. The prevalence of all types of MSDs among patients with diabetes was 58.15% (95% CI 41.4%-73.9%). The hand was the most common area of the body affected being 33.05% (95% CI 21.1-46.13) followed by the shoulder.

CONCLUSIONS

A high prevalence of MSDs was found among diabetic patients with the hand and shoulder being the most frequently reported areas affected. However, future studies with a larger sample and the relevant type of diabetes are required.

Association between Stenosing Tenosynovitis and Dupuytren's Contracture in the Hand

Background:

Both stenosing tenosynovitis and Dupuytren’s contracture are common conditions encountered in hand surgery. Connections between 2 diseases have been suggested in literature. The purpose of this study was to examine whether there’s an association between the 2 processes.

Methods:

A retrospective chart review was performed to include all patients seen by a single surgeon between 2014 and 2017 with the diagnosis of either trigger finger or Dupuytren’s contracture in the same hand. Patients’ demographics, medical history, social and surgical histories are recorded. Univariate and multivariate analysis were conducted.

Results:

A cohort of 238 patients was identified. One hundred ninety-two patients were diagnosed with trigger finger. Eighty-nine patients were diagnosed with Dupuytren’s contracture. Forty-three patients carried both diagnoses. Median age was 61.6 (56–72). Half were male (50.4%) and 66.8% reported current alcohol intake. Other factors include history of former or current tobacco use (52.9%), diabetes (23.9%), and manual labor (31.1%). In the univariate model, trigger finger, sex, and age were significantly associated with the diagnosis of Dupuytren’s contracture, and Dupuytren’s contracture and sex were significantly associated with the trigger finger diagnosis. Diabetes, manual labor, use of alcohol and tobacco were not significant. In the multivariate model, age and trigger finger were significantly associated with Dupuytren’s contracture.

Conclusions:

Significant association between stenosing tenosynovitis and Dupuytren’s contracture was identified in our patient cohort. Patients with stenosing tenosynovitis may be at an increased risk of developing Dupuytren’s contracture or vice versa.

A Systematic Review and Meta-Analysis on the Strength and Consistency of the Associations between Dupuytren Disease and Diabetes Mellitus, Liver Disease, and Epilepsy

Supplemental Digital Content is available in the text.

Background:

The role of diabetes mellitus, liver disease, and epilepsy as risk factors for Dupuytren disease remains unclear. In this systematic review and meta-analysis, the strength and consistency of these associations were examined.

Methods:

The MEDLINE, EMBASE, and Web of Science databases were searched for articles reporting an association between Dupuytren disease and diabetes mellitus, liver disease, and epilepsy published before September 26, 2016. The frequencies of Dupuytren disease and diabetes mellitus, liver disease, and epilepsy were extracted, as was information on potential confounders. Generalized linear mixed models were applied to estimate pooled odds ratios, adjusted for confounders. Heterogeneity between studies was quantified using an intraclass correlation coefficient and was accounted for by a random effect for study.

Results:

One thousand two hundred sixty unique studies were identified, of which 32 were used in the meta-analyses. An association between Dupuytren disease and diabetes mellitus was observed (OR, 3.06; 95 percent CI, 2.69 to 3.48, adjusted for age), which was stronger for type 1 diabetes mellitus than for type 2 diabetes mellitus but was not statistically significant (p = 0.24). An association between Dupuytren disease and liver disease was observed (OR, 2.92; 95 percent CI, 2.08 to 4.12, adjusted for sex). Dupuytren disease and epilepsy were associated, yielding an OR of 2.80 (95 percent CI, 2.49 to 3.15). Heterogeneity between studies was moderate to low.

Conclusions:

These findings demonstrate an association between Dupuytren disease and diabetes mellitus, liver disease, and epilepsy. Prospective, longitudinal studies are needed to elucidate the pathways causing these associations.

Cutaneous Manifestations of Scleroderma and Scleroderma-Like Disorders: a Comprehensive Review

Scleroderma refers to an autoimmune connective tissue fibrosing disease, including three different subsets: localized scleroderma, limited cutaneous systemic sclerosis, and diffuse cutaneous systemic sclerosis with divergent patterns of organ involvement, autoantibody profiles, management, and prognostic implications. Although systemic sclerosis is considered the disease prototype that causes cutaneous sclerosis, there are many other conditions that can mimic and be confused with SSc. They can be classified into immune-mediated/inflammatory, immune-mediated/inflammatory with abnormal deposit (mucinoses), genetic, drug-induced and toxic, metabolic, panniculitis/vascular, and (para)neoplastic disorders according to clinico-pathological and pathogenetic correlations. This article reviews the clinical presentation with emphasis on cutaneous disease, etiopathogenesis, diagnosis, and treatment options available for the different forms of scleroderma firstly and for scleroderma-like disorders, including scleromyxedema, scleredema, nephrogenic systemic fibrosis, eosinophilic fasciitis, chronic graft-versus-host disease, porphyria cutanea tarda, diabetic stiff-hand syndrome (diabetic cheiroartropathy), and other minor forms. This latter group of conditions, termed also scleroderma mimics, sclerodermiform diseases, or pseudosclerodermas, shares the common thread of skin thickening but presents with distinct cutaneous manifestations, skin histology, and systemic implications or disease associations, differentiating each entity from the others and from scleroderma. The lack of Raynaud's phenomenon, capillaroscopic abnormalities, or scleroderma-specific autoantibodies is also important diagnostic clues. As cutaneous involvement is the earliest, most frequent and characteristic manifestation of scleroderma and sclerodermoid disorders, dermatologists are often the first-line doctors who must be able to promptly recognize skin symptoms to provide the affected patient a correct diagnosis and appropriate management.

Musculoskeletal Disorders in Patients with Diabetes Mellitus: A Cross-Sectional Study

Introduction

A variety of musculoskeletal disorders (MS) have been associated with diabetes mellitus (DM). This study aimed at assessing the prevalence and associated factors of MS disorders in Moroccan diabetic patients.

Methods

A cross-sectional study enrolled consecutive patients with DM. We recorded demographic features of patients and characteristics of DM. MS disorders and vascular complications were assessed by clinical examinations and investigations. Associated factors of MS disorders were assessed by univariate and multivariate analyses.

Result

376 subjects were included; 84.6% had type 2 DM. The participants' median age was 54 years [45-62]; 41% had one or more vascular complications. 34.4% had one or more MS disorders. Osteoarthritis was present in 19.4% of patients. Hand disorders were seen in 14.4%. Shoulder capsulitis was present in 12.5%. Long duration of diabetes and dyslipidemia were associated with increased prevalence of hand abnormalities (P = 0.017; P = 0.019, respectively). Age and dyslipidemia were associated with shoulder capsulitis (P = 0.019; P = 0.047, respectively). Female gender, overweight, and nephropathy were associated with increased odds of osteoarthritis (P = 0.009, P = 0.004, and P = 0.032, respectively).

Conclusion

MS disorders are frequent in this population and associated with various factors. HbA1c level does not appear to be associated with development of MS disorders.

Relationship between limited joint mobility of hand and carotid atherosclerosis in patients with type 2 diabetes

AIM

Limited joint mobility (LJM) of hand, which is one of a complication of diabetic hand, has a close association with diabetic microangiopathy. However, it remains to be elucidated about the relationships between LJM of hand and subclinical atherosclerosis in patients with type 2 diabetes. Therefore, we conducted a cross-sectional study to evaluate the relationships between LJM of hand and carotid intima-media thickness (IMT) and plaque score in patients with type 2 diabetes.

METHODS

We evaluated the relationships between LJM of hand, and carotid IMT and plaque score, evaluated by carotid ultrasound examination, in 341 consecutive patients with type 2 diabetes. LJM of hand was diagnosed using a 'prayer sign' or 'table test'.

RESULTS

LJM of hand was present in 72 patients. Carotid IMT and plaque score were higher in patients with LJM of hand than those in patients without (1.45±0.66vs. 1.14±0.68mm, P=0.013 and 8.0±5.3vs. 5.4±4.8mm, P<0.001). Multivariate linear regression analysis revealed that LJM of hand was positively correlated with plaque score (β=0.423, P=0.043) after adjusted for age, sex, durations of diabetes, body mass index, hemoglobin A1c, creatinine, uric acid, smoking, hypertension and dyslipidemia.

CONCLUSIONS

Our results demonstrate a relation between LJM of hand and subclinical atherosclerosis, especially plaque score, in patients with type 2 diabetes. Diagnosis of diabetic hand is simple and non-invasive, and thus is a useful method for assessment of subclinical atherosclerosis in patients with type 2 diabetes.

Predictors of Outcomes Following Fasciectomy for Dupuytren’s Disease in Diabetic and Non-Diabetic Patients

Background: The aim of this study was to compare clinical outcomes, and identify predictors thereof, after fasciectomy for Dupuytren’s disease in a series of diabetic patients compared with non-diabetic patients.

Methods: Thirty-eight patients were examined following partial palmar and/or digital fasciectomy for Dupuytren’s disease (11 diabetics, 27 non-diabetics). Each patient was assessed for degree of pre- and post-operative flexion contractures at the MCP and PIP joints, post-operative Patient Evaluation Measure (PEM) total score, post-operative grip strength, limited joint mobility (LJM), recurrence, extension, and a composite outcomes score based upon grip strength and the degree of joint contractures. All measurements in the diabetic cohort were compared to those in the non-diabetic group, and a logistic regression analysis was performed to identify the predictive value of several variables on outcomes.

Results: Complication rates between the two groups were statistically similar (p = 0.67). There were no significant differences in pre-operative MCP (p = 0.69), post-operative MCP (p = 0.39), pre-operative PIP (p = 0.40), or post-operative PIP (p = 0.13) joint flexion contractures between the two groups. Additionally, there was no significant difference in extension (p = 0.35) or recurrence (p~1) rates, post-operative grip strengths (p = 0.64), or PEM total scores (p = 0.32). However, the rate of LJM was significantly higher in the diabetic population (p = 0.02). Both female gender (p = 0.01) and a non-smoking status (p = 0.04) were found to be predictive of better outcomes following fasciectomy. Diabetes was not found to be an independent predictor of outcome (p = 0.73).

Conclusions: Clinical results after fasciectomy for Dupuytren’s disease in diabetic patients are not different from results obtained in non-diabetic patients. Diabetes is not independently predictive of surgical outcomes. Female gender and non-smoking status are independent predictors of a better outcome following fasciectomy.

Medical claims-based case-control study of temporal relationship between clinical visits for hand syndromes and subsequent diabetes diagnosis: implications for identifying patients with undiagnosed type 2 diabetes mellitus

OBJECTIVES

To investigate whether a temporal relationship is present between clinical visits for diabetes-related hand syndromes (DHSs) and subsequent type 2 diabetes mellitus (T2DM) diagnosis and, accordingly, whether DHSs can be used for identifying patients with undiagnosed T2DM.

DESIGN

This study had a case-control design nested within a cohort of 1 million people from the general population, which was followed from 2005 to 2010. The odds of prior clinical visits for DHSs, namely carpal tunnel syndrome (CTS), flexor tenosynovitis, limited joint mobility and Dupuytren's disease, were estimated for cases and controls. We used a conditional logistic regression model to estimate the OR and 95% CI of T2DM in association with a history of DHSs. The validity and predictive value of using the history of DHSs in predicting T2DM diagnosis were calculated.

SETTING

Taiwan National Health Insurance medical claims.

PARTICIPANTS

We identified 33 571 patients receiving a new diagnosis of T2DM (cases) between 2005 and 2010. Each T2DM case was matched with 5 controls who had the same sex and birth year and were alive on the date of T2DM diagnosis.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was T2DM diagnosis.

RESULTS

The OR of T2DM in association with prior clinical visits was significantly increased for overall DHS and CTS, being 1.15 (95% CI 1.10 to 1.20) and 1.22 (95% CI 1.16 to 1.29), respectively. Moreover, 11% of patients with T2DM made clinical visits for CTS within 3 months prior to T2DM diagnosis. The history of DHSs had low sensitivity (<0.1% to 5.2%) and a positive predictive value (9.9% to 11.7%) in predicting T2DM.

CONCLUSIONS

Despite the unsatisfactory validity and performance of DHSs as a clinical tool for detecting patients with undiagnosed T2DM, this study provided evidence that clinical visits for DHSs, particularly for CTS, can be a sign of undiagnosed T2DM.

Diabetes as a risk factor for carpal tunnel syndrome: a systematic review and meta-analysis

AIMS

To assess whether diabetes increases the risk of carpal tunnel syndrome and to estimate the magnitude of the association with Type 1 and Type 2 diabetes.

METHODS

We conducted a systematic search of PubMed, Embase, Web of Science, Scopus, Google Scholar and ResearchGate for articles published between 1950 and January 2015. A total of 36 studies (eight cross-sectional, 21 case-control and seven cohort studies) qualified for meta-analysis. We used a random-effects meta-analysis and assessed heterogeneity and publication bias.

RESULTS

The pooled odds ratio of 25 studies (including a total of 92 564 individuals) that reported unadjusted estimates for the association between diabetes and carpal tunnel syndrome or carpal tunnel release was 1.97 (95% CI 1.56-2.49). The pooled odds ratio of 18 case-control or cohort studies consisting of >37 million individuals that reported estimates after controlling for potential confounders was 1.69 (95% CI 1.45-1.96). The association did not differ for Type 1 and Type 2 diabetes. Furthermore, there was no publication bias.

CONCLUSION

This meta-analysis suggests that both Type 1 and Type 2 diabetes are risk factors for carpal tunnel syndrome.

Risk of Hand Syndromes in Patients With Diabetes Mellitus: A Population-Based Cohort Study in Taiwan

The aim of this study was to assess the overall and cause-specific incidences of diabetic hand syndromes (DHS) in patients with diabetes mellitus (DM) by using age and sex stratifications.The DM and control cohorts comprised 606,152 patients with DM and 609,970 age- and sex-matched subjects, respectively, who were followed up from 2000 to 2008. We estimated the incidence densities (IDs) of overall and cause-specific DHS, namely carpal tunnel syndrome (CTS), stenosing flexor tenosynovitis (SFT), limited joint mobility (LJM), and Dupuytren disease (DD), and calculated the hazard ratios (HRs) of DHS in relation to DM by using a Cox proportional hazards model with adjustment for potential confounders.Over a 9-year period, 51,207 patients with DM (8.45%) and 39,153 matched controls (6.42%) sought ambulatory care visits for various DHS, with an ID of 117.7 and 80.7 per 10,000 person-years, respectively. The highest cause-specific ID was observed for CTS, followed by SFT, LJM, and DD, regardless of the diabetic status. After adjustment for potential confounders, patients with DM had a significantly high HR of overall DHS (1.51, 95% confidence interval [CI] = 1.48-1.53). Men and women aged <35 years had the highest HR (2.64, 95% CI = 2.15-3.24 and 2.99, 95% CI = 2.55-3.50, respectively). Cause-specific analyses revealed that DM was more strongly associated with SFT (HR = 1.90, 95% CI = 1.86-1.95) and DD (HR = 1.83, 95% CI = 1.39-2.39) than with CTS (HR = 1.31, 95% CI = 1.28-1.34) and LJM (HR = 1.24, 95% CI = 1.13-1.35).Men and younger patients with DM have the highest risk of DHS. Certain hand syndromes, such as SFT and DD, were more strongly associated with DM than with other syndromes and require the attention of clinicians.

Musculoskeletal disorders of the hand in type 2 diabetes mellitus: prevalence and its associated factors

AIM

To assess the prevalence of musculoskeletal disorders of the hand among adult patients with type 2 diabetes mellitus (T2DM) and their relation to disease duration, glycemic control and microvascular complications.

METHODS

A cross-sectional study was conducted at the National Center for Diabetes, Endocrinology and Genetics in Amman, Jordan.

RESULTS

One thousand patients with T2DM were included in this study (mean age 57.8 ± 9.5 years, 52.2% females and 47.8% males). Hand disorders were seen in 69.5% of patients, limited joint mobility (LJM) was the most prevalent (63.1%) condition followed by Dupuytren's contracture (DC) (18.6%). Trigger finger, thick skin and carpal tunnel syndrome (CTS) were found in 7.2%, 6.2% and 5.5% of patients, respectively. One disorder was seen in 45.4% of patients, two in18.2%, three in 4.9%, four in 0.9%, while only 0.1% of patients had all disorders. Female gender, age over 60 years and long duration of diabetes were associated with hand abnormalities. Hypertension was significantly associated with DC while retinopathy was associated with increased odds of thick skin, DC and CTS with P-values 0.037, < 0.005 and 0.002, respectively.

CONCLUSION

Hand disorders are very common in T2DM. Female gender, old age, duration of diabetes, retinopathy and hypertension were significantly associated with hand disorders in T2DM.

Factors associated with regional rheumatic pain disorders in a population of Puerto Ricans with diabetes mellitus

The aim of the study was to determine the prevalence and factors associated with bursitis/tendonitis disorders in Puerto Ricans with diabetes mellitus (DM). A cross-sectional study was performed in 202 adult Puerto Ricans (100 DM patients and 102 non-diabetic subjects). For each participant, a complete medical history and a musculoskeletal exam were systematically performed. Socio-demographic parameters, health-related behaviors, comorbidities, and pharmacotherapy were determined for all subjects. For DM patients, disease duration, glycemic control, and DM long-term complications were also examined. Multivariate logistic regression analyses were used to determine the factors associated with bursitis/tendonitis disorders. The mean (SD) age for DM patients and non-diabetic controls were 53.3 (12.9) and 50.0 (13.1) years; 64.0 and 64.7 % of DM patients and controls were females, respectively. Overall, the prevalence of bursitis/tendonitis was higher in DM patients than among non-diabetics (59.0 % vs. 29.4 %, p < 0.01). In multivariate analyses, DM patients had 2.47 (95 % CI 1.05, 5.84) the odds of having bursitis/tendonitis as compared to non-diabetics. Specifically, DM patients had a higher frequency of flexor tenosynovitis, De Quervain's tenosynovitis, lateral epicondylitis, medial epicondylitis, trochanteric bursitis, and anserine bursitis than non-diabetic subjects (p < 0.05). Among DM patients, multivariate analyses showed that those with bursitis/tendonitis were more likely to be female [OR (95 % CI) 4.55 (1.42, 14.55)] and have peripheral vascular disease [OR (95 % CI) 8.48 (1.71, 41.93)]. In conclusion, bursitis/tendonitis disorders were common in this population of Hispanics with DM. Among DM patients, bursitis/tendonitis disorders were more frequent in women and those with long-term complications such as peripheral vascular disease.

Trigger digits and diabetes mellitus

The problem of finger in the patient with diabetes mellitus is important consideration in diabetology. Generally, peripheral neuropathy that manifests with finger paresthesia is common. However, some recent reports mention the concern on trigger digits in diabetic patients. In this brief article, the authors focus review and discussion on this specific topic. The searching of standard database, PubMed, on available publication on this area selecting by keywords trigger digits and diabetes mellitus was done and all derived papers were extracted and further synthesized in this review article. Epidemiology and management of the condition are the mainly focused reviewed areas and presented in this article.