Ann Rehabil Med.  2016 Oct;40(5):779-785. 10.5535/arm.2016.40.5.779.

Relationship Between HbA1c and Complex Regional Pain Syndrome in Stroke Patients With Type 2 Diabetes Mellitus

• Choi JH
• Yu KP
• Yoon YS
• Kim ES
• Jeon JH

• KMID: 2382909
• DOI: http://doi.org/10.5535/arm.2016.40.5.779

Abstract

OBJECTIVE
To investigate the relationship between glycosylated hemoglobin A (HbA1c) and complex regional pain syndrome (CRPS) in stroke patients with type 2 diabetes mellitus (T2DM).
METHODS
A retrospective chart review was performed of stroke patients from January 2012 to December 2013. We reviewed 331 patients and included 200 in the analysis. We divided them into CRPS and non-CRPS groups and compared them by age, gender, stroke lesion, cause of stroke, duration of T2DM, HbA1c (%), National Institutes of Health Stroke Scale score, affected shoulder flexor muscle strength, Fugl-Meyer Assessment score, motricity index, Functional Independence Measure, Korean version of Modified Barthel Index, blood glucose level on admission day, duration from stroke onset to HbA1c check, and duration from stroke onset to three-phase bone scan for CRPS diagnosis. Thereafter, we classified the patients into five groups by HbA1c level (group 1, 5.0%-5.9%; group 2, 6.0%-6.9%; group 3, 7.0%-7.9%; group 4, 8.0%-8.9%; and group 5, 9.0%-9.9%) and we investigated the difference in CRPS prevalence between the two groups.
RESULTS
Of the 200 patients, 108 were in the CRPS group and 92 were in the non-CRPS group. There were significant differences in HbA1c (p<0.05) between the two groups but no significant differences in any other factors. Across the five HbA1c groups, there were significant differences in CRPS prevalence (p<0.01); specifically, it increased as HbA1c increased.
CONCLUSION
This study suggests that higher HbA1c relates to higher CRPS prevalence and thus that uncontrolled blood glucose can affect CRPS occurrence in stroke patients with diabetes.

Keyword

Glycosylated hemoglobin A; Complex regional pain syndromes; Diabetes mellitus; Stroke

MeSH Terms

Blood Glucose
Complex Regional Pain Syndromes
Diabetes Mellitus
Diabetes Mellitus, Type 2*
Diagnosis
Hemoglobin A, Glycosylated
Humans
Muscle Strength
National Institutes of Health (U.S.)
Prevalence
Retrospective Studies
Shoulder
Stroke*
Blood Glucose
Hemoglobin A, Glycosylated

Figure

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  Fig. 1 Flow diagram of patients included in this study by CRPS versus non-CRPS groups. DM, diabetes mellitus; CRPS, complex regional pain syndrome; PPN, peripheral polyneuropathy.

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  Fig. 2 Flow diagram of the five HbA1c groups. DM, diabetes mellitus; HbA1c, glycosylated hemoglobin A.

• 

  Fig. 3 CRPS prevalence by HbA1c; as HbA1c increased, CRPS prevalence increased. CRPS, complex regional pain syndrome; HbA1c, glycosylated hemoglobin A.

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