Results
The average age of the 702 diabetic patients evaluated in our study was 55.9 ± 13.2 years. Out of all patients, 55.1% (n = 387) were female and 44.9% (n = 315) were male, and 8.1% (n = 57) were diagnosed with type 1 diabetes and 91.9% (n = 645) with type 2 diabetes. The demographic and diabetes-related data of the patients are shown in Table 1 .
Musculoskeletal system problems were present in 45.9% (n = 322) of the patients included in the study. While 22.4% (n = 157) of the patients had a single finding, 23.5% (n = 155) had two and more findings together. The frequency of musculoskeletal system disorders were as follow: Carpal tunnel syndrome in 17.7% (n = 124), Dupuytren’s contracture in 14.4% (n = 101), limited joint mobility syndrome in 10.2% (n = 72), adhesive capsulitis in 13.8% (n = 97), flexor tenosynovitis in 2.8% (n = 20), diabetic foot in 6% (n = 39) and Charcot arthropathy in 1.7% (n = 12). The most common musculoskeletal disorder was carpal tunnel syndrome, and bilateral involvement of the disease was observed in 46.7% (n = 58) of patients. Dupuytren’s contracture was found to be more common in patients with type 2 diabetes compared to patients with type 1 diabetes (15% and 1.8%, respectively), and this result was statistically significant (p = 0.015). The relationship of musculoskeletal disorders with the type of diabetes is shown in Table 2 .
The relationship of the musculoskeletal disorders with age and the duration of diabetes was evaluated. There was a statistically significant relationship between Dupuytren’s contracture (p< 0.001), LJMS (p <0.001) and diabetic foot (p = 0.021) and the mean patient age. The duration of diabetes was associated with Dupuytren’s contracture, adhesive capsulitis, carpal tunnel syndrome, flexor tenosynovitis, and limited joint mobility syndrome (p <0.005).
In our study, the relationship between HbA1c level and musculoskeletal disorders was demonstrated. HbA1c levels were higher in patients with musculoskeletal disorders, and there was a statistically significant difference in Dupuytren’s contracture (p <0.001), adhesive capsulitis (p = 0.048), and carpal tunnel syndrome (p = 0.045). The relationship between musculoskeletal disorders and HbA1c is shown in Figure 1 .
The proteinuria level was also higher in patients with musculoskeletal manifestations. However, a statistically significant relationship with proteinuria was found only between flexor tenosynovitis and diabetic foot (p <0.05). An association between microvascular complications and musculoskeletal disorders was also found. A significant relationship between Dupuytren’s contracture and diabetic foot with all of the microvascular complications was detected. A relationship between adhesive capsulitis and retinopathy was also found to be significant. Likewise, there was a substantial relationship of LJMS and flexor tenosynovitis with nephropathy. The relationship of musculoskeletal system disorders with microvascular complications, age, duration of diabetes, HbA1c, and proteinuria are shown in Table 3.