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Pathophysiology/Complications
Diabetes mellitus as a risk factor for compression neuropathy: a longitudinal cohort study from southern Sweden
  1. Mattias Rydberg1,2,
  2. Malin Zimmerman1,2,
  3. Anders Gottsäter3,
  4. Peter M Nilsson4,5,
  5. Olle Melander4,5,
  6. Lars B Dahlin1,2
  1. 1Department of Translational Medicine – Hand Surgery, Lund University, Malmö, Sweden
  2. 2Department of Hand Surgery, Skånes Universitetssjukhus Malmö, Malmö, Sweden
  3. 3Department of Vascular Diseases, Skånes Universitetssjukhus Malmö, Malmö, Sweden
  4. 4Department of Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden
  5. 5Department of Internal Medicine, Clinical Research Unit, Lund University, Malmö, Sweden
  1. Correspondence to Dr Mattias Rydberg; mattias.rydberg{at}med.lu.se

Abstract

Introduction Compression 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 methods A 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.

Results A 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.

Conclusion This 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.

  • neuropathy
  • carpal tunnel syndrome
  • adult diabetes
  • clinical aspects of diabetes
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2020-001298

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    Footnotes

    • Contributors All stated authors made significant contributions to this article. MR, MZ and LBD designed the study and MR wrote the first draft. All authors contributed to the interpretation of the data, reviewed and accepted the final version before publishing.

    • Funding The Malmö Diet and Cancer Study was made possible by grants from the Swedish Cancer Society, the Swedish Medical Research Council, AFA Insurance, the Albert Påhlsson and Gunnar Nilsson Foundations and the Malmö City Council. This study was funded by the Swedish Diabetes Foundation, the Regional Agreement on Medical Training and Clinical Research (ALF) between Region Skåne and Lund University, Stig and Ragna Gorthons Foundation and local funds at Lund University.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was approved by the Regional Ethical Review Board in Lund, Sweden (DNR: 2019–01433), and all participants provided written informed consent.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement Data may be obtained from a third party and are not publicly available. Original study data can be applied for by contacting the Steering Committee of the Malmö Diet and Cancer Study (data manager Anders Dahlin, email: anders.dahlin@med.lu.se).