People with diabetes can face a variety of complications, including heart disease, kidney disease and vision loss. New research reveals that not only are musculoskeletal issues another potential complication of this condition, but they may be present in more than four in five diabetes patients.
Musculoskeletal disorders common with diabetes
This study was published in Primary Care Diabetes in December 2023 and involved a comprehensive review of research involving diabetes and musculoskeletal disorders. After analyzing individual sources, it was determined that between 34.4% and 83.5% of people with type 2 diabetes also had locomotor disease.
The most common musculoskeletal complications included:
- Osteoarthritis, particularly of the knee
- Shoulder adhesive capsulitis
- Carpal tunnel syndrome
- Hand contractures
- Tenosynovitis
Previous research, such as a study published in 2019 in the Journal of Diabetes Research, indicates that people with diabetes also have an elevated risk of musculoskeletal pain associated with osteoporosis and rheumatoid arthritis.
Connection between diabetes and musculoskeletal health
The link between these health issues is multi-layered and complex. A 2019 article published in Joint Bone Spine explains that both type 1 and type 2 diabetes are associated with low bone turnover, leading to reduced bone mineral density and strength. Insulin deficiency, advanced glycation end (AGE) product accumulation and low-grade inflammation all play a role. This leaves these patients at greater risk of bone fragility and fracture.
Other research suggests certain drugs used to treat diabetes may further contribute to worsening musculoskeletal health. As an example, a 2021 review reports that the drug thiazolidinedione—used to treat insulin resistance—intensifies bone degradation, especially in older female patients.
Improving musculoskeletal health in diabetes patients
The American Diabetes Association (ADA) offers several recommendations for providing patients optimal care in its 2024 Standards of Care in Diabetes guidelines. One relevant to chiropractic professionals is “new emphasis on the evaluation and treatment of bone health and added attention to diabetes-specific risk factors for fracture.”
Another is to help people with diabetes develop positive health behaviors through diabetes self-management education and support, thereby improving their musculoskeletal health outcomes. Ways to assist with this goal include:
- Providing patients with a list of resources where they can learn more about this disease, such as the National Institute of Diabetes and Digestive and Kidney Diseases website or the Centers for Disease Control and Prevention’s “Diabetes Basics.”
- Referring them to a healthcare provider who offers medical nutrition therapy to learn which foods to include and avoid in their diet based on their condition and diabetes type.
- Suggesting they engage in at least 150 minutes of moderate-intensity aerobic exercise per week, two to three days of resistance exercise and two to three days of balance and flexibility training. (For youth with diabetes, the recommendation is 60 minutes of aerobic activity per day.)
- Encouraging patients to get between six and eight hours of uninterrupted sleep nightly.
Consider the undiagnosed
According to the Centers for Disease Control and Prevention, in 2021, there were 38.1 million adults ages 18 years or older with diabetes. Of these, 8.7 million had diabetes but were undiagnosed.
Helping patients recognize warning signs of this condition can help reduce this percentage, enabling them to pursue the diagnosis and subsequent treatment needed to keep their blood sugar levels within a healthy range.
The American Diabetes Association shares common symptoms of this condition, which include:
- Frequent urination
- Excessive hunger or thirst
- Feeling fatigued
- Blurry vision or trouble healing
- Unexplained weight loss
- Tingling, pain or numbness in the extremities
Final thoughts
If patients experience any of these issues, having their blood sugar levels tested may provide the diagnosis needed to get help, which is also a good step toward reducing their risk of diabetes-related complications, such as those impacting their musculoskeletal health.