Clinical Factors Associated with Musculoskeletal Injuries in Children and Adolescents with Diabetes Mellitus

Abstract Background: To examine the incidence of traumatic and overuse Musculoskeletal Injuries (MSI) in children and adolescents with diagnosed diabetes mellitus, which has been understudied. Methods: Using a population-based, retrospective cohort design and South Carolina's (USA) Medicaid claims dataset covering outpatient and inpatient medical services, and medication prescriptions over an 11-year period for patients < 17 years of age with > 2 visits for ICD-9 diagnostic codes for diabetes mellitus, a cohort of 5448 cases was identified and analyzed using logistic regression to compare risk factors for those who sustained MSIs with those who did not. Results: Incident joint, back, or muscle pain, contracture, spasms, or swelling were diagnosed, in addition to upper limb fractures and sprains, costochondritis, and stress fractures, usually in adolescence. Comorbid obesity (30.6%), dyslipidemia (22.9%), primary hypertension (18.7%), substance use disorder (7.4%), and arrhythmia (5.6%) were diagnosed in the cohort as were peripheral neuropathy (2.7%) and early cardiovascular disease (5.5%). While traumatic fractures and concussions were more closely associated with cardiovascular conditions and substance abuse, sprains, dislocations, and all micro-traumatic, overuse injuries were associated with comorbid obesity, dyslipidemia, and hypertension, as well as with less-frequent incident arrhythmia, and the cardiovascular and peripheral neuropathy complications of diabetes. Conclusions: These findings add to the existing, primarily adult, literature regarding the musculoskeletal manifestations of diabetes and cardio-metabolic disorders in youth and update the knowledge base of pediatric practitioners to enable them to better anticipate the clinical care needs of such patients and provide them more effective care.