Association of Diabetic Polyneuropathy and Carpal Tunnel Syndrome: Role of Glycemic Control and Microvascular Complications

Year 2023, Volume: 13 Issue: 3, 440 - 445, 30.09.2023

Şule Deveci

https://doi.org/10.31832/smj.1331815

Abstract

Introduction: Carpal tunnel syndrome (CTS) is more common in diabetes mellitus (DM), especially in individuals with diabetic polyneuropathy (DPN). This study aimed to retrospectively investigate the effects of elevated glycosylated hemoglobin (HbA1c) levels, duration of diabetes, and other microvascular complications of DM on the frequency and severity of CTS in patients with DPN.
Material and methods: 124 DPN patients were included in the study. In these patients, fasting blood glucose (FBG) and HbA1c levels, duration of DM, antidiabetic drugs used, comorbidities, and other complications of diabetes were questioned. According to the results of the electrophysiological examination, the patients were divided into 2 groups: those with only DPN and those with DPN + CTS.
Results: When diabetes complications were investigated, diabetic nephropathy was found only in those with DPN + CTS (p=0.045). Electrophysiologically, in sensory fibers in all patients, In 43 patients (34.7%), involvement of motor fibers was accompanied. A positive correlation was found between the severity of CTS and duration of diabetes, FBG and HbA1c levels, and subcutaneous insulin use (p=0.018, p=0.014, p=0.003, p=0.029, respectively).
Conclusion: Good glycemic control can reduce the risk of developing CTS with microvascular complications of diabetes. Therefore, it is important for patients to protect their hand function and prevent the development of CTS by being informed about the complications of diabetes.

Keywords

Carpal tunnel syndrome, Diabetic polyneuropathy, HbA1c, Microvascular complications, Glycemic control

Thanks

I would like to thank Prof. Dr. Zeliha Matur from Bezmiâlem Vakıf University Faculty of Medicine, Department of Neurology for her contribution to the statistical analysis and revision of the manuscript.

Diyabetik Polinöropati ve Karpal Tünel Sendromu İlişkisi: Glisemik Kontrol ve Mikrovasküler Komplikasyonların Rolü

Abstract

Amaç: Karpal tünel sendromu (KTS) diabetes mellitusta (DM), özellikle de diyabetik polinöropatisi (DPN) olan bireylerde daha sık görülmektedir. Bu çalışmada, DPN'li hastalarda yüksek glikozile hemoglobin (HbA1c) düzeylerinin, diyabet süresinin ve DM'nin diğer mikrovasküler komplikasyonlarının KTS sıklığı ve şiddeti üzerindeki etkilerinin retrospektif olarak araştırılması amaçlanmıştır.
Gereç ve yöntemler: 124 DPN hastası çalışmaya dahil edildi. Bu hastalarda; açlık kan şekeri (AKŞ) ve HbA1c düzeyleri, DM süresi, kullanılan antidiyabetik ilaçlar, eşlik eden hastalıklar ve diyabetin diğer komplikasyonları sorgulandı. Elektrofizyolojik inceleme sonuçlarına göre hastalar sadece DPN olanlar ve DPN + KTS olanlar olmak üzere 2 gruba ayrıldı.
Bulgular: Diyabet komplikasyonları araştırıldığında, diyabetik nefropati sadece DPN + KTS olanlarda saptandı (p=0.045). Elektrofizyolojik olarak tüm hastalarda duyusal liflerde; 43 hastada (%34,7) ise motor liflerde tutulum eşlik etti. KTS şiddeti ile diyabet süresi, AKŞ ve HbA1c düzeyleri ve subkutan insülin kullanımı arasında pozitif korelasyon bulundu (sırasıyla p=0.018, p=0.014, p=0.003, p=0.029).
Sonuç: İyi glisemik kontrol, diyabetin mikrovasküler komplikasyonları ile KTS gelişme riskini azaltabilir. Bu nedenle hastaların diyabetin komplikasyonları hakkında bilgi sahibi olarak el fonksiyonlarını korumaları ve KTS gelişimini önlemeleri önemlidir.

Keywords

Karpal tünel sendromu, Diyabetik polinöropati, HbA1c, Mikrovasküler komplikasyonlar, Glisemik kontrol

References

• 1. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998;21(9):1414-1431 https://doi: 10.2337/ diacare.21.9.1414.
• 2. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N et al. TURDEP-II Study Group. Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol. 2013;28(2):169-180 https://doi: 10.1007/s10654-013-9771-5.
• 3. Jaiswal M, Divers J, Dabelea D, Isom S, Bell RA, Martin CL et al. Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth With Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study. Diabetes Care. 2017;40(9):1226-1232 https://doi: 10.2337/dc17-0179.
• 4. Vakilinia SR, Vaghasloo MA, Aliasl F, Mohammadbeigi A, Bitarafan B, Etripoor G et al. Evaluation of the e icacy of warm salt water foot-bath on patients with painful diabetic peripheral neuropathy: a randomized clinical trial. Complement  er Med. 2020;49:102325 https://doi: 10.1016/j.ctim.2020.102325.
• 5. Writing Team for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. E ect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA. 2002;287(19):2563-2569 https:// doi: 10.1001/jama.287.19.2563.
• 6. Ghasemi-Rad M, Nosair E, Vegh A, Mohammadi A, Akkad A, Lesha E et al. A handy review of carpal tunnel syndrome: From anatomy to diagnosis and treatment. World J Radiol. 2014;6:284-300 https://doi: 10.4329/wjr.v6.i6.284.
• 7. Chammas M, Bousquet P, Renard E, Poirier JL, Ja iol C, Allieu Y. Dupuytren’s disease, carpal tunnel syndrome, trigger finger, and diabetes mellitus. J Hand Surg Am. 1995:20(1):109- 114 https://doi: 10.1016/S0363-5023(05)80068-1.
• 8. Perkins BA, Olaleye D, Bril V. Carpal tunnel syndrome in patients with diabetic polyneuropathy. Diabetes Care. 2002;25(3):565-569 https://doi: 10.2337/diacare.25.3.565.
• 9. Olsson C, Rydberg M, Zimmerman M. Diabetic retinopathy as a predictor for peripheral compression neuropathies, a registry-based study. PLoS One. 2022:17(10):e0275598 https:// doi: 10.1371/journal.pone.0275598.
• 10. Padua L, LoMonaco M, Gregori B, Valente EM, Padua R, Tonali P. Neurophysiological classification and sensitivity in 500 carpal tunnel syndrome hands. Acta Neurol Scand. 1997;96(4):211-217 https://doi: 10.1111/j.1600-0404.1997.tb00271.x.
• 11. Moon HI, Shin J, Kim YW, Chang JS, Yoon S. Diabetic polyneuropathy and the risk of developing carpal tunnel syndrome: A nationwide, population-based study. Muscle Nerve. 2020;62(2):208-213 https://doi: 10.1002/mus.26901.
• 12. Dong D, Liu H. Prevalence of carpal tunnel syndrome in patients with long- term type 2 diabetes mellitus. Heliyon. 2022;8(12):e12615 https://doi: 10.1016/j.heliyon.2022.e12615.
• 13. Kikkawa Y, Kuwabara S, Misawa S, Tamura N, Kitano Y, Ogawara K et al.  e acute e ects of glycemic control on nerve conduction in human diabetics. Clin Neurophysiol. 2005;116(2):270-274 https://doi: 10.1016/j.clinph.2004.08.011.
• 14. Monge L, De Mattei M, Dani F, Sciarretta A, Carta Q. E ect of treatment with an aldose-reductase inhibitor on symptomatic carpal tunnel syndrome in type 2 diabetes. Diabet Med. 1995;12(12):1097-1101 https://doi: 10.1111/j.1464-5491.1995.tb00427.x.
• 15. Çelik M. Diabetic entrapment neuropathies. I. National diabetic neuropathy symposium book. National diabetic neuropathy symposium organizing committee. Mersin 2002;75-78.
• 16. Diabetes Control and Complications Trial Research Group; Nathan DM, Genuth S, Lachin J, Cro ord O, Davis M, Rand L et al.  e e ect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986 https://doi: 10.1056/NEJM199309303291401.
• 17. Said G. Uremic neuropathy. Handb Clin Neurol. 2013;115:607-612 https://doi: 10.1016/ B978-0-444-52902-2.00035-7.
• 18. Yusifov M, Alpaydin Baslo S, Tekin B, Erdogan M, Ozturk O, Atakli D. Metabolic syndrome and anthropometric indices in CTS hands: an electrophysiological study. Neurol Sci. 2022;43(2):1375-1384 https://doi: 10.1007/s10072-021-05430-9.
• 19. Nazish S, Zafar A, Shahid R, Al Sulaiman A, Alabdali M, Aljaafari D et al. Electrophysiologic severity of carpal tunnel syndrome in diabetic patients of the Saudi population. Neurosciences (Riyadh). 2019;24(1):22-28 https://doi: 10.17712/nsj.2019.1.20180217.