Short summary

This project is an online questionnaire cross-sectional study sent to patients followed with diabetes at two centers in the region of Southern Denmark (Odense University Hospital and Hospital of Southwest Denmark). We aim to map the location, characteristics and consequences of pain in the musculoskeletal system in patients with diabetes. Furthermore, we aim to determine the prevalence of diseases in the musculoskeletal system and the consequences of these diseases in Danish patients with diabetes. 

Rationale

Background:

Diabetes mellitus (DM) is a chronic metabolic disease characterized by persistent hyperglycemia, which causes micro- and macro vascular complications,  reduced quality of life and a shorter lifespan in affected individuals. DM is mainly categorized into two types. Type 1 DM is the result of an absolute lack of insulin, as a consequence of autoimmune mediated destruction of insulin producing beta-cells of the pancreas. Type 2 DM is relative lack of insulin, as a result of insulin resistance, excessive hepatic glucose production and abnormal fat metabolism. The most frequent form of DM is Type 2 DM acounting for approximately 90% of all diabetic cases, and the increasing prevalence is attributed to a combination of the increase in obesity and the reduction in physical activities as countries become more industrialized.

The prevalence of DM has globally increased by 33% since 1990. The burden of the disease can be measured as the years lived with disability, and by this measure DM has gone from being the 10th to the 7th leading cause. Additionally, the disease is attributed 8.4% of all deaths - which amounts to nearly 5.2 million deaths annually. In Denmark the prevalence is also increasing. In 2012, 320.545 people were diagnosed with DM and it is estimated that there are an almost equal number of undiagnosed cases of DM. A diabetic patient costs twice as much as in health care those without DM, and thus constitutes an economic burden. In 2011, the social cost of DM in Denmark was estimated to 31.73 billion DKK (4.27 billion Euros) - equivalent to 106.633 DKK (14.349 EUR) per patient per year.

The cost of DM is partly due to complications, which can affect the musculoskeletal system. Musculoskeletal disorders are a widespread problem throughout the world and affect especially the quality of life. In 2013 it was globally estimated that 1.5 billion people were affected by musculoskeletal disorders. In Denmark almost 1.8 million people have musculoskeletal disorders, of which nearly 1.2 million are very bothered by pain in either shoulders, neck, hip, knee or spine.

Rheumatologic disorders are most often seen in patients with diabetes due the long-term metabolic changes, but knowledge about the non-specific and regional pain in the musculoskeletal system is still inadequate. Several studies have found associations between DM and pain syndromes such stiff hand syndrome, Dupuytren's contracture, adhesive capsulitis, trigger finger, carpal tunnel syndrome, diffuse idiopathic skeletal hyperostosis (DISH) and Charcot arthropathy. Influence on the musculoskeletal system complicates the patient's progress and leads to further contact with the health care system, which ultimately increases costs for both the patient and society. It is important for the patient's quality of life to identify and treating these conditions as soon as possible and thereby reduce the morbidity. Influence on the musculoskeletal system is more frequent in patients with Type 2 diabetes compared to the general population - it also seems that pain syndromes around the shoulder, knee and wrist manifest already with prediabetes. Identifying specific musculoskeletal conditions will allow for an earlier diagnosis of both groups, and therefore a reduction of complications.

So far, an association between diabetes and musculoskeletal disorders has not been investigated in Denmark and it is not yet known how many patients with diabetes who also have a musculoskeletal disease. The lack of information about factors leading to pain, intensity and localization of pain leads to unawareness about what consequences the muskuloskeletal disorders have to Danish patients with diabetes. No previous studies have involved over 15,000 patients with diabetes and compared information about their working and social relationship with their musculoskeletal disorders. This indicates the possibility of creating new and important knowledge by mapping the musculoskeletal pain in Danish patients with diabetes.

Purpose:

The overall purpose of this study is to map the location, characteristics and consequences of pain in the musculoskeletal system for Danish patients with diabetes

Specifically, we want to:

• Determine the prevalence of pain in the musculoskeletal system for Type 1 and Type 2 patients with diabetes registered in the Clinical databases used by clinicians treating patients with DM in the region of Southern Denmark at the Hospital of Southwest Denmark and OUH.
• Characterize the pain in terms of localization, duration, intensity and consequences in terms of influences in everyday functions, search of treatment, absence from work and early retirement.
• Describe the prevalence and patterns in subgroups such as gender, age, type of diabetes, duration of diabetes, profession etc.

Description of the cohort

Subjects eligible for this study are adults (above 18 years of age) with type 1 and type 2 diabetes who are registered in the Clinical databases used by clinicians treating patients with DM in the region of Southern Denmark at the Hospital of Southwest Denmark and OUH. 

Data and biological material

The project is carried out as a cross-sectional study in which an electronic questionnaire will be sent. The questionnaire will include questions on social, occupational and lifestyle factors, and 1) Standardised Nordic Questionnaire for the analysis of musculoskeletal symptoms, 2) a numerical ranking scale for pain intensity 3) Major Depression Inventory and 4) Short form 36 version 1. 

Collaborating researchers and departments

Department of Sports Science and Clinical Biomechanics, University of Southern Denmark

• Stud. Manu Amalie Frost Stammerjohan

• Physician Lars Folkestad, PhD

Department of Sports Science and Clinical Biomechanics, University of Southern Denmark

• Professor Jan Hartvigsen

Department of Endocrinology, Odense University Hospital

• Professor Henning Beck-Nielsen

Publications associated with the project