Diabetes mellitus as a risk factor for compression neuropathy: a longitudinal cohort study from southern Sweden

Abstract

IntroductionCompression neuropathies (CN) in the upper extremity, the most common being carpal tunnel syndrome (CTS) and ulnar nerve entrapment (UNE), are frequent among patients with diabetes mellitus (DM). Earlier studies have shown contradicting results regarding DM as a risk factor for CN. Thus, the aim of the present population-based, longitudinal study was to explore potential associations between DM, CTS, and UNE during long-term follow-up.Research design and methodsA total of 30 466 participants aged 46–73 years, included in the population-based Malmö Diet and Cancer Study during 1991–1996, were followed up in Swedish national registries regarding incident CTS and UNE until 2016. Associations between prevalent DM at baseline and incident CTS or UNE were calculated using Cox proportional hazard models, adjusted for baseline confounders, such as sex, age at study entry, smoking, hypertension, use of antihypertensive treatment, alcohol consumption, and body mass index (BMI). HbA1c and fasting plasma glucose levels had been measured at baseline in a subgroup of 5508 participants and were related to incident CTS and UNE in age and sex-adjusted binary logistic regression models.ResultsA total of 1081 participants developed CTS and 223 participants developed UNE during a median follow-up of 21 years. Participants with incident CTS or UNE had higher prevalence of DM and higher BMI at baseline. Using multivariate Cox regression models, prevalent DM at baseline was independently associated with both incident CTS (HR 2.10; 95% CI 1.65 to 2.70, p<0.0001) and incident UNE (HR 2.20; 95% CI 1.30 to 3.74, p=0.003). Higher levels of HbA1c and plasma glucose were associated with an increased risk for CTS, but not for UNE.ConclusionThis study establishes DM as a major risk factor in the development of both CTS and UNE. Furthermore, a higher BMI is associated with both CTS and UNE. Finally, hyperglycemia seems to affect the median and ulnar nerves differently.

Association Between Diabetes Mellitus and Carpal Tunnel Syndrome: Results From the United States National Ambulatory Medical Care Survey

“…It is possible that the association between diabetes and CTS only exists in specific subgroups (e.g., uncontrolled diabetes). Additionally, our study cannot exclude the possibility of underreporting of CTS, as evidenced by the low prevalence of the condition compared to previous studies [3,4]. Furthermore, the database only collected ICD-9 information on a maximum of three chronic conditions or diagnoses related to the visit per patient.…”

“…In the hyperglycemic state, excess metabolism of glucose leads to intracellular sorbitol accumulation in the neuron and the adjacent Schwann cells. Ultimately, this leads to axonal degeneration and segmental demyelination of the nerve, making it more vulnerable to compression with a lower threshold to develop CTS [4]. Studies reporting on the association between DM and CTS vary greatly on the magnitude based on the geographic location where the study took place; the association was reported to be lower in populationbased studies than in hospital-based studies [4,[6][7][8].…”

“…Ultimately, this leads to axonal degeneration and segmental demyelination of the nerve, making it more vulnerable to compression with a lower threshold to develop CTS [4]. Studies reporting on the association between DM and CTS vary greatly on the magnitude based on the geographic location where the study took place; the association was reported to be lower in populationbased studies than in hospital-based studies [4,[6][7][8]. A study from a university hospital in Turkey found that the odds of CTS was 60 times higher in the DM group compared to the control group (odds ratio [OR]: 60; 95% confidence interval [CI]: 13-246) [6].…”

Acute onset monoparesis in newly diagnosed patients with type 2 diabetes mellitus with poor glycemia

“…7 Rydberg, et al did a longitudinal study to explore potential associations between diabetes mellitus and entrapment neuropathies during long term follow up and found hyperglycemia to affect the median and ulnar nerves differently. 8 Kocer et al examined different methods of studying sural nerve conduction in a group of patients with impaired glucose tolerance supporting the idea that impaired glucose tolerance is a transitional state before diabetes and also the importance of dorsal sural nerve latencies for early detection of neuropathy. 9 Ogawa et al reported a case of a 48-year old man with a 14-year history of type 2 diabetes with proliferative diabetic retinopathy and distal symmetrical diabetic polyneuropathy and within a span of 8 months, he sub acutely developed difficulty in both shoulder movement and trouble standing up from a squatting position with severe bilateral shoulder and thigh pain.…”

The prevalence of ulnar neuropathy at the elbow and ulnar nerve dislocation in recreational wheelchair marathon athletes

“…This effect may be related to several factors. For instance, obesity, Diabetes Mellitus and smoking have been reported as risk factors for Ulnar Neuropathy [ 10 , 29 ]. Although there is large inter-individual variability in weight loss following regular exercise training [ 30 ], it is conceivable that the ~4.5 h training/week of the wheelchair athletes included in the present study has contributed to the maintenance of what is considered a healthy body mass.…”