Published: 2009-09-17 19:49:56
Author: Joseph DiDuro | Dynamic Chiropractic | August 26, 2009
Just how many patients who seek chiropractic care have diabetes? Furthermore, why should it matter to chiropractors? The diabetes epidemic is probably the greatest health problem facing developed and developing nations alike.
The current global prevalence of diagnosed diabetes is 165 million and is estimated to increase to 250 million by 2010 and to 330 million by 2025. These alarming figures do not include undiagnosed diabetes or pre-diabetic states.1
If that's not enough of a reason, diabetes mellitus (DM) has clearly been associated with several musculoskeletal disorders (see table).2-7These musculoskeletal complaints tend to lead more patients with diabetes to the chiropractic office. When you add to this the increasing incidence of DM, along with the life expectancy of the diabetic patient, there is an increased prevalence of older patients presenting to the chiropractor with DM.2It is more important than ever for clinicians to understand the musculoskeletal alterations in diabetic patients. Most chiropractors do not need an article on limited joint mobility or shoulder capsulitis, but they may need a primer on how these musculoskeletal disorders relate to the nerve damage caused by DM.
| Musculoskeletal Disorders Associated With Diabetes Mellitus (DM)2-7 |
| Intrisic Complications of DM |
| Limited joint mobility |
| Stiff hand syndrome |
| Diabetic muscular infarction |
| Increased Incidence With DM |
| Dupuytren's disease |
| Shoulder capsulitis |
| Neuropathic arthroplasty |
| Osteopenia (in type I) |
| Flexor tenosynovitis |
| Acute proximal neuropathy |
| Proximal motor neuropathy |
| Pyomyositis |
| Diffuse idiopathic skeletal hyperostosis |
| Possible Association With DM |
| Osteoarthritis |
| Carpal Tunnel Syndrome |
Peripheral nervous system compromise is a common long-term complication of diabetes. In severe cases, this can lead to limb amputations and sudden cardiac death secondary to autonomic polyneuropathy.1 Peripheral neuropathy leading to an increased risk of falling is the most common neurological deficit seen in patients with DM.8
The central nervous system is affected secondarily by diabetic macrovascular disease, with an increased incidence of stroke. Direct cerebral effects of metabolic aberrations result in a diabetes duration-related cognitive decline - so-called primary diabetic encephalopathy - and may even predispose patients to Alzheimer's disease.1
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