https://orcid.org/0000-0002-9949-5044
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Abstract
Aim
Patients with type 2 diabetes (T2DM) often suffer from muscle cramps of varying severity. Studies have shown that muscle cramp is closely related to local microcirculation perfusion disorders. Diabetic retinopathy can not only reflect the microcirculation perfusion in the eye but also the systemic microcirculation in patients with diabetes. The aims of this study were to investigate the relationship between muscle cramps and diabetic retinopathy in patients with type 2 diabetes.
Methods
A total of 150 adult patients with type 2 diabetes were enrolled and administered a questionnaire on muscle cramping, along with a visual analogue scale for pain. Diabetic retinopathy (DR) was determined by using fundus photography and graded as non-proliferative DR (NPDR) and proliferative DR (PDR). To assess whether there was an association between the muscle cramps and diabetic retinopathy, we conducted binomial logistic regression analysis.
Results
Our study revealed that 48% of patients with T2DM experienced muscle cramps in the past three months. Patients self-reported suffering from muscle cramps exhibited a higher prevalence of DR (61% vs 38%, P < 0.05) and PDR (22% vs 4%, P < 0.05) compared with patients without muscle cramps. Serum 25-(OH) vitamin D, calcium, and magnesium levels were not significantly different between patients with and without muscle cramps. After adjusting for age, duration of diabetes, HbA1c, vitamin D, potassium, calcium, and magnesium, we demonstrated that diabetic retinopathy (OR, 2.18; 95% CI, 1.01–4.69; P< 0.05) and albumin (OR, 0.90; 95% CI, 0.82–1.00; P< 0.05) were highly associated with muscle cramps. Binomial logistic regression analysis also indicated that severity of DR is associated with muscle cramps. In addition, DR and PDR were found to be associated with muscle cramp frequency (P for trend < 0.05), duration (P for trend < 0.05), and pain severity (P for trend < 0.05).
Conclusion
Muscle cramps occur frequently in diabetes and are correlated with diabetic retinopathy and albumin. Patients with PDR exhibited a higher frequency, severity, and longer duration relative to those with NPDR or without DR. Our findings suggested that muscle cramps in individuals with T2DM might be a result of microvascular dysfunction. Modulation of microvascular perfusion might thus provide a therapeutic target for alleviating muscle cramps.
Data Sharing Statement
The data used to support the findings of this study are available from the corresponding author upon request.
Ethical Statements
The research protocol was approved by the ethics committee of Qilu Hospital of Shandong University, and the ethics number is 20210701. All enrolled patients signed the informed consent form. Approval date of Registry is July 2, 2021. The study complied with the Declaration of Helsinki.
Acknowledgments
The authors thank all of the involved clinicians, nurses, and technicians for dedicating their time and skill to this study.
Author Contributions
Huiqing Hu collected and analyzed data. Fei Yan analyzed data and wrote the manuscript. Chuan Wang and Kai Liang, Qin He enrolled patients in the study. Xinghong Guo and Jia Song coordinated research. Xinguo Hou and Li Chen conceived the idea, designed the study. Fei Yan is the guarantor of this work and takes responsibility for the integrity of the data and the accuracy of the data analysis. All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.
Disclosure
The authors report no conflicts of interest in this work.