Occurrence of Undiagnosed Diabetes Mellitus With Musculoskeletal Disorders of the Upper Extremity: Prospective...

Upper extremity conditions such as carpal tunnel syndrome (CTS) are more prevalent in patients with diabetes mellitus (DM) than in the general population. This prospective study aimed to determine the viability of DM screening for patients presenting with upper extremity musculoskeletal disorders in an orthopaedic hand clinic and to inform future testing criteria for orthopaedic surgeons.

Patients with a diagnosis of CTS, trigger finger, Dupuytren's contracture, and/or De Quervain's disease were prospectively enroled. Eighty-four patients (60.7% female, 60.0% White) underwent point-of-care haemoglobin A1c (HbA1c) fingerstick testing at their appointment at the orthopaedic surgeon's office. Patient demographics and disease characteristics (symptom laterality, diagnosis of upper extremity pathologies) were collected and compared between patients with HbA1c within normal limits (HbA1c < 5.7) and in the range of prediabetes or type 2 DM (HbA1c ≥ 5.7).

Among 84 patients, 58.3% had HbA1c in the range of prediabetes and 4.8% in the T2DM range. The most prevalent upper extremity condition was trigger finger (78.6%), and 62.1% of patients presenting with trigger finger had elevated HbA1c. Among patients with prediabetes/T2DM, 43.4% did not have a primary care provider. Patients with elevated HbA1c were significantly more likely to have unilateral symptoms (p = 0.03) and be female (p = 0.008).

Hand surgeons can successfully identify patients with elevated HbA1c, particularly in the range of prediabetes where the disease state is more reversible. Point-of-care HbA1c testing could be incorporated into hand surgery practices as a low-cost and rapid intervention to optimise outcomes of surgery and facilitate earlier treatment of hyperglycemia.