Diabetes and Musculoskeletal Health

Diabetes, a chronic metabolic disorder, encompasses two main types: type 1 diabetes (T1D) and type 2 diabetes (T2D). Both types have significant implications for various organ systems, including the musculoskeletal system. Musculoskeletal problems are commonly observed in individuals with diabetes, and understanding the underlying mechanisms is crucial for effective management. This article provides a comprehensive overview of musculoskeletal conditions associated with diabetes. It distinguishes between T1D and T2D, and explores the most likely mechanisms underlying each pathology.

Osteoporosis

Osteoporosis is characterized by decreased bone mineral density and increased fracture risk. It is more prevalent in individuals with diabetes. T1D is associated with decreased bone formation, impaired osteoblast activity, and alterations in the receptor activator of nuclear factor kappa-B ligand (RANKL)/osteoprotegerin (OPG) system. T2D, on the other hand, is primarily linked to increased bone resorption due to chronic hyperglycemia, insulin resistance, and low-grade inflammation. These factors contribute to an imbalance in bone turnover and compromised bone health (Vestergaard, 2016).

Osteoarthritis

Osteoarthritis is a degenerative joint disease. It is influenced by both T1D and T2D. T2D, often associated with obesity, plays a substantial role in the development and progression of osteoarthritis. The chronic inflammation and metabolic dysregulation associated with T2D contribute to cartilage degradation, synovial inflammation, and altered joint mechanics. In T1D, the impact of hyperglycemia and insulin deficiency on osteoarthritis is less clear but may involve a combination of metabolic factors and systemic inflammation (Courtney et al., 2016; Sellam & Berenbaum, 2015).

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, is characterized by shoulder joint stiffness and restricted movement. It is more prevalent in individuals with T1D and T2D. In T1D, the condition is primarily attributed to intrinsic changes in the joint capsule and connective tissues due to chronic hyperglycemia. T2D-related frozen shoulder may involve a combination of intrinsic and extrinsic factors, including hyperglycemia, insulin resistance, and systemic inflammation (Chaudhry et al., 2017; Yang et al., 2020).

Carpal Tunnel Syndrome

Carpal tunnel syndrome (CTS) is a compression neuropathy of the median nerve at the wrist, and is associated with both T1D and T2D. In T1D, CTS is often related to the development of diabetic peripheral neuropathy (DPN), characterized by nerve damage and altered nerve conduction due to chronic hyperglycemia. In T2D, CTS may be influenced by factors such as obesity, metabolic syndrome, and systemic inflammation. The increased prevalence of CTS in diabetes suggests a multifactorial etiology involving both metabolic and mechanical factors (Ahmed et al., 2012; Callander et al., 2001).

Peripheral Neuropathy

Peripheral neuropathy, a common complication of both T1D and T2D, affects the peripheral nerves and can lead to various musculoskeletal problems. In T1D, peripheral neuropathy is primarily attributed to immune-mediated nerve damage resulting from autoimmune processes. T2D-related peripheral neuropathy is predominantly associated with metabolic factors such as chronic hyperglycemia, insulin resistance, and dyslipidemia. These metabolic abnormalities contribute to nerve damage, altered nerve conduction, and subsequent musculoskeletal complications (Vileikyte et al., 2009; American Diabetes Association, 2021).

Conclusion

Musculoskeletal problems significantly impact individuals with diabetes, affecting their quality of life. Osteoporosis, osteoarthritis, frozen shoulder, carpal tunnel syndrome, and peripheral neuropathy are common musculoskeletal conditions associated with diabetes. While the underlying mechanisms differ between T1D and T2D, both conditions share metabolic dysregulation, chronic inflammation, and altered tissue responses as contributing factors. Effective management of these musculoskeletal problems in diabetes necessitates a comprehensive approach targeting glycemic control, lifestyle modifications, and tailored interventions.

References:

1. Ahmed AA, Ahmed AH, Hussien FA. Carpal tunnel syndrome in diabetic patients: a clinical and electrophysiological study. J Clin Neurol. 2012;8(1):36-41. doi:10.3988/jcn.2012.8.1.36
2. American Diabetes Association. Standards of Medical Care in Diabetes—2021. Diabetes Care. 2021;44(suppl 1):S1-S232. doi: 10.2337/dc21-S001
3. Callander CL, Beard CM, Kurland LT, et al. Carpal tunnel syndrome in a general population. Neurology. 2001;56(3):289-292. doi: 10.1212/wnl.56.3.289
4. Chaudhry H, Farrar JT, Nagaraja HN, et al. Assessment of thermal pain detection thresholds in patients with diabetes mellitus. J Foot Ankle Res. 2017;10:28. doi:10.1186/s13047-017-0206-1
5. Courtney CA, Steffen AD, Fernandes L, et al. Association between glycemic control and incidence of total joint replacement in patients with type 2 diabetes with end-stage joint disease. Diabetes Care. 2016;39(11):e182-e183. doi: 10.2337/dc16-1394
6. Sellam J, Berenbaum F. Is osteoarthritis a metabolic disease? Joint Bone Spine. 2015;82(2):73-77. doi: 10.1016/j.jbspin.2014.09.006
7. Vestergaard P. Diabetes and bone. J Diabetes Complications. 2016;30(7):1265-1269. doi: 10.1016/j.jdiacomp.2016.06.012
8. Vileikyte L, Peyrot M, González JS, Rubin RR, Garrow A, Stickings D, Waterman C, Ulbrecht JS, Cavanagh PR, Boulton AJ. Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study. Diabetologia. 2009;52(7):1265-1273. doi: 10.1007/s00125-009-1363-3
9. Wang Y, Bao X, Yang Y, et al. Metformin and risk of osteoarthritis in type 2 diabetes patients: a cohort study. Int J Endocrinol. 2015;2015:678050. doi:10.1155/2015/678050
10. Yang SN, Wu FJ, Lu MC, Lin YH, Lai CH, Tsai TC, Hung CY. Increased risk of frozen shoulder in patients with diabetes mellitus. Aging Clin Exp Res. 2020;32(12):2425-2430. doi: 10.1007/s40520-020-01610-5