Upper extremity impairments in type 1 diabetes with long duration; common problems with great impact on daily life

Abstract

Purpose: To investigate the prevalence, activity limitations and potential risk factors of upper extremity impairments in type 1 diabetes in comparison to controls.

Methods: In a cross-sectional population-based study in the southeast of Sweden, patients with type 1 diabetes <35 years at onset, duration ≥20 years, <67 years old and matched controls were invited to answer a questionnaire on upper extremity impairments and activity limitations and to take blood samples.

Results: Seven hundred and seventy-three patients (ages 50 ± 10 years, diabetes duration 35 ± 10 years) and 708 controls (ages 54 ± 9 years) were included. Shoulder pain and stiffness, hand paraesthesia and finger impairments were common in patients with a prevalence of 28–48%, which was 2–4-folds higher than in controls. Compared to controls, the patients had more bilateral impairments, often had coexistence of several upper extremity impairments, and in the presence of impairments, reported more pronounced activity limitations. Female gender (1.72 (1.066–2.272), p = 0.014), longer duration (1.046 (1.015–1.077), p = 0.003), higher body mass index (1.08 (1.017–1.147), p = 0.013) and HbA1c (1.029 (1.008–1.05), p = 0.007) were associated with upper extremity impairments.

Conclusions: Compared to controls, patients with type 1 diabetes have a high prevalence of upper extremity impairments, often bilateral, which are strongly associated with activity limitations. Recognising these in clinical practise is crucial, and improved preventative, therapeutic and rehabilitative interventions are needed.

Implications for rehabilitation

• Upper extremity impairments affecting the shoulder, hand and fingers are common in patients with type 1 diabetes, the prevalence being 2–4-fold higher compared to non-diabetic persons.

• Patients with diabetes type 1 with upper extremity impairments have more pronounced limitations in daily activities compared to controls with similar impairments.

• Recognising upper extremity impairments and activity limitations are important and improved preventive, therapeutic and rehabilitation methods are needed.

Keywords:

• Type 1 diabetes
• frozen shoulder
• carpal tunnel syndrome
• trigger finger disorder
• Dupuytren’s disease

Acknowledgements

We are grateful to all patients and controls who participated in our study by answering a questionnaire and donating blood samples. We thank the late Torbjörn Lindström for invaluable advice and support.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the Medical Research Council of Southeast Sweden (FORSS), the County council and Stiftelseförvaltningen of Region Östergötland, Sweden.