Quality of metabolic control, serum potassium, and aging are the major determinants of severity of musculoskeletal disorders in hospitalized diabetic patients

Abstract

Diabetes is strongly associated with numerous musculoskeletal disorders (MSD) and may be considered as another group of diabetic complications. We explored the association of diabetes type, duration, quality of metabolic control, applied therapy, and serum electrolytes, with prevalence and extent of musculoskeletal disorders as well as radiographic and EMG changes. The case-control clinical study involved 80 patients with type 1 and 2 diabetes hospitalized at General Hospital Berane and Clinical Center Podgorica, Montenegro, in 2013. More than half of the diabetics had MSD. Peripheral nerve disorders were diagnosed by EMG. The musculoskeletal disorders were evaluated using the translated Short Musculoskeletal Function Assessment (SMFA) questionnaire. The statistical methodology involved T-testing, χ2 test, Spearman’s multiple correlation, and ordinal logistic regression. The incidence and the severity of MSD were significantly related to patients age, duration of diabetes, quality of metabolic control, serum potassium, radiographic, and EMG findings. However, in the regression analysis, only aging, mean blood glucose levels, and serum potassium were associated with the significant risk for development of MSD. Advanced age, metabolic control, and hypokalemia are the main determinants of both prevalence and extent of musculoskeletal disorders in diabetics. Along with the strict glycemic control, an additional effort should be taken to avoid potassium depletion associated with diabetic ketoacidosis and to maintain optimal potassium homeostasis in diabetic patients receiving insulin, diuretics, or suffer gastrointestinal motility disorders.