Association between type 2 diabetes and chronic low back pain in general practices in Germany

Abstract

IntroductionThere are conflicting results on the association between type 2 diabetes and chronic low back pain (CLBP). Therefore, the goal was to investigate the relationship between type 2 diabetes and CLBP in individuals followed in general practices in Germany.Research design and methodsAdults diagnosed for the first time with type 2 diabetes in 809 general practices in Germany between 2005 and 2018 (index date) were included. Adults without type 2 diabetes were matched (1:1) to those with type 2 diabetes by sex, age, index year, and the annual number of medical consultations (index date: a randomly selected visit date). The association between type 2 diabetes and the 10-year incidence of CLBP was analyzed in conditional Cox regression models adjusted for a wide range of comorbidities, including hypertension, lipid metabolism disorders, and obesity.ResultsThere were 139 002 individuals included in this study (women: 58.0%; mean (SD) age 62.5 (13.4) years). There was a positive association between type 2 diabetes and the incidence of CLBP in the overall sample (HR=1.23, 95% CI: 1.13 to 1.35). Sex-stratified analyses showed a higher risk of CLBP in women (HR=1.68, 95% CI: 1.43 to 1.90) and a lower risk in men with than in their counterparts without type 2 diabetes (HR=0.83, 95% CI: 0.71 to 0.97).ConclusionsNewly diagnosed type 2 diabetes was associated with an increased risk of CLBP. There were important sex differences in the type 2 diabetes-CLBP relationship, and more research is warranted to investigate the underlying factors explaining these differences.

Time Trends and Sex Differences in the Association between Diabetes and Chronic Neck Pain, Chronic Low Back Pain, and Migraine. Analysis of Population-Based National Surveys in Spain (2014–2020)

“…The figures were around twice as high for spinal pain and almost three-fold for MFH. This significantly higher presence of self-reported pain among women was frequently found in previous studies conducted in Spain and other countries [ 8 , 10 , 11 , 12 , 16 , 24 , 36 , 37 ].…”

“…Different authors have suggested possible reasons to explain these sex differences in people with diabetes [ 8 , 12 , 24 ]. Glycemic control is poorer in women than in men with diabetes; therefore, low-grade systemic inflammation may be more severe in women than in their male counterparts.…”

“…Previous studies have suggested that diabetes is associated with a higher risk of suffering from these three pains; however, thus far, no conclusive results have been obtained [ 6 , 7 , 8 , 9 ].…”

“…Among the possible causes that can explain the association of spinal pain (NP and/or LBP) with diabetes are that people with diabetes have an increased risk of cartilage inflammation, loss of muscle strength, spinal stenosis, and degenerative intervertebral disc (IVD) disease [ 6 , 7 , 8 , 13 , 14 ]. The arguments for a spurious association between spinal pain and diabetes include the confounding effect of obesity, depression, and sedentarism, conditions more frequent among people with diabetes than without [ 6 , 7 , 8 ].…”

“…A higher prevalence of NP, LBP, and migraine among women than men is a constant finding in the presence of diabetes [ 5 , 8 , 10 , 11 , 15 , 20 , 21 , 22 , 23 , 24 , 25 , 26 ].…”