Incidence of Diabetes Mellitus Type II and Pre-Diabetes among Hand Nerves Entrapment Neuropathy Patients: Epidemiological Study

Abstract

Objective: Measure the incidence of Diabetes Mellitus (DM)/pre-diabetes among patients with hand nerves entrapment syndromes. Design: Prospective cross sectional. Settings: Outpatient. Participants: 412 patients presented with unilateral or bilateral hand numbness suspecting Carpal Tunnel Syndrome (CTS). Exclusion criteria: Cervical spine or hand trauma history, nerve injury history. Interventions: Each patient was subjected to the following; demographic data including occupation, body mass index, detailed medical history including DM history. Neck exam including Spurling test. Full neurological exam. Main outcome measures: Upper extremities Nerve conduction studies and electromyography of segment pointing muscles. Laboratory testing including glycosylated hemoglobin (HgA1c), liver and kidney functions. Cervical spine MRI if possible. Results: Mean age 59.4 ± 11.123. All patients were right-handed, Male 37.1%, female 62.9%, Mean body mass index (BMI) 32.2 ± 8.2. majority were manual workers (55.1%). HgA1c <5.5 has the fewest patients (7.3%), highest number of patients with HgA1c 5.5-6.0. significant relation between HgA1c categories and sensory CTS p=0.001 and sensory motor CTS p=0.001. No significant relation between HgA1c categories and demyelinating pathology p=0.123 but significant with demyelinating axonal pathology p=0.017. Significant relation between HgA1c and Guyon canal syndrome p=0.001 and polyneuropathy p=0.001. No significance between HgA1c and cervical radiculopathy p=0321. Conclusions: High incidence of DM and pre-diabetes among patients with hand nerve entrapment: CTS, Guyon syndrome together with polyneuropathy. EN may be the earliest neurophysiological abnormalities in DM, particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. Due to the metabolic alterations consequent to abnormal glucose metabolism, the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage, making them more prone to entrapment in anatomically constrained channels.