Musculoskeletal Impairments Are Often Unrecognized and Underappreciated Complications From Diabetes.

Abstract

Medical professionals and laypeople alike understand the fact that people with diabetes are at increased risk for serious medical complications such as cardiovascular disease, kidney disease, peripheral neuropathy, and lower extremity amputations.1 However, I have observed that many people, including people with diabetes and the rehabilitation health providers treating them, are not aware of a large body of evidence linking diabetes with increased risk for numerous musculoskeletal impairments and complications.2 These impairments are apparent in type 1 diabetes (due to beta cell destruction, usually leading to absolute insulin deficiency) and type 2 diabetes (due to progressive loss of insulin secretion on the background of insulin resistance). The purpose of this point of view is to highlight the musculoskeletal impairments that are exacerbated, or potentially even caused, by metabolic disorders associated with diabetes. This article will focus on those musculoskeletal impairments most often encountered by physical therapists and other rehabilitation practitioners, describe the systemic condition of limited joint mobility, and briefly outline a likely mechanism for musculoskeletal impairments. Finally, the article will briefly provide clinical and research implications for those in rehabilitation working with this population. Metabolic dysfunctions clearly leave people with diabetes at high risk for developing musculoskeletal pain and impairments. In a large Danish study that compared patients with type 2 diabetes (n=951) directly with age-, sex-, and region-matched control participants (n=22,923), the patients with diabetes were 1.7 to 2.1 times more likely to report musculoskeletal pain compared with those without diabetes.3 Consistent with this high risk for musculoskeletal disorders, the group with diabetes reported high incidences of shoulder or neck pain (52%); low back pain (60%); and arm, hand, knee, or hip pain (71%).3 Furthermore, people pursuing physical therapy for musculoskeletal pain and impairments often have a secondary diagnosis of diabetes or have risk …