Prevalence and association of chronic musculoskeletal pain on self-management, glycemic control and quality of life among Chinese type 2 diabetes patients in primary care

Aims: To examine the prevalence of chronic musculoskeletal (MSK) pain and its association with diabetes selfmanagement, glycemic control and health-related quality of life (HRQoL) in patients with diabetes mellitus (DM) in primary care. Methods: 329 patients with type 2 DM were recruited at public primary care clinics in Hong Kong. Chronic MSK pain was defined as having MSK pain >= 3 months, and the pain severity was measured by Brief Pain Inventory (BPI). Diabetes Management Self-Efficacy Scale (DMSES), hemoglobin A1c (HbA1c) and EuroQuol-5D (EQ5D) were collected. Multivariable regression was used to examine the association between the presence of chronic MSK pain with DMSES, HbA1c and EQ5D, adjusted for baseline confounders such as age, sex, BMI, duration of DM and comorbid depression. Results: Approximately 49.5% of respondents reported chronic MSK pain with a median BPI severity score of 3.5 (2.0-5.0). The presence of chronic MSK pain was associated with lower HRQoL (beta = -0.053, 95% CI -0.087 to -0.018, P = 0.003), but was not associated with the diabetes self-management and glycemic control. Depression was associated with poorer diabetes self-management (beta = -2.776, 95% CI -4.247 to -1.304, P < 0.001) and HRQoL.(beta = -0.018,95% CI-0.025 to -0.012, P < 0.001). Conclusions: Chronic MSK pain was present in nearly half of the diabetic patients in primary care; however, the degree of pain was mild and had not shown to affect diabetes self-management and glycemic control. Depression was associated with poorer diabetes self-management. Chronic MSK pain and depression were both associated with poorer HRQoL.