A study of musculoskeletal manifestations of diabetes mellitus and their association with HbA1C among diabetic patients

Background: The prevalence of diabetes mellitus (DM) is increasing significantly throughout the world. While the vascular complications of diabetes are well recognized and account for the principle mortality and morbidity from the condition, the musculoskeletal manifestations of diabetes are common and not life-threatening, which are an important cause for morbidity, pain, and disability. The most common reported forms of various musculoskeletal manifestations of DM include adhesive capsulitis, hand syndromes such as limited joint mobility syndrome (LJMS), Dupuytren's contracture (DC), and carpal tunnel syndrome (CTS), flexor tenosynovitis, reflex sympathetic dystrophy, diffuse idiopathic skeletal hyperostosis (DISH), Charcot's joints, diabetic amyotrophy (DA), and osteoarthritis. Materials and Methods: The study was conducted on a total of 150 patients with type 2 DM for a duration of at least 5 years in Bangalore during the study period from January 2020 to June 2021. The patients fulfilling the inclusion criteria were enrolled for the study after obtaining informed consent. Detailed history was taken and general physical examination was done to determine the musculoskeletal manifestations of DM. The Disability of Arm Shoulder and Hand (DASH) questionnaire was also completed as per the patient's responses. Laboratory reports were collected, data compiled, and the data were analyzed. Results: Of the 150 cases enrolled, the maximum number of cases belonged to the age group of 36-50 years. About 64% of the diabetic cases were suffering from musculoskeletal disorders (MSDs) (LMJS, CTS, shoulder capsulitis, DC, trigger finger, DISH, DA). Among the MSDs, the highest prevalence was by LJMS (28%). There was a positive correlation among the duration of diabetes, HbA1C, and the DASH score among patients with MSDs in this study and this is statistically significant (P < 0.05). We also see that MSDs are present in 72.7% of the females and 57.1% of the males in the study and this was statistically significant (P = 0.048). Conclusion: MSDs have a high prevalence in diabetic patients. With advancing age and uncontrolled HbA1C levels, the number of MSDs was more as well as the severity as indicated by the DASH score. Early and better glycemic control in diabetic patients can reduce the morbidity associated with MSDs as evidenced by the reduced intensity of DASH score in well-controlled patients.