Hu Huiqing, Wang Chuan, Liang Kai, He Qin, Song Jia, Guo Xinghong, Hou Xinguo, Chen Li, Yan Fei
Department of Endocrinology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, People's Republic of China.
Institute of Endocrine and Metabolic Diseases of Shandong University, Jinan, 250012, People's Republic of China.
Diabetes Metab Syndr Obes. 2022 Mar 15;15:827-837. doi: 10.2147/DMSO.S352735. eCollection 2022.
Patients with type 2 diabetes (T2DM) often suffer from muscle cramps of varying severity. Studies have shown that muscle cramp is closely related to local microcirculation perfusion disorders. Diabetic retinopathy can not only reflect the microcirculation perfusion in the eye but also the systemic microcirculation in patients with diabetes. The aims of this study were to investigate the relationship between muscle cramps and diabetic retinopathy in patients with type 2 diabetes.
A total of 150 adult patients with type 2 diabetes were enrolled and administered a questionnaire on muscle cramping, along with a visual analogue scale for pain. Diabetic retinopathy (DR) was determined by using fundus photography and graded as non-proliferative DR (NPDR) and proliferative DR (PDR). To assess whether there was an association between the muscle cramps and diabetic retinopathy, we conducted binomial logistic regression analysis.
Our study revealed that 48% of patients with T2DM experienced muscle cramps in the past three months. Patients self-reported suffering from muscle cramps exhibited a higher prevalence of DR (61% vs 38%, P < 0.05) and PDR (22% vs 4%, P < 0.05) compared with patients without muscle cramps. Serum 25-(OH) vitamin D, calcium, and magnesium levels were not significantly different between patients with and without muscle cramps. After adjusting for age, duration of diabetes, HbA1c, vitamin D, potassium, calcium, and magnesium, we demonstrated that diabetic retinopathy (OR, 2.18; 95% CI, 1.01-4.69; P< 0.05) and albumin (OR, 0.90; 95% CI, 0.82-1.00; P< 0.05) were highly associated with muscle cramps. Binomial logistic regression analysis also indicated that severity of DR is associated with muscle cramps. In addition, DR and PDR were found to be associated with muscle cramp frequency (P for trend < 0.05), duration (P for trend < 0.05), and pain severity (P for trend < 0.05).
Muscle cramps occur frequently in diabetes and are correlated with diabetic retinopathy and albumin. Patients with PDR exhibited a higher frequency, severity, and longer duration relative to those with NPDR or without DR. Our findings suggested that muscle cramps in individuals with T2DM might be a result of microvascular dysfunction. Modulation of microvascular perfusion might thus provide a therapeutic target for alleviating muscle cramps.
2型糖尿病（T2DM）患者常遭受不同程度的肌肉痉挛。研究表明，肌肉痉挛与局部微循环灌注障碍密切相关。糖尿病视网膜病变不仅能反映眼部的微循环灌注，还能反映糖尿病患者的全身微循环情况。本研究旨在探讨2型糖尿病患者肌肉痉挛与糖尿病视网膜病变之间的关系。
共纳入150例成年2型糖尿病患者，对其进行肌肉痉挛问卷调查，并采用视觉模拟疼痛量表进行评估。通过眼底照相确定糖尿病视网膜病变（DR），并分为非增殖性DR（NPDR）和增殖性DR（PDR）。为评估肌肉痉挛与糖尿病视网膜病变之间是否存在关联，我们进行了二项逻辑回归分析。
我们的研究显示，48%的T2DM患者在过去三个月内经历过肌肉痉挛。与无肌肉痉挛的患者相比，自述有肌肉痉挛的患者DR患病率更高（61%对38%，P<0.05），PDR患病率更高（22%对4%，P<0.05）。有和无肌肉痉挛的患者血清25-（OH）维生素D、钙和镁水平无显著差异。在调整年龄、糖尿病病程、糖化血红蛋白、维生素D、钾、钙和镁后，我们发现糖尿病视网膜病变（OR，2.18；95%CI，1.01-4.69；P<0.05）和白蛋白（OR，0.90；95%CI，0.82-1.00；P<0.05）与肌肉痉挛高度相关。二项逻辑回归分析还表明，DR的严重程度与肌肉痉挛有关。此外，发现DR和PDR与肌肉痉挛频率（趋势P<0.05）、持续时间（趋势P<0.05）和疼痛严重程度（趋势P<0.05）有关。
糖尿病患者中肌肉痉挛频繁发生，且与糖尿病视网膜病变和白蛋白相关。与NPDR或无DR的患者相比，PDR患者的肌肉痉挛频率更高、严重程度更高且持续时间更长。我们的研究结果表明，T2DM患者的肌肉痉挛可能是微血管功能障碍的结果。因此，调节微血管灌注可能为缓解肌肉痉挛提供一个治疗靶点。
