Hand conditions associated with diabetes: an observational study characterising hand function.

Abstract

In Chapter 1 of this thesis, I review the literature relating to the hand syndromes associated with diabetes. I describe their unique clinical features and current treatment options. I consider how these hand syndromes may contribute to physical disability in diabetes and formulate questions relating to the degree and the course of this disability. In Chapter 2, I describe and discuss the rationale for selecting the methods used to measure hand function. The methods used to measure disability and quality of life from the individual’s perspective and evaluate motor and sensory impairments of the hand are explained. Other data that was collected, such as body weight, height and information on diabetes duration and control, are discussed. The sample size required to detect a change in hand function is calculated and the clinics from which study participants were recruited are outlined. In Chapter 3, I describe the characteristics of the sample of adults with diabetes and the associated hand syndromes at their first assessment. My analysis of the factors that predicted hand disability at the initial presentation in this heterogeneous group is presented. In Chapters 4, I describe the change in hand function measured over the second and third assessments and determine the factors that were associated with this change. My analysis is extended to examine differences between the dominant and non-dominant hands and between men and women. In Chapter 5, I consider the precision of measures of hand function and discuss how this affected the data obtained. Minimal detectable changes are analysed and recommendations regarding hand assessments are made. In Chapter 6, I summarize the evidence that carpal tunnel syndrome and trigger finger contributed to hand disability in adults with diabetes. In addition to specific treatment strategies for these disorders strategies to address broader health issues are recommended. A greater emphasis should be given to strengthening the upper limb and implementing strategies to address physical inactivity and obesity in adults with diabetes.