Relationship Between HbA1c and Complex Regional Pain Syndrome in Stroke Patients With Type 2 Diabetes Mellitus
Jong Ho Choi1, Ki Pi Yu1, Yong-Soon Yoon1
1Department of Rehabilitation Medicine, Presbyterian Medical Center, Seonam University College of Medicine, Jeonju, Korea.
Insights
Higher glycosylated hemoglobin A (HbA1c) levels are linked to increased complex regional pain syndrome (CRPS) prevalence in stroke patients with type 2 diabetes mellitus (T2DM). Uncontrolled blood glucose may contribute to CRPS development post-stroke.
Area of Science:
- Neurology
- Endocrinology
- Pain Medicine
Background:
- Type 2 diabetes mellitus (T2DM) is a common comorbidity in stroke patients.
- Complex regional pain syndrome (CRPS) is a debilitating condition that can affect stroke survivors.
- The relationship between glycemic control and CRPS in this population remains unclear.
Purpose of the Study:
- To investigate the association between glycosylated hemoglobin A (HbA1c) levels and the prevalence of CRPS.
- To explore the impact of glycemic control on CRPS development in stroke patients with T2DM.
Main Methods:
- Retrospective chart review of 200 stroke patients with T2DM.
- Patients were categorized into CRPS and non-CRPS groups.
- Analysis included comparison of HbA1c levels and CRPS prevalence across five HbA1c-defined groups.
Main Results:
- A significant difference in HbA1c levels was observed between CRPS and non-CRPS groups (p<0.05).
- CRPS prevalence significantly differed across HbA1c level groups (p<0.01).
- CRPS prevalence increased proportionally with rising HbA1c levels.
Conclusions:
- Elevated HbA1c is associated with a higher prevalence of CRPS in stroke patients with T2DM.
- Uncontrolled blood glucose may be a contributing factor to CRPS occurrence in this patient cohort.
- Glycemic management is crucial for potentially mitigating CRPS risk in diabetic stroke survivors.
Objective:
To investigate the relationship between glycosylated hemoglobin A (HbA1c) and complex regional pain syndrome (CRPS) in stroke patients with type 2 diabetes mellitus (T2DM).
Methods:
A retrospective chart review was performed of stroke patients from January 2012 to December 2013. We reviewed 331 patients and included 200 in the analysis. We divided them into CRPS and non-CRPS groups and compared them by age, gender, stroke lesion, cause of stroke, duration of T2DM, HbA1c (%), National Institutes of Health Stroke Scale score, affected shoulder flexor muscle strength, Fugl-Meyer Assessment score, motricity index, Functional Independence Measure, Korean version of Modified Barthel Index, blood glucose level on admission day, duration from stroke onset to HbA1c check, and duration from stroke onset to three-phase bone scan for CRPS diagnosis. Thereafter, we classified the patients into five groups by HbA1c level (group 1, 5.0%-5.9%; group 2, 6.0%-6.9%; group 3, 7.0%-7.9%; group 4, 8.0%-8.9%; and group 5, 9.0%-9.9%) and we investigated the difference in CRPS prevalence between the two groups.
Results:
Of the 200 patients, 108 were in the CRPS group and 92 were in the non-CRPS group. There were significant differences in HbA1c (p<0.05) between the two groups but no significant differences in any other factors. Across the five HbA1c groups, there were significant differences in CRPS prevalence (p<0.01); specifically, it increased as HbA1c increased.
Conclusion:
This study suggests that higher HbA1c relates to higher CRPS prevalence and thus that uncontrolled blood glucose can affect CRPS occurrence in stroke patients with diabetes.
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