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dc.contributor.advisorKluding, Patricia M
dc.contributor.authorAlenazi, Aqeel M
dc.date.accessioned2020-03-25T18:01:06Z
dc.date.available2020-03-25T18:01:06Z
dc.date.issued2019-12-31
dc.date.submitted2019
dc.identifier.otherhttp://dissertations.umi.com/ku:16786
dc.identifier.urihttp://hdl.handle.net/1808/30164
dc.description.abstractA growing body of evidence shows that there is an association between osteoarthritis (OA) and Type 2 diabetes mellitus (DM). However, the impact of DM on OA prevalence, specific OA locations, and pain remain poorly understood. Therefore, the primary purpose of this work was to examine the association of DM with OA in terms of prevalence and pain using large data sets. Particularly, three specific aims were studied in this dissertation. First, we examined the prevalence and risk factors for generalized OA (involving 3 or more joints) compared localized OA (involving only one or two joints). Second, we examined the association between type 2 DM and pain severity in people with localized OA. Finally, we examined the association between DM and knee pain locations, including localized, regional and diffused knee pain in people with knee OA. Chapter 2 describes a preliminary work for this dissertation examining the association of DM with knee pain severity and knee pain distribution (unilateral or bilateral versus no pain) in people with knee OA. This work included a cross-sectional analysis of the baseline visit of individuals who were enrolled in the Osteoarthritis Initiative. Data for participants with knee OA were used for this analysis (n=1319). Pain severity was measured using a numeric rating scale from 0 to 10 over the past 7 and 30 days for each knee. We found that DM was significantly associated with increased knee pain severity. Moreover, we observed a significant association between DM and unilateral and bilateral knee pain. These results indicated the potential effect of DM on short-term and long-term knee pain severity as well as joint distribution. Building upon the preliminary findings from the preliminary study in chapter 2, we examined the association between DM and OA with a focus on comparing people with generalized and localized OA. As described in chapter 3, we examined the prevalence of type 2 DM among people with generalized OA compared to localized OA along with the associated risk factors including demographic risk factors and chronic diseases (i.e. Type 2 DM, hypertension, dyslipidemia, neuropathy, and body mass index). A retrospective review of data was performed using the Healthcare Enterprise Repository for Ontological Narration (HERON), and patients with diagnostic codes for OA were selected. Data from 3855 individuals included patients with generalized OA (n=1265) and localized OA (n=2590). The prevalence of type 2 DM was significantly greater among patients with generalized OA compared to localized OA. Significant associations were found between generalized OA and type 2 DM, hypertension, and dyslipidemia. The findings from this chapter highlighted that chronic diseases including type 2 DM, hypertension and dyslipidemia might affect any joints or multiple parts due to their systemic inflammatory impact on joints and vascular systems innervating joints resulting in generalized OA. Investigating the association between type 2 DM and OA in further details, we analyzed the association of type 2 DM with pain severity in people with localized OA to understand the association whether limited to knee joint as described in chapter 2 or at any other localized joint. Chapter 4 examined the association between Type 2 Diabetes and pain severity in people with localized OA, and explored the association between glycemic control measured by A1c level and pain severity in people with localized OA and type 2 DM. A retrospective design using HERON database was used, and data from 819 patients were obtained and grouped into localized OA only (n=671) and localized OA+type2 DM (n=148) based on diagnoses codes. An index date was set as the first diagnosis date of localized OA and linked to pain severity, measured by numeric rating scale from 0 to 10. Hemoglobin A1c values were obtained for patients with T2D within six months of the index date. Type 2 DM was significantly associated with increased pain severity. Furthermore, for patients with type 2 DM and localized OA with available data for A1c (n=87), the results showed that increased A1c value was significantly associated with higher pain severity. These results suggested a negative impact of type 2 DM on pain severity in people with localized OA and extends beyond the knee joint, as shown in chapter 2 using a different dataset and population. To study in-depth the association of DM with pain in people with OA, Chapter 5 described the results of the association of DM with knee pain locations in people with knee OA. Another exploratory analysis emerged to identify the association of DM with knee pain during walk and walking speed. This study used data from 1790 individuals from the osteoarthritis initiative with knee pain and grouped into knee OA and diabetes (n=236) or knee OA only (n=1554). Knee pain locations were categorized to no pain, localized, regional, or diffused pain. Knee pain during a 20-meter walk test was categorized as: no pain, mild, moderate, and severe knee pain. Walking speed was measured using a 20 m walk test. The results showed that DM was associated with regional knee pain, moderate, and severe pain during walk. Additionally, DM was associated with decreased walking speed. These results suggested that DM can cause damage to the musculoskeletal system and might affect pain locations and walking performance in people with knee OA. In summary, this body of work has shown that DM was associated with higher pain severity, bilateral and unilateral knee pain in people with knee OA. This work has identified the prevalence of DM in people with generalized OA and age, sex, DM, hypertension, and dyslipidemia were associated with generalized OA compared to localized OA. Our results found that DM was associated with higher pain severity in people with localized OA. Furthermore, glycemic control measured by A1c was associated with higher pain severity in people with DM and localized OA. Our findings demonstrated that DM was associated with specific knee pain pattern (regional knee pain), but not diffused or localized knee pain in people with knee OA. Finally, we found that DM was associated with increased knee pain during walk and walking speed in people with knee OA. This body of work is important for clinicians in many aspects. First, clinicians should consider DM as a risk factor during pain management for people with knee OA, whether bilateral or unilateral. Second, because people with DM, hypertension, and dyslipidemia appear to be at higher risk of generalized OA, they may benefit from screening and an interventional approach to manage arthritis in multiple parts of the body. Third, health care providers should emphasize that better A1c control might help with pain management in people with DM and OA. Finally, we suggest that clinicians should include walking speed assessments for patients with DM and knee OA to rule out any future risk. The findings from this dissertation highlighted the need for future research to identify whether DM causes OA or vice versa. In addition, the potential mechanisms for the association between DM and OA is an essential step for future studies. Although parts of this dissertation focused on pain, there is a critical need to examine the longitudinal impact of DM on pain and symptoms in this population.
dc.format.extent161 pages
dc.language.isoen
dc.publisherUniversity of Kansas
dc.rightsCopyright held by the author.
dc.subjectHealth sciences
dc.subjectPhysical therapy
dc.subjectdiabetes
dc.subjectgeneralized osteoarthritis
dc.subjectlocations
dc.subjectosteoarthritis
dc.subjectpain
dc.subjectprevalence
dc.titleThe Impact of Diabetes on Osteoarthritis Prevalence and Pain
dc.typeDissertation
dc.contributor.cmtememberRucker, Jason
dc.contributor.cmtememberSharma, Neena K
dc.contributor.cmtememberWick, Jo
dc.contributor.cmtememberWaitman, Lemuel R
dc.thesis.degreeDisciplinePhysical Therapy & Rehabilitation Sciences
dc.thesis.degreeLevelPh.D.
dc.identifier.orcid
dc.rights.accessrightsopenAccess


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