Type 1 diabetes and musculoskeletal conditions

Research presented today at the Diabetes UK Professional Conference (DUKPC) 2021 has revealed that type 1 diabetes is likely to directly cause certain musculoskeletal conditions, including frozen shoulder.

By analysing genetic and health data, researchers identified four conditions that should now be considered as complications of type 1 diabetes.

It is well-known that some musculoskeletal conditions – which affect the muscles, bones, and joints – are more common in people with type 1 diabetes. However, until now, it has not been clear whether type 1 diabetes is a direct cause, or whether there are other factors in play.

The team of researchers led by Dr Harry Green at the University of Exeter analysed data from UK Biobank – one of the largest health studies in the world – and FinnGen, a similar database in Finland. The team used genetic and health information to investigate whether people with type 1 diabetes were more likely to develop a range of common conditions. When a link between type 1 diabetes and another health condition was found, the team used a statistical technique called Mendelian randomisation to understand whether type 1 diabetes played a causal role.

The analysis revealed that type 1 diabetes directly increased the risk of developing frozen shoulder, trigger finger, carpal tunnel syndrome and Dupuytren’s contracture – musculoskeletal conditions that are all characterised by pain and reduced mobility in the shoulder, hand, wrist, or fingers. However, type 1 diabetes was not found to be play a causal role in the development of osteoarthrosis – degeneration of joints.

If blood sugars aren’t carefully managed, over time type 1 diabetes can lead to serious chronic complications such as kidney failure, eye and foot problems, heart attacks and stroke. People with type 1 diabetes are also at an increased risk of developing other autoimmune conditions such as coeliac disease, because autoimmune conditions are often genetically linked.

As is the case with other established complications of type 1 diabetes, musculoskeletal damage is likely to be caused by having high blood sugar levels over a long period of time. Raising awareness among healthcare professionals that these four musculoskeletal conditions are chronic complications of type 1 diabetes will facilitate early diagnosis and timely treatment, and improved outcomes for people living with type 1 diabetes.

Dr Harry Green, Independent Research Fellow at the University of Exeter, said:

“Many conditions are known to be associated with diabetes, but it is often unclear whether diabetes has a direct causal role or is associated for other reasons. We hope that understanding more about the causal role that type 1 diabetes and long-term high blood sugars play in the development of musculoskeletal conditions will pave the way for these conditions to be recognised earlier in patients with diabetes.”

Dr Elizabeth Robertson, Director of Research at Diabetes UK, said:

“Dr Green’s research has shown, for the first time, that several musculoskeletal conditions can be a direct complication of type 1 diabetes. People with type 1 diabetes should now be made aware of these conditions, alongside established complications such as heart and kidney disease.

“These results are a reminder of the importance of supporting people with type 1 diabetes to manage their blood sugar levels so that they can live well with the condition and avoid future complications.

“It is crucial that healthcare professionals are aware of these complications, so they are armed with the knowledge to facilitate early diagnosis and treatment, ensuring the best possible care for people with type 1 diabetes.”

Type 1 diabetes is an autoimmune condition that occurs when the body’s immune system attacks the insulin-producing cells of the pancreas. This means the pancreas can no longer produce insulin, leading to high blood sugar levels. Around 8% of the 3.9 million people in the UK who have been diagnosed with diabetes have type 1.

For more information about diabetes, visit diabetes.org.uk.