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Pappalardo M, Gori L, Randazzo E, Morganti R, Scaglione M, Valiani M, Beni A, Di Cicco M, Peroni DG, Franzoni F, Comberiati P. Ultrasound and Clinical Alterations in the Foot of Children with Obesity and Diabetes. Diagnostics (Basel) 2023; 13:2781. [PMID: 37685319 PMCID: PMC10486527 DOI: 10.3390/diagnostics13172781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 08/22/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Alterations in plantar soft tissues are often reported in adults with diabetes, whereas data on children are conflicting. Also, the extent of foot damage caused by excess body fat in children has not been fully characterized yet. This study aimed to address the relationship between body mass and structural changes of the foot in children and adolescents with and without diabetes. METHODS In a case-control study, 43 participants (age 13 ± 2.6 years) were recruited, 29 (67%) with type 1 diabetes (T1D) and 14 (33%) controls. Anthropometric parameters [body mass index (BMI), waist circumference (WC), and waist-to-height ratio (WHtR)], foot posture index-6 (FPI-6) for static foot posture, and navicular drop test (NDT) for medial longitudinal arch height (MLA) were measured in all participants. The thickness of the midfoot plantar fascia (MPF) and medial midfoot fat pad (MMFP) were quantified using ultrasound. RESULTS No differences in clinical and ultrasonographical parameters were observed between the study groups. MMFP thickness was correlated with MPF thickness (p = 0.027). MMFP and MPF thicknesses were positively associated with BMI (p < 0.001 and p = 0.013, respectively), WC (p < 0.001 and p = 0.013), and WHtR (p < 0.001 and p = 0.026). The NDT measured on the right and left foot correlated with WHtR (p = 0.038 and p = 0.009, respectively), but not with WC and BMI. CONCLUSIONS Children with T1D show structural alterations of plantar soft tissues which seem related to body mass increase rather than diabetes pathology. Ultrasound is a valuable tool to assess early structural changes of the foot in young people with an elevated BMI.
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Affiliation(s)
- Martina Pappalardo
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
| | - Laura Gori
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
| | - Emioli Randazzo
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
| | - Riccardo Morganti
- Section of Statistics, University Hospital of Pisa, 56126 Pisa, Italy
| | | | - Margherita Valiani
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
| | - Alessandra Beni
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
| | - Maria Di Cicco
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Diego G. Peroni
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Ferdinando Franzoni
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
| | - Pasquale Comberiati
- Azienda Ospedaliero Universitaria Pisana, UO Pediatria Universitaria, 56126 Pisa, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy
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Swain J, Teli B, Sahoo A, Kasukurti L. Limited Joint Mobility in Type 1 Diabetes: Diabetic Cheiroarthropathy, a Neglected Entity. JCEM CASE REPORTS 2023; 1:luad068. [PMID: 37908990 PMCID: PMC10580465 DOI: 10.1210/jcemcr/luad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Indexed: 11/02/2023]
Abstract
Musculoskeletal disorders are common in type 1 and type 2 diabetes mellitus. Among them, diabetic cheiroarthropathy (DCA), more commonly seen in type 1 diabetes, is a late complication that often causes physical and emotional disturbance. DCA, characterized by movement restrictions in the small joints of hands, is usually a clinical diagnosis and bears significance owing to the functional hand disabilities that it causes and its association with various microvascular complications, most importantly retinopathy. A 24-year-old male patient, with type 1 diabetes of 20 years duration, presented to us with difficulties in performing fine motor tasks such as buttoning his shirt and with positive "Namaste" sign and "Table Top" sign. He had reduced sensation on monofilament testing, decreased vibration perception threshold, and a nerve conduction study suggested distal sensory demyelinating and axonal polyneuropathy. He had a restrictive pattern on pulmonary function tests, normal lung parenchyma on high-resolution computed tomography of his thorax, proliferative diabetic retinopathy, proteinuria, vitamin D deficiency, and subclinical hypothyroidism. He was followed closely with tight glycemic control and physiotherapy. In rural setups, DCA can act as a mirror to screen for macrovascular and microvascular complications if not already done routinely or previously. Management includes physiotherapy, glycemic control, patient education, and regular follow-up, with surgical procedures being only the last option.
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Affiliation(s)
- Jayshree Swain
- Department of Endocrinology, IMS & Sum Hospital, Bhubaneswar, 751003, Odisha, India
| | - Brij Teli
- Department of Endocrinology, IMS & Sum Hospital, Bhubaneswar, 751003, Odisha, India
| | - Abhay Sahoo
- Department of Endocrinology, IMS & Sum Hospital, Bhubaneswar, 751003, Odisha, India
| | - Lavanya Kasukurti
- Department of Endocrinology, IMS & Sum Hospital, Bhubaneswar, 751003, Odisha, India
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Muacevic A, Adler JR, Jain V, Mannar V, Dalvi M. Diabetic Cheiroarthropathy in Type 1 Diabetes Mellitus and Coeliac Disease. Cureus 2022; 14:e31708. [PMID: 36561602 PMCID: PMC9767792 DOI: 10.7759/cureus.31708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2022] [Indexed: 11/22/2022] Open
Abstract
Diabetes mellitus can be associated with a variety of musculoskeletal disorders. Diabetic cheiroarthropathy or diabetic hand syndrome is one of the complications encountered in long-standing uncontrolled diabetes. It is characterized by limited movement of the joints of the hands along with thickening of the skin on the palmar and dorsal surfaces. There is an association between diabetic cheiroarthropathy and microvascular complications of diabetes, most commonly diabetic retinopathy. Early diagnosis of cheiroarthropathy can give the clinician an opportunity to screen for microvascular complications. Cheiroarthropathy is usually a clinical diagnosis. Treatment involves achievement of good glycemic control along with physiotherapy and occupational therapy. We have described the case of a 16-year-old adolescent male with uncontrolled type 1 diabetes and coeliac disease who presented to us with diabetic cheiroarthropathy.
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STIRLING PHC, DUCKWORTH AD, McEACHAN JE. Self-Reported Disability Following Surgery for Dupuytren Contracture in Diabetic and Non-Diabetic Patients. J Hand Surg Asian Pac Vol 2022; 27:453-458. [DOI: 10.1142/s2424835522500473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The aims of this study were to investigate the impact of diabetes mellitus on patient-reported functional outcome measures (PROMs) and satisfaction following surgical treatment of Dupuytren contracture. Methods: Preoperative and 1-year postoperative PROMs were collected prospectively over 6 years (2013–2019). Patients completed the QuickDASH score and were asked ‘how normal is your hand?’, recording responses on a 100-point visual analogue scale. Patient satisfaction was also self-reported. Results: Paired responses were available for 520 hands (478 patients; 72% follow-up rate). There were 62 patients with diabetes (12%). Pre (12.5 vs. 9.1; p = 0.01) and postoperative (11.4 vs. 6.8; p = 0.02) QuickDASH scores were significantly, but not clinically, worse in diabetic patients. Patient satisfaction was high in both groups. A large and significant improvement in self-perceived hand normality was observed in both groups (p < 0.05). No significant differences were observed in preoperative or change in hand normality between the groups, but the postoperative normal hand score was significantly higher in non-diabetic patients (94 vs. 90; p = 0.02). Conclusion: Our study has demonstrated statistically significantly worse disability in diabetic patients with Dupuytren contracture both pre- and postoperatively, though the observed differences were far below the minimum clinically important difference for the QuickDASH. Both groups reported a large and statistically significant improvement in self-perceived hand normality following surgery. Level of Evidence: Level III (Therapeutic)
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Affiliation(s)
- Paul H. C. STIRLING
- Queen Margaret Hospital, Dunfermline, UK
- Edinburgh Orthopaedics, University of Edinburgh and Royal Infirmary of Edinburgh, UK
| | - Andrew D. DUCKWORTH
- Edinburgh Orthopaedics, University of Edinburgh and Royal Infirmary of Edinburgh, UK
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Royle LN, Muthee BW, Rosenbaum DG. Inflammatory conditions of the pediatric hand and non-inflammatory mimics. Pediatr Radiol 2022; 52:104-121. [PMID: 34415360 DOI: 10.1007/s00247-021-05162-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/18/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
Hand involvement can assume an outsized role in the perception and presentation of disease as a result of functional impairment, visual conspicuity and susceptibility to early structural damage. Rheumatologic referral for inflammatory conditions can be delayed because of assumptions of a traumatic, infectious or neoplastic etiology; conversely, initial rheumatologic evaluation might be pursued for many of the same non-inflammatory causes. This pictorial essay highlights inflammatory conditions affecting the pediatric hand, including juvenile idiopathic arthritis, infectious arthritis, systemic connective tissue disorders, and a variety of less common inflammatory diseases, as well as non-inflammatory congenital, vascular, neoplastic and metabolic differential considerations.
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Affiliation(s)
- Leanne N Royle
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Bernadette W Muthee
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada
| | - Daniel G Rosenbaum
- Department of Radiology, British Columbia Children's Hospital, University of British Columbia, 4500 Oak St., Vancouver, BC, V6H 3N1, Canada.
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Muluneh AG, Adem KS, Dawud JS, Kibret AK, Yitayal MM, Eriku GA. Upper-Extremity Musculoskeletal Disorders and Their Associated Factors Among Diabetes Mellitus Patients Attending at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Northwest Ethiopia: Cross-Sectional Study. Front Endocrinol (Lausanne) 2022; 13:856521. [PMID: 35557847 PMCID: PMC9086430 DOI: 10.3389/fendo.2022.856521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/03/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Globally, diabetes mellitus (DM) is a major public health, causing functional disability among those affected. Among the common diabetes mellitus-related complications, musculoskeletal disorders had a significant negative impact on the social health quality of life and productivity of individuals. Evidence in this regard, however, is scarce in Ethiopia. Therefore, this study aimed at determining the prevalence of musculoskeletal disorders and identifying factors associated in people with diabetes in Felege Hiwot Comprehensive Specialized Hospital, northwest Ethiopia. METHODS A cross-sectional study design was employed at Felege Hiwot Comprehensive Specialized Hospital from June 01 to August 30, 2020, among 413 participants. A systematic random sampling was employed to select the study participants. A structured, pretested questionnaire was used to collect data on socio-demographic, clinical, and lifestyle characteristics. Musculoskeletal disorders were assessed through clinical and physical examination. A logistic regression model was used to explore factors associated with musculoskeletal disorders. RESULT The prevalence of musculoskeletal disorders among diabetes mellitus patients was 24% (95% CI 20, 28.3). In logistic regression, factors such as being female, older age, occupation (farmer, merchant, and retired), and long duration of diabetes were significantly associated with musculoskeletal disorders. CONCLUSION Nearly one quarter of the study participants had musculoskeletal disorders. Special attention should be given for those individuals living with diabetes mellitus, particularly for those who are female, are older, and had a prolonged history of diabetes mellitus.
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Affiliation(s)
- Assefa Gebeyehu Muluneh
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kedir Sany Adem
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Jemal Suleyman Dawud
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemu Kassaw Kibret
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Melisew Mekie Yitayal
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Azeze Eriku
- Department of Physiotherapy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- *Correspondence: Getachew Azeze Eriku,
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Mineoka Y, Ishii M, Hashimoto Y, Yuge H, Toyoda M, Nakamura N, Katsumi Y, Fukui M. Trigger finger is associated with risk of incident cardiovascular disease in individuals with type 2 diabetes: a retrospective cohort study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002070. [PMID: 33832915 PMCID: PMC8039242 DOI: 10.1136/bmjdrc-2020-002070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/09/2021] [Accepted: 03/14/2021] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Trigger finger is one of the complications affecting the upper extremity in patients with diabetes. Diabetes is also a well-known risk factor that predisposes individuals to cardiovascular diseases (CVDs). This retrospective cohort study aimed to establish the association between trigger finger and the patients with incident CVD with type 2 diabetes. MATERIALS AND METHODS Trigger finger was diagnosed by palpating a thickened tendon during flexion or on the manifestation of a locking phenomenon during extension or flexion of either finger. The relationship between trigger finger and other clinical parameters or complications of diabetes was examined by a comparative analysis. Cox regression analysis was used to evaluate the association between trigger finger and incidence of CVD. We calculated the propensity scores using sex, body mass index, age, smoking status, duration of diabetes, estimated glomerular filtration rate, hypertension, dyslipidemia, and hemoglobin A1c as the number of patients with incident CVD during the follow-up period was low. RESULTS Among the 399 patients with type 2 diabetes, 54 patients had trigger finger. Patients with trigger finger were significantly older in age and had been suffering from diabetes for a longer duration. They also displayed worse renal function and glycemic control, along with a higher incidence of hypertension, neuropathy and nephropathy. During the average 5.66±1.12 years of follow-up, a total of 18 incidents occurred. According to the Cox regression analysis, trigger finger was shown to be associated with enhanced risk of the incidence of CVD after adjustment for the covariates (adjusted HR=3.33 (95% CI 1.25 to 8.66), p=0.017). CONCLUSIONS Trigger finger is associated with the risk of incident CVD in patients with type 2 diabetes. Thus, clinicians must consider these factors at the time of diagnosis of such patients.
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Affiliation(s)
- Yusuke Mineoka
- Department of Internal Medicine, Otsu City Hospital, Otsu, Shiga, Japan
| | - Michiyo Ishii
- Department of Internal Medicine, Otsu City Hospital, Otsu, Shiga, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Hiroki Yuge
- Department of Internal Medicine, Otsu City Hospital, Otsu, Shiga, Japan
| | - Machiko Toyoda
- Department of Internal Medicine, Otsu City Hospital, Otsu, Shiga, Japan
| | - Naoto Nakamura
- Department of Internal Medicine, Saiseikai Kyoto Hospital, Nagaokakyo, Japan
| | | | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Uslu S, Gülle S, Can G, Sarı İ, Önen F, Birlik M. Evaluation of limited hand mobility in systemic sclerosis patients by using "prayer sign" and "tabletop sign". Clin Rheumatol 2021; 40:2771-2777. [PMID: 33555460 DOI: 10.1007/s10067-021-05623-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 01/27/2021] [Accepted: 01/31/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine limited joint mobility (LJM) of the hand in patients with systemic sclerosis (SSc). METHODS LJM was evaluated with "prayer sign" and "tabletop sign" tests. LJM staging was done by Rosenbloom classification method. LJM (+) and LJM (-) patients were compared in terms of demographic findings (gender, age and duration of disease), laboratory results (ESR, CRP, anti-nuclear antibody (ANA), anti-topoisomerase I and anti-centromere), and modified Rodnan skin score (mRss) results. RESULTS In our study, a total of 217 patients, including 113 patients with a diagnosis of SSc, and 104 as a healthy control group with similar age and gender distribution to these patients, were included. A total of 113 (F=98, M=15) patients (limited cutaneous SSc (lcSSc=71), diffuse cutaneous SSc (dcSSc=42)) were included in this study and LJM positivity was found in 66.4% (lcSSc=38, dcSSc=37). A statistically significant difference was observed in between lcSSc and dcSSc patients according to the presence of LJM (p<0.001). There was a moderate positivity relationship between LJM and mRss (lcSSc r=0.449, p<0.001; dcSSc r=0.565, p<0.001). CONCLUSIONS In our study, it was found that LJM staging correlated with mRss and dcSSc patients had more severe LJM findings than lcSSc. We conclude that "prayer sign" and "tabletop sign" tests used in hand evaluation in SSc patients have similar clinical results with mRss and can be simple bedside tests in daily practice. Key Points • This is the first study examining limited joint mobility (LJM) with "prayer sign" and "tabletop sign" tests in systemic sclerosis (SSc) patients. • "Prayer sign" and "tabletop sign" tests can be easily performed in daily practice. • We found Rosenbloom LJM staging correlated with modified Rodnan skin score. LJM of the hand can be a good prognostic indicator for early stage SSc patients.
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Affiliation(s)
- Sadettin Uslu
- Department of Rheumatology, Ömer Halisdemir University Bor Physical Medicine and Rehabilitation, Training and Research Hospital, Niğde, Turkey.
| | - Semih Gülle
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Gerçek Can
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - İsmail Sarı
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Fatoş Önen
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
| | - Merih Birlik
- Department of Rheumatology, Dokuz Eylul University School of Medicine, Izmir, Turkey
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Trihan JE, Lanéelle D, Metcalfe N, Perez Martin A, Frances P. Diabetes-associated dermatological manifestations in primary care and their association with vascular complications. J Diabetes Metab Disord 2020; 19:989-996. [PMID: 33520817 PMCID: PMC7843712 DOI: 10.1007/s40200-020-00594-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although type 2 diabetes mellitus (DM) is a global public health problem, the diabetes-associated dermatological (non-infectious) manifestations (DADM) remain poorly understood and under-diagnosed. We aimed to evaluate the prevalence of 7 known DADM in a primary care setting, and their association macro/microvascular complications. METHODS Cross-sectionnal study included patients consulting in general practice for DM-follow up, from November 2016 to January 2017. Patients aged <18 years old or consulting for other reason than DM follow up were excluded. Each patient were screened for diabetic dermopathy (DD), Huntley's papules (HP), necrobiosis lipoidica diabeticorum (NL), acanthosis nigricans (AN), cheiroarthropathy (CA, or stiff hand syndrom), scleredema adultorum of Buschke (SB) and bullosis diabeticorum (BD). RESULTS 213 diabetic patients were included over a period of 3 months. We found a prevalence of 17.8% (38 patients) for DD, 8.5% (18) for HP, 2.8% (6) for NL, 2.3% (5) for AN, 1.9% (4) for CA, 1.4% (3) for SB and 1.4% (3) for BD. DADM seems to be a risk factor for vascular complications (OR 1.97, p ≤ 0.001). Association with vascular involvement was stronger with DD and macroangiopathy (OR 1.86, p ≤ 0.001), and with NL and microangiopathy (OR 9.7, p ≤ 0.001). CONCLUSION In primary care, DM-associated dermatological manifestations present similar prevalence rates to a tertiary care setting, based on litterature. Complete dermatological examination of diabetic patients is essential and could lead to a better overall management of the pathology, as diabetic cutaneous manifestations appear as a sign of vascular involvement.
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Affiliation(s)
- Jean-Eudes Trihan
- Vascular Medicine Department, University Hospital, 86000 Poitiers, France
| | - Damien Lanéelle
- Vascular Medicine Department, University Hospital, 14000 Caen, France
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Mineoka Y, Ishii M, Hashimoto Y, Hata S, Tominaga H, Nakamura N, Katsumi Y, Fukui M. Limited joint mobility of the hand correlates incident hospitalisation with infection in patients with type 2 diabetes. Diabetes Res Clin Pract 2020; 161:108049. [PMID: 32017959 DOI: 10.1016/j.diabres.2020.108049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 01/22/2020] [Accepted: 01/31/2020] [Indexed: 01/11/2023]
Abstract
AIM Limited joint mobility (LJM) of the hand is one of the important complications of diabetes. Diabetes is a risk factor for hospitalisation with infection. This study investigated the relationship between LJM of the hand and the incidence of hospitalisation with infection in type 2 diabetic patients. MATERIALS AND METHODS LJM of hand was defined as the 'prayer sign' or 'table test'. The association between LJM of the hand and incident hospitalisations was evaluated using Cox regression analysis. The number of incident hospitalisations was small over the course of the study, which we compensated for by calculating propensity scores using age, body mass index, sex, duration of diabetes, creatinine, smoking status, haemoglobin A1c and dyslipidaemia. RESULTS In this retrospective cohort study of 502 patients with type 2 diabetes, 102 patients had LJM of the hand. These patients were, on average, older and had worse renal function and glycaemic control, and a higher proportion of microangiopathy significantly. During the study period, 56 patients were hospitalised with infection. A Cox regression analysis showed that LJM of the hand was associated with an increased probability of incident hospitalisation with infection after adjustment for covariates (HR = 1.65 [95% CI 1.60-1.70], p < 0.001). CONCLUSIONS Our results reveal that LJM of the hand is associated with incident of hospitalisation with infection. A diagnosis of LJM of the hand might, therefore, be a useful indicator for assessing the risk of hospitalisation with infection in type 2 diabetic patients.
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Affiliation(s)
- Yusuke Mineoka
- Department of Internal Medicine, Otsu City Hospital, Japan
| | - Michiyo Ishii
- Department of Internal Medicine, Otsu City Hospital, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan
| | - Shinnosuke Hata
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan
| | | | - Naoto Nakamura
- Department of Internal Medicine, Saiseikai Kyoto Hospital, Japan
| | - Yasukazu Katsumi
- Department of Orthopedics, Jujo Takeda Rehabilitation Hospital, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan.
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Simón-Pérez E, Simón-Pérez C, Alonso-Peña D, Pontón-Cortina A, Chicharro-Luna E, Martínez-Nova A, Navarro-Flores E. Stiffness degree of ankle range of motion in diabetic patients with atypical amputation. Rev Assoc Med Bras (1992) 2020; 66:216-221. [DOI: 10.1590/1806-9282.66.2.216] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 07/28/2019] [Indexed: 12/16/2022] Open
Abstract
SUMMARY In diabetics, foot deformities are risk factors that increase the risk of amputation as a result of developing ulcers. However, knowledge of the influence of plantar stiffness is still limited. The main objective was to describe connections between the degree of stiffness of the ankle, atypical amputation, and the Foot Posture Index (FPI). METHODS 62 diabetic patients, 58 with type 2 and 4 with type 1 (average age 63.35 years) were included. Records of foot deformities were included; A range of motion test of the ankle joint was used to determine the degree of stiffness. An exploratory analysis of the association of foot position and the degree of rigidity was performed. RESULTS The dorsal flexion range of the ankle was 9.6 ± 5.1 0, 13.8 ± 5.9 0 and 17.2 ± 6.5 0 and 20.5 ± 6.8 0 to 45, 67, 89 and 111 N respectively in the amputated feet., And 14 patients (22.58%) had a high level of pronation of IPF with an average value of 3.7 ± 2.629, CI (3.032.-4.367) in amputated feet compared to non-amputees. We use the device “Iowa ankle range of motion” (IAROM) to determine the differences in ankle stiffness. Proper IPF was associated with the presence of amputation and an increase in stiffness CONCLUSIONS There was an increase in the degree of limitation of movement of the ankle, as a greater force was applied. Comparing FPI between the groups, there was a higher frequency of prone feet in the group of amputees
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El Dayem SMA, El Bohy AEM, Battah AA. Sclerodactyly and Diabetic Complications among Egyptian Adolescent Type 1 Diabetic Patient. Open Access Maced J Med Sci 2019; 7:4004-4009. [PMID: 32165942 PMCID: PMC7061366 DOI: 10.3889/oamjms.2019.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/02/2019] [Accepted: 11/03/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND One of the common complications of diabetic patients is sclerodactyly which is considered as a part of limited joint mobility. AIM To assess sclerodactyly in adolescent type 1 diabetics and to detect its relation to other diabetic complications. METHODS Sixty-three diabetics and 60 controls were studied. Clinical, laboratory assessment, ultrasonography of the skin, carotid artery intima-media thickness (cIMT) & renal colour duplex were done for all participants. RESULTS Sclerodactyly was positive in 12 (19%) of diabetics. Patients with sclerodactyly had a significantly thickened skin compared to patients without sclerodactyly and controls, P = 0.0001. Male diabetics had significantly thickened skin (p = 0.0001). Diabetic patients with sclerodactyly had significant higher systolic blood pressure (p = 0.03), cholesterol (p = 0.05) and triglyceride (p = 0.004) and lower HDL-c (p = 0.04). Skin thickness had a significant positive correlation with age of diabetic patients (p = 0.02), waist/height ratio (p = 0.04), glycosylated hemoglobin (p = 0.03), albumin/creatinine ratio (p = 0.03), and cIMT (p = 0.03). CONCLUSION Ultrasound easily diagnoses sclerodactyly. Diabetic patients had a high prevalence of sclerodactyly with increased macrovascular and microvascular complications. Sclerodactyly may be a marker for diabetic vascular complications. Frequent follow up of diabetic patients for early detection of sclerodactyly in uncontrolled diabetic patients is recommended. It could be an alarming sign for microalbuminuria, hypertension, hyperlipidaemia and atherosclerosis.
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Affiliation(s)
| | | | - Ahmed A Battah
- Critical Care Department, Cairo University, Cairo, Egypt
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Quality of metabolic control, serum potassium, and aging are the major determinants of severity of musculoskeletal disorders in hospitalized diabetic patients. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00776-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Varjú C, Kumánovics G, Czirják L, Matucci-Cerinic M, Minier T. Sclerodermalike syndromes: Great imitators. Clin Dermatol 2019; 38:235-249. [PMID: 32513403 DOI: 10.1016/j.clindermatol.2019.10.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sclerodermalike syndromes (SLSs) comprise diseases with mucin deposition (eg, scleromyxedema, scleredema), with eosinophilia (eg, eosinophilic fasciitis), metabolic or biochemical abnormalities (eg, nephrogenic systemic fibrosis), or endocrine disorders (eg, POEMS syndrome, or polyneuropathy, organomegaly, endocrinopathy, monoclonal lymphoproliferative disorder, and hypothyroidism). Chronic graft-versus-host disease may also show sclerodermalike skin changes. Inherited progeria syndromes with early aging (eg, Werner syndrome) and a heterogeneous group of hereditary disorders with either skin thickening (eg, stiff skin syndrome) or atrophy and tightening (eg, acrogeria) can also imitate classic systemic sclerosis (SSc). In addition, SLSs can be provoked by several drugs, chemicals, or even physical injury (eg, trauma, vibration stress, radiation). In SLSs, the distribution of skin involvement seems to be atypical compared with SSc. The acral skin involvement is usually missing, and lack of Raynaud phenomenon, scleroderma-specific antinuclear antibodies, the absence of scleroderma capillary pattern, and internal organ manifestations indicate the presence of an SLS. Skin involvement is sometimes nodular, and the underlying tissues can also be affected. For the differential diagnosis, a skin biopsy of the deeper layers including fascia and muscle is required. Histology does not always allow differentiation between SSc and SLSs; therefore, the diagnosis is often based on the distribution, quality of cutaneous involvement, and other accompanying clinical features.
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Affiliation(s)
- Cecília Varjú
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - Gábor Kumánovics
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - László Czirják
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary
| | - Marco Matucci-Cerinic
- Department of Experimental and Clinical Medicine, Division of Rheumatology, Florence, Italy
| | - Tünde Minier
- Department of Rheumatology and Immunology, University of Pécs Clinical Center, Pecs, Hungary.
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Hill NE, Roscoe D, Stacey MJ, Chew S. Cheiroarthropathy and tendinopathy in diabetes. Diabet Med 2019; 36:939-947. [PMID: 30920669 DOI: 10.1111/dme.13955] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/25/2019] [Indexed: 12/25/2022]
Abstract
Joint problems commonly occur in people with diabetes. Cheiroarthropathy affects the hands and results in painless limited finger joint extension, appearing to be associated with longer diabetes duration and the presence of microvascular complications. The prevalence of cheiroarthropathy seems to be falling, perhaps as a result of improvements in glycaemic management. Non-enzymatic glycation of collagen results in abnormally crosslinked protein resistant to degradation with subsequent increased build-up of collagen in joints. The management of cheiroarthropathy is predominantly conservative, with occupational and hand therapy at the forefront. Tendinopathy is more common in people with diabetes than those without, and is associated with obesity and insulin resistance. As with cheiroarthropathy, the exact causative mechanism of tendinopathy in diabetes is not known, but may be linked to inflammation, apoptosis and increased vascularity of affected tendons, driven by hyperinsulinaemia. Local fat pads have also been suggested to play a role in the pathogenesis of tendinopathy.
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Affiliation(s)
- N E Hill
- Imperial College Healthcare NHS Trust, London
| | - D Roscoe
- Defence Medical Rehabilitation Centre, Loughborough
- University of Loughborough, Loughborough
| | - M J Stacey
- Imperial College Healthcare NHS Trust, London
- Defence Medical Services, Lichfield, UK
| | - S Chew
- Imperial College Healthcare NHS Trust, London
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Hamdy Deso D, Abd El-Wah MS, Nour El-Di SM. Effect of Low Level Laser Therapy on Hand Function Performance
of Children with Type I Diabetes Cheiroarthropathy. JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.3923/jms.2019.56.62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Kaka B, Maharaj SS, Fatoye F. Prevalence of musculoskeletal disorders in patients with diabetes mellitus: A systematic review and meta-analysis. J Back Musculoskelet Rehabil 2019; 32:223-235. [PMID: 30248032 DOI: 10.3233/bmr-171086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is associated with musculoskeletal disorders (MSDs) and is often not clinically diagnosed and managed. There are also no systematic reviews of literature relating to the prevalence of MSDs among people with diabetes. OBJECTIVE To determine the prevalence and areas of the body affected by MSDs in diabetic patients. METHODS A literature search of the electronic databases of CINAH, PubMed, Web of Science and Google Scholar using the keywords of "MSDs and DM" as the search term was conducted. Pooled estimates were calculated using a meta-analysis of proportion. RESULTS Five thousand and eighty-eight studies were identified from the databases; 21 studies fulfilled the inclusion criteria and were included in the review. Five studies were of high quality, 13 were of moderate quality and three were of low quality. The prevalence of all types of MSDs among patients with diabetes was 58.15% (95% CI 41.4%-73.9%). The hand was the most common area of the body affected being 33.05% (95% CI 21.1-46.13) followed by the shoulder. CONCLUSIONS A high prevalence of MSDs was found among diabetic patients with the hand and shoulder being the most frequently reported areas affected. However, future studies with a larger sample and the relevant type of diabetes are required.
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Affiliation(s)
- Bashir Kaka
- Divisions of Physiotherapy, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Sonill Sooknunan Maharaj
- Divisions of Physiotherapy, School of Health Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville, Durban, South Africa
| | - Francis Fatoye
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
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Takahara M, Katakami N, Shiraiwa T, Abe K, Ayame H, Ishimaru Y, Iwamoto M, Shimizu M, Tomonaga O, Yokoyama H, Matsuoka TA, Shimomura I. Evaluation of health utility values for diabetic complications, treatment regimens, glycemic control and other subjective symptoms in diabetic patients using the EQ-5D-5L. Acta Diabetol 2019; 56:309-319. [PMID: 30353354 DOI: 10.1007/s00592-018-1244-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/14/2018] [Indexed: 02/06/2023]
Abstract
AIMS This study aimed to reveal health utility values for diabetic complications and treatment regimens with adjustment for glycemic control and other clinical manifestations in a diabetic population. METHODS The EuroQol 5-Dimension 5-Level (EQ-5D-5L) health utility values for 4963 Japanese diabetic patients were analyzed using a multivariate regression model including major complications and treatment regiments (minimally adjusted model), and that additionally included glycemic control and other subjective symptoms (musculoskeletal, dental, respiratory, gastrointestinal, urinary, and cutaneous symptoms, and hearing impairment) (further adjusted model). RESULTS The mean utility value was 0.901 ± 0.137. In the minimally adjusted model, blindness, overt nephropathy, regular dialysis, cardiac symptom, sequelae of stroke, symptomatic peripheral neuropathy, decreased sensation, claudication, foot ulcer/gangrene, major amputation, and complex treatment regimens were significantly associated with lower utility values, whereas proliferative retinopathy without blindness, coronary artery disease without cardiac symptom, sequela-free cerebrovascular disease, asymptomatic peripheral artery disease, and minor amputation were not. Major complications and treatment regimens that showed significant association in the minimally adjusted model still presented significant impact on the utility decrement in the further adjusted model. However, most of their regression coefficients were lower in absolute value compared to those in the minimally adjusted model. CONCLUSIONS The utility decrement related to each diabetic complication varied with its severity and accompanying symptoms. Complex treatment regimens were independently associated with lower utility values. The utility decrement associated with diabetic complication and complex treatment regimens would be overestimated in the analysis without adjustment for glycemic control or other subjective symptoms.
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Affiliation(s)
- Mitsuyoshi Takahara
- Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Naoto Katakami
- Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | | | - Yasuaki Ishimaru
- Dr. Yasuyo Ishimaru Memorial Kumagaya Diabetes Clinic, Saitama, Japan
| | | | | | - Osamu Tomonaga
- Diabetes and Lifestyle Center, Tomonaga Clinic, Tokyo, Japan
| | - Hiroki Yokoyama
- Internal Medicine, Jiyugaoka Medical Clinic, Hokkaido, Japan
| | - Taka-Aki Matsuoka
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Iichiro Shimomura
- Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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Mineoka Y, Ishii M, Hashimoto Y, Nakamura N, Katsumi Y, Isono M, Fukui M. Neutrophil-lymphocyte ratio correlates with limited joint mobility of hand in patients with type 2 diabetes. Endocr J 2018; 65:1011-1017. [PMID: 30012904 DOI: 10.1507/endocrj.ej18-0143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Limited joint mobility (LJM) of hand, which is one of the complications of diabetic hand, is associated with diabetic micro- and macroangiopathy although the precise pathogenesis is not completely understood. Neutrophil-lymphocyte ratio (NLR), a simple and novel inflammatory marker, has been reported to have a predictive effect to some diabetic complications in recent years. However, it is not elucidated about the relationship between LJM of hand and NLR in patients with type 2 diabetes. We evaluated the relationships between LJM of hand and NLR in 335 consecutive patients with type 2 diabetes in this cross-sectional study. LJM of hand was diagnosed by a 'prayer sign' or 'table test'. LJM of hand was present in 80 patients. The patients with LJM of hand had significantly older age, longer duration of diabetes, worse renal function, and higher proportion of diabetic neuropathy, retinopathy and nephropathy. NLR in patients with LJM of hand was higher than that in patients without LJM of hand (2.54 ± 1.46 vs. 2.11 ± 1.04, p = 0.004). Multivariate logistic regression analysis revealed that LJM of hand was positively correlated with NLR (odds ratio, 1.31; 95% confidence interval 1.03-1.69, p = 0.027) after adjustment for age, sex, duration of diabetes, body mass index, hemoglobin A1c, hypertension and dyslipidemia. Our results demonstrate a positive relation between LJM of hand and NLR in patients with type 2 diabetes.
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Affiliation(s)
- Yusuke Mineoka
- Department of Internal Medicine, Otsu Municipal Hospital, Otsu, Japan
| | - Michiyo Ishii
- Department of Internal Medicine, Otsu Municipal Hospital, Otsu, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Naoto Nakamura
- Department of Internal Medicine, Saiseikai Kyoto Hospital, Nagaokakyo, Japan
| | | | - Motohide Isono
- Department of Internal Medicine, Otsu Municipal Hospital, Otsu, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Mueller MJ, Sorensen CJ, McGill JB, Clark BR, Lang CE, Chen L, Bohnert KL, Hastings MK. Effect of a Shoulder Movement Intervention on Joint Mobility, Pain, and Disability in People With Diabetes: A Randomized Controlled Trial. Phys Ther 2018; 98:745-753. [PMID: 29893977 PMCID: PMC6692706 DOI: 10.1093/ptj/pzy070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 06/06/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND People with diabetes are at high risk for shoulder pain, limited joint mobility, and adhesive capsulitis. OBJECTIVE The objective of this study was to evaluate the effects of a shoulder movement intervention (ShoMo) compared to a wellness intervention on the primary outcomes of active shoulder flexion and reported Shoulder Pain and Disability Index (SPADI) measured after intervention and 9 months later. DESIGN The design was a prospective, randomized, controlled clinical trial. SETTING The setting was a research center at an academic medical center. PARTICIPANTS Fifty-two participants with type 2 diabetes and shoulder pain or limited motion were randomized to a group receiving ShoMo (N = 27; mean age = 59.3; SD = 7.0) or a group receiving wellness activities (N = 25; mean age = 57.9; SD = 7.7). INTERVENTION The ShoMo group received instruction in a progressive, active shoulder movement program. The wellness group received instruction in diabetes management. MEASUREMENTS Measurements were made at baseline, after 3 months of intervention, and at 6, 9, and 12 months after baseline. RESULTS After intervention, the ShoMo group had a 7.2-degree increase in active shoulder flexion compared with the wellness group (95% CI = 0.9-13.5°), but there was no difference at subsequent follow-ups. The ShoMo group showed a 12.7-point improvement in the SPADI score compared to the wellness group after intervention (95% CI = 1.1-24.3), which remained better than the wellness group 9 months later. LIMITATIONS The number of participants and duration of follow-up were inadequate to determine if intervention can help to prevent future severe shoulder problems. CONCLUSIONS A progressive shoulder movement program can have meaningful effects on active motion and symptoms in people with type 2 diabetes and mild-to-moderate shoulder symptoms, with symptom improvement lasting at least 9 months.
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Affiliation(s)
- Michael J Mueller
- Program in Physical Therapy and Department of Radiology, Washington University School of Medicine, Campus Box 8502, 4444 Forest Park Blvd, St Louis, MO 63108 (USA),Address all correspondence to Dr Mueller at:
| | | | - Janet B McGill
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine
| | - B Ruth Clark
- Program in Physical Therapy and Department of Neurology, Washington University School of Medicine
| | - Catherine E Lang
- Program in Physical Therapy, Program in Occupational Therapy, and Department of Neurology, Washington University School of Medicine
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine
| | - Kathryn L Bohnert
- Program in Physical Therapy, Washington University School of Medicine
| | - Mary K Hastings
- Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University School of Medicine
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Ueda Y, Inui A, Mifune Y, Sakata R, Muto T, Harada Y, Takase F, Kataoka T, Kokubu T, Kuroda R. The effects of high glucose condition on rat tenocytes in vitro and rat Achilles tendon in vivo. Bone Joint Res 2018; 7:362-372. [PMID: 29922457 PMCID: PMC5987694 DOI: 10.1302/2046-3758.75.bjr-2017-0126.r2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objectives The aim of this study was to investigate the effect of hyperglycaemia on oxidative stress markers and inflammatory and matrix gene expression within tendons of normal and diabetic rats and to give insights into the processes involved in tendinopathy. Methods Using tenocytes from normal Sprague-Dawley rats, cultured both in control and high glucose conditions, reactive oxygen species (ROS) production, cell proliferation, messenger RNA (mRNA) expression of NADPH oxidase (NOX) 1 and 4, interleukin-6 (IL-6), matrix metalloproteinase (MMP)-2, tissue inhibitors of matrix metalloproteinase (TIMP)-1 and -2 and type I and III collagens were determined after 48 and 72 hours in vitro. In an in vivo study, using diabetic rats and controls, NOX1 and 4 expressions in Achilles tendon were also determined. Results In tenocyte cultures grown under high glucose conditions, gene expressions of NOX1, MMP-2, TIMP-1 and -2 after 48 and 72 hours, NOX4 after 48 hours and IL-6, type III collagen and TIMP-2 after 72 hours were significantly higher than those in control cultures grown under control glucose conditions. Type I collagen expression was significantly lower after 72 hours. ROS accumulation was significantly higher after 48 hours, and cell proliferation after 48 and 72 hours was significantly lower in high glucose than in control glucose conditions. In the diabetic rat model, NOX1 expression within the Achilles tendon was also significantly increased. Conclusion This study suggests that high glucose conditions upregulate the expression of mRNA for NOX1 and IL-6 and the production of ROS. Moreover, high glucose conditions induce an abnormal tendon matrix expression pattern of type I collagen and a decrease in the proliferation of rat tenocytes. Cite this article: Y. Ueda, A. Inui, Y. Mifune, R. Sakata, T. Muto, Y. Harada, F. Takase, T. Kataoka, T. Kokubu, R. Kuroda. The effects of high glucose condition on rat tenocytes in vitro and rat Achilles tendon in vivo. Bone Joint Res 2018;7:362–372. DOI: 10.1302/2046-3758.75.BJR-2017-0126.R2
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Affiliation(s)
- Y Ueda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - A Inui
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Y Mifune
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - R Sakata
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - T Muto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Y Harada
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - F Takase
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - T Kataoka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - T Kokubu
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - R Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Francia P, Toni S, Iannone G, Seghieri G, Piccini B, Vittori A, Santosuosso U, Casalini E, Gulisano M. Type 1 diabetes, sport practiced, and ankle joint mobility in young patients: What is the relationship? Pediatr Diabetes 2018; 19:801-808. [PMID: 29493073 DOI: 10.1111/pedi.12643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/26/2017] [Accepted: 12/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND/OBJECTIVE It is known that patients with diabetes can develop limited joint mobility (LJM) and that this can depend on the metabolic control maintained and the duration of the disease. The aims of this study were to verify the presence of ankle joint mobility (AJM) deficits in both plantar and dorsiflexion in young type 1 diabetic patients (T1D) considering also the possible role of sport practiced as a further factor, able to modify AJM. METHODS AJM was evaluated by an inclinometer in 82 T1D patients (M/F: 48/34), mean age 12.9 ± 2.6 years, body mass index (BMI) 19.7 ± 3.6 kg/m2 , duration of diabetes 5.6 ± 3.3 years, mean HbA1c 7.5 ± 1.0% and in 226 healthy controls (M/F: 146/80), age-, gender-, and BMI-matched practicing different sports (soccer, volleyball, basketball, and dance). RESULTS The patients' ankle range of motion was significantly lower than that in controls (132.7 ± 22.3° vs 126.1 ± 17.9°; P < .017). In particular, ankle plantar flexion was significantly lower in the patients group (31.6° ± 7.9° vs 28.5° ± 6.6°; P < .002). Soccer players showed lower AJM in both groups: patients (120.1 ± 15.9° vs 127.3 ± 18.1) and controls (119.4 ± 21.1° vs 142.0 ± 18.1; P < .0001) than subjects practicing other sports or who were sedentary. In both groups, patients and controls, age, sex, duration of disease, hemoglobin 1Ac, and BMI have not been shown to be correlated to the mobility assessed. CONCLUSIONS The results of this study, in addition to confirming the negative effect of diabetes on AJM of young T1D patients, suggest that during these evaluations the sport-related effect should be considered because it can induce significant changes of AJM.
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Affiliation(s)
- Piergiorgio Francia
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | - Sonia Toni
- Diabetes Unit, Meyer Children's Hospital, Florence, Italy
| | - Giulia Iannone
- National Association of Movement Sciences (ANIMO), Florence, Italy
| | | | | | - Alessandro Vittori
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | - Ugo Santosuosso
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | | | - Massimo Gulisano
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
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Martini D, Guareschi C, Biasini B, Bedogni G, Galli C, Angelino D, Marchi L, Zavaroni I, Pruneti C, Ventura M, Galli D, Mirandola P, Vitale M, Dei Cas A, Bonadonna RC, Passeri G, Del Rio D. Claimed effects, outcome variables and methods of measurement for health claims proposed under Regulation (EC) 1924/2006 in the framework of bone health. PHARMANUTRITION 2018. [DOI: 10.1016/j.phanu.2017.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Francia P, Anichini R, Seghieri G, De Bellis A, Gulisano M. History, Prevalence and Assessment of Limited Joint Mobility, from Stiff Hand Syndrome to Diabetic Foot Ulcer Prevention: A Narrative Review of the Literature. Curr Diabetes Rev 2018; 14:411-426. [PMID: 28814244 PMCID: PMC6343166 DOI: 10.2174/1573399813666170816142731] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/06/2017] [Accepted: 07/12/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Limited Joint Mobility (LJM) is a dreaded complication of Diabetes Mellitus (DM). During the last half century, LJM has been studied in patients of different age because it has been considered useful for the monitoring of a patient's condition and for the prevention of vascular disease and diabetic foot. OBJECTIVES The main aims of this review are to describe the relationship between DM and joint mobility as well as its prevalence and assessment. We have also investigated the role of LJM in the development of diabetic foot ulcers. METHODOLOGY An in-depth literature search was conducted to identify studies that examined the prevalence and characteristics of LJM in patients with DM of different types, age, durations and chronic complications. RESULTS Many factors (therapy improvements, population characteristics and different evaluation methods) concur to hinder an exact assessment of the prevalence of LJM. However, it has been confirmed that LJM is widespread among patients with DM and may affect more than two-thirds of them in addition to being a major risk factor for foot ulcer. Its role in the monitoring of a patient's condition is also important for the definition of risk thresholds such as in patients with diabetic foot. The efficacy of exercise therapy for the treatment of LJM, also in patients at risk of foot ulcer, has not been discussed. CONCLUSION Difficulties encountered in the definition of the prevalence of LJM may hinder its study and the establishment of preventive interventions. However, LJM plays a key role in the monitoring of patients, especially those at risk for ulcer.
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Affiliation(s)
- Piergiorgio Francia
- Address correspondence to this author at the Department of Experimental and Clinical, Medicine, University of Florence, Largo Brambilla, 3 - 50134 Florence, Italy; Tel/Fax: +39 0552758050;, E-mail:
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Chang CJ, Chang SP, Kao LT, Tai TW, Jou IM. A Meta-analysis of Corticosteroid Injection for Trigger Digits Among Patients With Diabetes. Orthopedics 2018; 41:e8-e14. [PMID: 28776635 DOI: 10.3928/01477447-20170727-02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Accepted: 04/17/2017] [Indexed: 02/03/2023]
Abstract
A majority of patients with diabetes have trigger digits. Initial management of symptomatic trigger digits commonly involves corticosteroid injection. However, varying outcomes have been reported for patients with diabetes who receive corticosteroid injections. The authors conducted a meta-analysis to evaluate the effect of diabetes on outcome after corticosteroid injection for trigger digit. PubMed and other Internet databases were searched for the period 1977 to 2015. Five articles, involving 381 diabetic digits and 449 non-diabetic digits, were included in the meta-analysis. The authors found treatment failure rates of 78% for patients with insulin-dependent diabetes, 47% for patients with non-insulin-dependent diabetes, and 49% for patients without diabetes when a single injection of corticosteroid was administered for trigger digit. After 3 injections, the failure rates were 57%, 39%, and 30%, respectively. The pooled data showed that patients with insulin-dependent diabetes and patients with non-insulin-dependent diabetes had worse prognoses after corticosteroid injection for trigger digit than patients without diabetes. Furthermore, the patients with insulin-dependent diabetes had a trend toward multiple digit involvement and much worse treatment outcomes than the patients with non-insulin-dependent diabetes. The authors conclude that more aggressive treatment, such as surgical intervention, should be considered for those patients expected to have high failure rates after injection. [Orthopedics. 2018; 41(1):e8-e14.].
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Labad J, Rozadilla A, Garcia-Sancho P, Nolla JM, Montanya E. Limited Joint Mobility Progression in Type 1 Diabetes: A 15-Year Follow-Up Study. Int J Endocrinol 2018; 2018:1897058. [PMID: 29853876 PMCID: PMC5954902 DOI: 10.1155/2018/1897058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/28/2017] [Accepted: 01/03/2018] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To assess the evolution of joint mobility over a period of 15 years in type 1 diabetic patients and healthy controls and to determine whether microalbuminuria is associated with a different evolution of joint mobility. METHODS Joint mobility of hand and wrist was determined in 63 patients with type 1 diabetes and 63 healthy subjects. Fifteen years later, 37 (58.7%) diabetic patients and 16 (25.4%) healthy subjects were studied again. Joint mobility was assessed with the Prayer sign and by measuring the angle of maximal flexion of the fifth and third metacarpophalangeal (MCP) joints and wrist. Patients with diabetes were visited 2-4 times every year with regular assessment of glycated hemoglobin (HbA1c), urinary albumin excretion (UAE), and ophthalmoscopy. RESULTS Fifteen years after the initial exam, diabetic patients showed reduced flexion of the fifth MCP joint (82.6 ± 5.8 versus 76.0 ± 6.4 degrees, p < 0.001) and wrist (75.9 ± 8.1 versus 73.2 ± 7.4 degrees, p = 0.015) compared to baseline examination. Joint mobility did not change significantly in healthy subjects. Patients with microalbuminuria showed greater reduction in hand joint mobility than diabetic patients with normal UAE or than healthy subjects (p < 0.001). CONCLUSIONS In type 1 diabetic patients, the severity of LJM progresses with time, and the progression is enhanced in patients with microalbuminuria.
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Affiliation(s)
- Javier Labad
- Endocrine Unit, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Parc Tauli Hospital Universitari, I3PT, Universitat Autònoma, CIBERSAM, Barcelona, Spain
| | - Antoni Rozadilla
- Rheumatology Section, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Paula Garcia-Sancho
- Endocrine Unit, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Joan M. Nolla
- Rheumatology Section, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Institut d'Investigació Biomedical de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Eduard Montanya
- Endocrine Unit, Hospital Universitari Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Institut d'Investigació Biomedical de Bellvitge (IDIBELL), Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, Spain
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Comparison of Hand Function Between Children With Type 1 Diabetes Mellitus and Children Without Type 1 Diabetes Mellitus. Pediatr Phys Ther 2018; 30:58-65. [PMID: 29252840 DOI: 10.1097/pep.0000000000000465] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study compared the hand function of children between the ages of 8 and 12 years with type 1 diabetes mellitus (T1DM) with that of children without diabetes. METHODS The Modified Jebsen-Taylor Hand Function Test and the Purdue Pegboard Test were used to assess hand function. The Pediatric Quality of Life Inventory 4.0 was used for evaluating health-related quality of life. RESULTS Duration of writing was found to be significantly longer on the dominant side of the T1DM group compared with the children without T1DM. The durations of card turning, moving large, light objects, and large, heavy objects on the nondominant side of the T1DM group were also found to be significantly longer than those in the children without T1DM. The total scale score of health-related quality of life was significantly lower in the T1DM group compared with the children without T1DM. CONCLUSIONS T1DM affects hand function, particularly the dominant side for writing and nondominant side for card turning and moving large objects.
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Mineoka Y, Ishii M, Hashimoto Y, Tanaka M, Nakamura N, Katsumi Y, Isono M, Fukui M. Relationship between limited joint mobility of hand and carotid atherosclerosis in patients with type 2 diabetes. Diabetes Res Clin Pract 2017; 132:79-84. [PMID: 28802699 DOI: 10.1016/j.diabres.2017.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022]
Abstract
AIM Limited joint mobility (LJM) of hand, which is one of a complication of diabetic hand, has a close association with diabetic microangiopathy. However, it remains to be elucidated about the relationships between LJM of hand and subclinical atherosclerosis in patients with type 2 diabetes. Therefore, we conducted a cross-sectional study to evaluate the relationships between LJM of hand and carotid intima-media thickness (IMT) and plaque score in patients with type 2 diabetes. METHODS We evaluated the relationships between LJM of hand, and carotid IMT and plaque score, evaluated by carotid ultrasound examination, in 341 consecutive patients with type 2 diabetes. LJM of hand was diagnosed using a 'prayer sign' or 'table test'. RESULTS LJM of hand was present in 72 patients. Carotid IMT and plaque score were higher in patients with LJM of hand than those in patients without (1.45±0.66vs. 1.14±0.68mm, P=0.013 and 8.0±5.3vs. 5.4±4.8mm, P<0.001). Multivariate linear regression analysis revealed that LJM of hand was positively correlated with plaque score (β=0.423, P=0.043) after adjusted for age, sex, durations of diabetes, body mass index, hemoglobin A1c, creatinine, uric acid, smoking, hypertension and dyslipidemia. CONCLUSIONS Our results demonstrate a relation between LJM of hand and subclinical atherosclerosis, especially plaque score, in patients with type 2 diabetes. Diagnosis of diabetic hand is simple and non-invasive, and thus is a useful method for assessment of subclinical atherosclerosis in patients with type 2 diabetes.
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Affiliation(s)
- Yusuke Mineoka
- Department of Internal Medicine, Otsu Municipal Hospital, Japan
| | - Michiyo Ishii
- Department of Internal Medicine, Otsu Municipal Hospital, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan
| | - Muhei Tanaka
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan
| | - Naoto Nakamura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan; Department of Internal Medicine, Saiseikai Kyoto Hospital, Japan
| | | | - Motohide Isono
- Department of Internal Medicine, Otsu Municipal Hospital, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Japan.
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Sorensen CJ, Hastings MK, Lang CE, McGill JB, Clark BR, Bohnert KL, Mueller MJ. Relationship of shoulder activity and skin intrinsic fluorescence with low level shoulder pain and disability in people with type 2 diabetes. J Diabetes Complications 2017; 31:983-987. [PMID: 28392042 PMCID: PMC5438882 DOI: 10.1016/j.jdiacomp.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 11/26/2022]
Abstract
AIM People with type 2 diabetes (T2DM) have a high incidence of musculoskeletal disorders thought to be influenced by high non-enzymatic advanced glycated end-products (AGEs). The goals of this study were to determine differences in shoulder activity level and AGEs in people with T2DM compared to matched controls, and to determine factors associated with shoulder pain and disability. METHODS Eighty-one participants, T2DM (n=52) and controls (n=29), were examined for magnitude and duration of shoulder activity (measured using accelerometers), skin intrinsic florescence (SIF) as a surrogate measure of AGE level, and the Shoulder Pain and Disability Index (SPADI) as a self-report of shoulder pain and disability. RESULTS Compared with controls, T2DM participants had 23% less shoulder activity (p=0.01), greater SIF level (3.6±1.7 vs 2.7±0.6AU, p=0.01), less shoulder strength (p<0.05), and the duration of their shoulder activity was moderately associated (r=0.40; p<0.01) with reported shoulder pain and disability. Shoulder pain and disability were not related to SIF level. CONCLUSIONS Persons with T2DM have higher SIF levels and shoulder symptoms and disability indices than controls. Research is needed to determine if a shoulder mobility intervention to increase strength and mobility can help decrease shoulder pain and disability.
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Affiliation(s)
- Christopher J Sorensen
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO.
| | - Mary K Hastings
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Catherine E Lang
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Program in Occupational Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Janet B McGill
- Division of Endocrinology, Metabolism, and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - B Ruth Clark
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Neurology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Kathryn L Bohnert
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Michael J Mueller
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO; Department of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO
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Mineoka Y, Ishii M, Tsuji A, Komatsu Y, Katayama Y, Yamauchi M, Yamashita A, Hashimoto Y, Nakamura N, Katsumi Y, Isono M, Fukui M. Relationship between limited joint mobility of the hand and diabetic foot risk in patients with type 2 diabetes. J Diabetes 2017; 9:628-633. [PMID: 27531043 DOI: 10.1111/1753-0407.12460] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 07/22/2016] [Accepted: 08/14/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Foot ulceration is a serious problem for patients with type 2 diabetes (T2D), and the early detection of risks for this condition is important to prevent complications. The present cross-sectional study in T2D patients determined the relationship between limited joint mobility (LJM) of the hand and diabetic foot risk classified using the criteria of the International Working Group on the Diabetic Foot (IWGDF). METHODS Relationships between LJM of the hand and foot risk according to IWGDF category, HbA1c, age, body mass index, blood pressure, estimated glomerular filtration (eGFR), and diabetic complications (including diabetic peripheral neuropathy [DPN] and peripheral arterial disease [PAD]) were evaluated in 528 consecutive T2D patients. Poor glycemic control was defined as HbA1c ≥ 7%. RESULTS Patients with LJM of the hand were older and had a longer duration of diabetes, a higher prevalence of diabetic complications, including DPN and PAD, and a higher IWDGF category (all P < 0.001). Multivariate logistic regression analysis revealed that the foot risk assessed with IWDGF category was correlated with age (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01-1.06; P = 0.001), poor glycemic control (OR 1.66; 95% CI 1.00-2.77; P = 0.04), eGFR (OR 0.98; 95% CI 0.97-0.99; P = 0.02), and the presence of LJM of the hand (OR 3.86; 95% CI 2.21-6.86; P < 0.001). CONCLUSIONS The results demonstrate a correlation between LJM of the hand and foot risk. Diagnosis of diabetic hand is simple and non-invasive, and is thus a useful method for assessing the risk of diabetic foot in T2D patients.
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Affiliation(s)
- Yusuke Mineoka
- Department of Internal Medicine, Otsu Municipal Hospital, Otsu, Japan
| | - Michiyo Ishii
- Department of Internal Medicine, Otsu Municipal Hospital, Otsu, Japan
| | - Akiko Tsuji
- Department of Internal Medicine, Otsu Municipal Hospital, Otsu, Japan
| | - Yoriko Komatsu
- Department of Internal Medicine, Otsu Municipal Hospital, Otsu, Japan
| | - Yuko Katayama
- Department of Nursing, Otsu Municipal Hospital, Otsu, Japan
| | | | - Aki Yamashita
- Department of Nursing, Otsu Municipal Hospital, Otsu, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Naoto Nakamura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | | | - Motohide Isono
- Department of Internal Medicine, Otsu Municipal Hospital, Otsu, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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Musculoskeletal Impairments Are Often Unrecognized and Underappreciated Complications From Diabetes. Phys Ther 2016; 96:1861-1864. [PMID: 27909254 PMCID: PMC5131183 DOI: 10.2522/ptj.20160326] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 12/25/2022]
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Renart I. La mano diabética. REVISTA IBEROAMERICANA DE CIRUGÍA DE LA MANO 2015. [DOI: 10.1016/j.ricma.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
La diabetes es una de las enfermedades con mayor prevalencia y repercusión sociosanitaria, no solo por su elevada frecuencia, sino también por el impacto de las complicaciones crónicas de la enfermedad y el papel que desempeña como factor de riesgo en la afección cardiovascular. Sin embargo, la diabetes también puede involucrar al sistema musculoesquelético y a los tejidos blandos de forma muy diversa, siendo la mano una de las regiones más afectadas. De hecho, se estima que el 40% de los pacientes diabéticos tienen problemas significativos de la mano que requieren una atención médica.En el presente artículo se revisan las principales enfermedades de la mano que van asociadas a la diabetes, haciendo especial hincapié en el tratamiento y el pronóstico de cada una de ellas.
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Mustafa KN, Khader YS, Bsoul AK, Ajlouni K. Musculoskeletal disorders of the hand in type 2 diabetes mellitus: prevalence and its associated factors. Int J Rheum Dis 2015; 19:730-5. [PMID: 26259148 DOI: 10.1111/1756-185x.12617] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM To assess the prevalence of musculoskeletal disorders of the hand among adult patients with type 2 diabetes mellitus (T2DM) and their relation to disease duration, glycemic control and microvascular complications. METHODS A cross-sectional study was conducted at the National Center for Diabetes, Endocrinology and Genetics in Amman, Jordan. RESULTS One thousand patients with T2DM were included in this study (mean age 57.8 ± 9.5 years, 52.2% females and 47.8% males). Hand disorders were seen in 69.5% of patients, limited joint mobility (LJM) was the most prevalent (63.1%) condition followed by Dupuytren's contracture (DC) (18.6%). Trigger finger, thick skin and carpal tunnel syndrome (CTS) were found in 7.2%, 6.2% and 5.5% of patients, respectively. One disorder was seen in 45.4% of patients, two in18.2%, three in 4.9%, four in 0.9%, while only 0.1% of patients had all disorders. Female gender, age over 60 years and long duration of diabetes were associated with hand abnormalities. Hypertension was significantly associated with DC while retinopathy was associated with increased odds of thick skin, DC and CTS with P-values 0.037, < 0.005 and 0.002, respectively. CONCLUSION Hand disorders are very common in T2DM. Female gender, old age, duration of diabetes, retinopathy and hypertension were significantly associated with hand disorders in T2DM.
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Affiliation(s)
- Khader N Mustafa
- Section of Rheumatology, Department of Internal Medicine, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Yousef S Khader
- Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan
| | - Amal K Bsoul
- Faculty of Nursing/Adult Health Department, Jordan University of Science and Technology, Irbid, Jordan
| | - Kamel Ajlouni
- The National Center for Diabetes, Endocrinology and Genetics, Amman, Jordan
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Gerrits EG, Landman GW, Nijenhuis-Rosien L, Bilo HJ. Limited joint mobility syndrome in diabetes mellitus: A minireview. World J Diabetes 2015; 6:1108-1112. [PMID: 26265997 PMCID: PMC4530324 DOI: 10.4239/wjd.v6.i9.1108] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 06/16/2015] [Accepted: 07/27/2015] [Indexed: 02/05/2023] Open
Abstract
Limited joint mobility syndrome (LJMS) or diabetic cheiroarthropathy is a long term complication of diabetes mellitus. The diagnosis of LJMS is based on clinical features: progression of painless stiffness of hands and fingers, fixed flexion contractures of the small hand and foot joints, impairment of fine motion and impaired grip strength in the hands. As the syndrome progresses, it can also affect other joints. It is important to properly diagnose such a complication as LJMS. Moreover, it is important to diagnose LJMS because it is known that the presence of LJMS is associated with micro- and macrovascular complications of diabetes. Due to the lack of curative treatment options, the suggested method to prevent or decelerate the development of LJMS is improving or maintaining good glycemic control. Daily stretching excercises of joints aim to prevent or delay progression of joint stiffness, may reduce the risk of inadvertent falls and will add to maintain quality of life.
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Relationship Between Skin Intrinsic Fluorescence--an Indicator of Advanced Glycation End Products-and Upper Extremity Impairments in Individuals With Diabetes Mellitus. Phys Ther 2015; 95:1111-9. [PMID: 25858973 PMCID: PMC4528014 DOI: 10.2522/ptj.20140340] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 04/02/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Accumulation of advanced glycation end products (AGEs) is thought to contribute to limited joint mobility in people with diabetes mellitus (DM), but the relationships among AGEs, shoulder structural changes, movement, and disability are not understood. OBJECTIVE The purpose of this study was to determine the differences and relationships among skin intrinsic fluorescence (SIF), a proxy measure of AGEs, biceps and supraspinatus tendon thickness, upper extremity movement, and disability in groups with and without DM. DESIGN This was a cross-sectional, case-control study. METHODS Fifty-two individuals participated: 26 with type 2 DM and 26 controls matched for sex, age, and body mass index. The main outcome measures were: SIF; biceps and supraspinatus tendon thickness; 3-dimensional peak shoulder motion; and Disability of the Arm, Shoulder and Hand (DASH) questionnaire scores. RESULTS Mean SIF measurements were 19% higher in the DM group compared with the control group (P<.05). Biceps tendons (mean and 95% confidence interval [CI]) (4.7 mm [4.4, 5.0] versus 3.2 mm [2.9, 3.5]) and supraspinatus tendons (6.4 mm [5.9, 6.8] versus 4.9 mm [4.4, 5.3]) were thicker and peak humerothoracic elevation (139° [135°, 146°] versus 150° [146°, 155°]) and glenohumeral external rotation (35° [26°, 46°] versus 51° [41°, 58°]) were reduced in the DM group compared with the control group (P<.05). In the DM group, SIF was correlated to biceps tendon thickness, DASH score, and shoulder motion (r=.44-.51, P<.05). The SIF score and shoulder strength explained 64% of the DASH scores (P<.01). LIMITATIONS Because this was a cross-sectional study design, a cause-effect relationship could not be established. CONCLUSIONS Accumulation of AGEs in the connective tissues of individuals with DM appears to be associated with increased tendon thickness and decreased shoulder joint mobility and upper extremity function. Physical therapists should be aware of these possible metabolic effects on structure, movement, and disability when treating people with diabetes.
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Raje YR, Cracknell G, Davoren PM. Frequency of hand and shoulder symptoms in patients with type 1 diabetes. Diabet Med 2015; 32:968-71. [PMID: 25644754 DOI: 10.1111/dme.12704] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
AIMS To characterize the frequency of joint symptoms in patients with Type 1 diabetes mellitus and to determine the subset of patients at risk of developing these symptoms. METHODS We invited patients with Type 1 diabetes to complete a survey in which upper limb joint symptoms were scored using a composite of the Shoulder Pain and Disability Index and a visual analogue scale. Family or friends of the participants, without diabetes, completed control surveys. RESULTS A total of 131 patients and 79 age- and sex-matched control subjects completed the surveys. Patients with Type 1 diabetes had higher composite symptom scores than did the control subjects [median (range) score 25 (0-208) vs. 12 (0-145); P < 0.001]. Patients with long-standing diabetes had significantly higher median (range) scores than those with diabetes of shorter duration [diabetes >30 years: 63(0-208), 15-30 years: 46(0-168), diabetes <15 years: 17(0-143)]. Patients with diabetic nephropathy had higher scores than those without [median (range) score 103 (0-173) vs. 22 (0-208); P = 0.007 between groups]. Neither blood glucose control nor age at diagnosis predicted higher scores. CONCLUSION Upper limb joint symptoms occur with greater frequency in patients with Type 1 diabetes. Longer duration of disease is the best predictor of symptoms. Blood glucose control does not appear to be associated with development of symptoms.
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Affiliation(s)
- Y R Raje
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - G Cracknell
- Gold Coast University Hospital, Southport, Queensland, Australia
| | - P M Davoren
- Gold Coast University Hospital, Southport, Queensland, Australia
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Francia P, Seghieri G, Gulisano M, De Bellis A, Toni S, Tedeschi A, Anichini R. The role of joint mobility in evaluating and monitoring the risk of diabetic foot ulcer. Diabetes Res Clin Pract 2015; 108:398-404. [PMID: 25906705 DOI: 10.1016/j.diabres.2015.04.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/19/2015] [Accepted: 04/03/2015] [Indexed: 10/23/2022]
Abstract
AIMS Evaluation of how ankle joint mobility (AJM) can be useful in the identification of patients with diabetes at risk of foot ulcer (FU). METHODS Plantar and dorsal flexion of foot were evaluated using an inclinometer in 87 patients (54 type 2 and 33 type 1), and 35 healthy sex- and age-matched control subjects. Patients with diabetes were followed up for diagnosis of FU over the next 8 years and subsequently, patients were subdivided into: those without a history of FU (18 type 1 and 33 type 2), those who had a history of FU detected before baseline evaluation (14 type 2) and those who had history of first ulceration detected by the 8th year of the evaluation period (7 type 2). RESULTS Aging and diabetes caused a significant reduction in mobility of each of the movements investigated (p<0.001), whereas after adjusting for the confounding effect of age, diabetes specifically reduced plantar flexion (p<0.0001). AJM was significantly lower in those with history of previous FU compared to all the other groups (p<0.001). The first ulceration was detected in the same foot presenting lower AJM in 17 of the 22 subjects with diabetes with history of ulcer (77.27%). CONCLUSIONS Diabetes and aging reduce AJM although diabetes seems to reduce plantar flexion to a more specific extent. Reduced AJM is mostly associated with a previous history of FU. The evaluation of AJM is a valid and reliable ulcer risk scale that indicates which foot is at higher ulcer risk.
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Affiliation(s)
- Piergiorgio Francia
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
| | | | - Massimo Gulisano
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | - Sonia Toni
- Diabetes Unit, Meyer Children's Hospital, Florence, Italy
| | - Anna Tedeschi
- Diabetes Unit, USL 3, St. Jacopo Hospital, Pistoia, Italy
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Shah KM, Clark BR, McGill JB, Lang CE, Mueller MJ. Shoulder limited joint mobility in people with diabetes mellitus. Clin Biomech (Bristol, Avon) 2015; 30:308-13. [PMID: 25595462 PMCID: PMC4363299 DOI: 10.1016/j.clinbiomech.2014.12.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 12/26/2014] [Accepted: 12/29/2014] [Indexed: 02/07/2023]
Abstract
BACKGROUND Limited joint mobility at the shoulder is an understudied problem in people with diabetes mellitus. The purpose of this study was to determine the differences in shoulder kinematics between a group with diabetes and those without diabetes. METHODS Fifty-two participants were recruited, 26 with diabetes and 26 non-diabetes controls (matched for age, BMI and sex). Three-dimensional position of the trunk, scapula and humerus were collected using electromagnetic tracking sensors during scapular plane elevation and rotation movements. FINDINGS Glenohumeral external rotation was reduced by 11.1°-16.3° (P<0.05) throughout the humerothoracic elevation range of motion, from neutral to peak elevation, in individuals with diabetes as compared to controls. Peak humerothoracic elevation was decreased by 10-14°, and peak external rotation with the arm abducted was decreased 22° in the diabetes group compared to controls (P<0.05). Scapulothoracic and glenohumeral internal rotation motions were not different between the two groups. INTERPRETATION Shoulder limited joint mobility, in particular decreased external rotation, was seen in individuals with diabetes as compared to control participants. Future research should investigate causes of diabetic limited joint mobility and strategies to improve shoulder mobility and prevent additional detrimental changes in movement and function.
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Affiliation(s)
| | - B. Ruth Clark
- Program in Physical Therapy, Washington University School of Medicine in St. Louis
| | - Janet B. McGill
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine in St. Louis
| | - Catherine E. Lang
- Program in Physical Therapy, Program in Occupational Therapy, Department of Neurology, Washington University School of Medicine in St. Louis
| | - Michael J. Mueller
- Program in Physical Therapy and Department of Radiology, Washington University School of Medicine in St. Louis
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Helfgott SM. Rheumatoid manifestations of endocrine and lipid disease. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00193-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Shah KM, Clark BR, McGill JB, Mueller MJ. Upper extremity impairments, pain and disability in patients with diabetes mellitus. Physiotherapy 2014; 101:147-54. [PMID: 25442298 DOI: 10.1016/j.physio.2014.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 07/25/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES To determine the severity of, and relationships between, upper extremity impairments, pain and disability in patients with diabetes mellitus, and to compare upper extremity impairments in patients with diabetes with non-diabetic controls. DESIGN Case-control, cross-sectional design. SETTING University-based, outpatient diabetes centre and physical therapy research clinic. PARTICIPANTS Two hundred and thirty-six patients with diabetes attending an outpatient diabetes clinic completed the Shoulder Pain and Disability Index (SPADI) questionnaire. A detailed shoulder and hand examination was conducted on a subgroup of 29 volunteers with type 2 diabetes, and 27 controls matched for age, sex and body mass index. INTERVENTIONS None. MAIN OUTCOME MEASURES SPADI score, passive shoulder range of motion (ROM) and strength, grip strength, hand sensation, dexterity and limited joint mobility of the hand. RESULTS Sixty-three percent (149/236) of patients with diabetes reported shoulder pain and/or disability [median SPADI score 10.0 (interquartile range 0.0 to 39.6)]. Compared with the control group, the subgroup of patients with diabetes had substantial reductions in shoulder ROM, shoulder muscle strength, grip and key pinch strength (P<0.05). Patients with diabetes had a greater prevalence of decreased sensation (26/27 vs 14/27) and limited joint mobility of the hand (17/27 vs 4/27) compared with the control group. Total SPADI score was negatively correlated (P<0.05) with shoulder ROM (r=-0.42 to -0.74) and strength measures (r=-0.44 to -0.63) in patients with diabetes. CONCLUSIONS Upper extremity impairments in this sample of patients with diabetes were common, severe and related to complaints of pain and disability. Additional research is needed to understand the unique reasons for upper extremity problems in patients with diabetes, and to identify preventative treatments.
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Affiliation(s)
- K M Shah
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA.
| | - B R Clark
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA
| | - J B McGill
- Division of Endocrinology, Metabolism and Lipid Research, Department of Medicine, Washington University School of Medicine in St. Louis, USA
| | - M J Mueller
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, USA; Department of Radiology, Washington University School of Medicine in St. Louis, USA
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Kordonouri O, Klingensmith G, Knip M, Holl RW, Aanstoot HJ, Menon PSN, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2014. Other complications and diabetes-associated conditions in children and adolescents. Pediatr Diabetes 2014; 15 Suppl 20:270-8. [PMID: 25182319 DOI: 10.1111/pedi.12183] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 06/14/2014] [Indexed: 12/27/2022] Open
Affiliation(s)
- Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Children's Hospital auf der Bult, Hannover, Germany
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Valencia-Torres L, Bradshaw CM, Bouzas A, Hong E, Orduña V. Effect of streptozotocin-induced diabetes on performance on a progressive ratio schedule. Psychopharmacology (Berl) 2014; 231:2375-84. [PMID: 24402135 DOI: 10.1007/s00213-013-3401-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/02/2013] [Indexed: 12/29/2022]
Abstract
RATIONALE It has been suggested that streptozotocin (STZ)-induced diabetes causes a motivational deficit in rodents. However, some of the evidence adduced in support of this suggestion may be interpreted in terms of a motor impairment rather than a motivational deficit. OBJECTIVE This experiment examined the effect of STZ-induced diabetes on performance on a progressive ratio schedule. The data were analysed using a new model derived from Killeen's (Behav Brain Sci 17:105-172, 1994) Mathematical Principles of Reinforcement model which enables the effects of interventions on motivation or incentive value to be separated from effects on motor function. METHOD Animals were trained under a progressive ratio schedule using food-pellet reinforcement. Then they received a single intraperitoneal injection of 50 mg/kg of STZ or the vehicle. Training continued for 30 sessions after treatment. Running and overall response rates in successive ratios were analysed using the new model, and estimates of the model's parameters were compared between groups. RESULTS The parameter expressing incentive value was reduced in the group treated with STZ, whereas the parameters expressing motor capacity and post-reinforcement pausing were not affected by the treatment. Blood glucose concentration was significantly elevated in the STZ-treated group compared to the vehicle-treated group. CONCLUSIONS The results are consistent with the suggestion that STZ-induced diabetes is associated with a reduction of the incentive value of food.
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Francia P, Gulisano M, Anichini R, Seghieri G. Diabetic foot and exercise therapy: step by step the role of rigid posture and biomechanics treatment. Curr Diabetes Rev 2014; 10:86-99. [PMID: 24807636 PMCID: PMC5750747 DOI: 10.2174/1573399810666140507112536] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/02/2014] [Accepted: 05/05/2014] [Indexed: 12/16/2022]
Abstract
Lower extremity ulcers represent a serious and costly complication of diabetes mellitus. Many factors contribute to the development of diabetic foot. Peripheral neuropathy and peripheral vascular disease are the main causes of foot ulceration and contribute in turn to the growth of additional risk factors such as limited joint mobility, muscular alterations and foot deformities. Moreover, a deficit of balance, posture and biomechanics can be present, in particular in patients at high risk for ulceration. The result of this process may be the development of a vicious cycle which leads to abnormal distribution of the foot's plantar pressures in static and dynamic postural conditions. This review shows that some of these risk factors significantly improve after a few weeks of exercise therapy (ET) intervention. Accordingly it has been suggested that ET can be an important weapon in the prevention of foot ulcer. The aim of ET can relate to one or more alterations typically found in diabetic patients, although greater attention should be paid to the evaluation and possible correction of body balance, rigid posture and biomechanics. Some of the most important limitations of ET are difficult access to therapy, patient compliance and the transitoriness of the results if the training stops. Many proposals have been made to overcome such limitations. In particular, it is important that specialized centers offer the opportunity to participate in ET and during the treatment the team should work to change the patient's lifestyle by improving the execution of appropriate daily physical activity.
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Affiliation(s)
| | | | | | - Giuseppe Seghieri
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3 - 50134 Florence, Italy.
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Font YM, Castro-Santana LE, Nieves-Plaza M, Maldonado M, Mayor AM, Vilá LM. Factors associated with regional rheumatic pain disorders in a population of Puerto Ricans with diabetes mellitus. Clin Rheumatol 2014; 33:995-1000. [PMID: 24522480 DOI: 10.1007/s10067-013-2474-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Revised: 11/25/2013] [Accepted: 12/20/2013] [Indexed: 12/26/2022]
Abstract
The aim of the study was to determine the prevalence and factors associated with bursitis/tendonitis disorders in Puerto Ricans with diabetes mellitus (DM). A cross-sectional study was performed in 202 adult Puerto Ricans (100 DM patients and 102 non-diabetic subjects). For each participant, a complete medical history and a musculoskeletal exam were systematically performed. Socio-demographic parameters, health-related behaviors, comorbidities, and pharmacotherapy were determined for all subjects. For DM patients, disease duration, glycemic control, and DM long-term complications were also examined. Multivariate logistic regression analyses were used to determine the factors associated with bursitis/tendonitis disorders. The mean (SD) age for DM patients and non-diabetic controls were 53.3 (12.9) and 50.0 (13.1) years; 64.0 and 64.7 % of DM patients and controls were females, respectively. Overall, the prevalence of bursitis/tendonitis was higher in DM patients than among non-diabetics (59.0 % vs. 29.4 %, p < 0.01). In multivariate analyses, DM patients had 2.47 (95 % CI 1.05, 5.84) the odds of having bursitis/tendonitis as compared to non-diabetics. Specifically, DM patients had a higher frequency of flexor tenosynovitis, De Quervain's tenosynovitis, lateral epicondylitis, medial epicondylitis, trochanteric bursitis, and anserine bursitis than non-diabetic subjects (p < 0.05). Among DM patients, multivariate analyses showed that those with bursitis/tendonitis were more likely to be female [OR (95 % CI) 4.55 (1.42, 14.55)] and have peripheral vascular disease [OR (95 % CI) 8.48 (1.71, 41.93)]. In conclusion, bursitis/tendonitis disorders were common in this population of Hispanics with DM. Among DM patients, bursitis/tendonitis disorders were more frequent in women and those with long-term complications such as peripheral vascular disease.
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Affiliation(s)
- Yvonne M Font
- Division of Rheumatology, Department of Medicine, University of Puerto Rico Medical Sciences Campus, PO Box 365067, San Juan, PR, 00936-5067, USA
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Murphy-Chutorian B, Han G, Cohen SR. Dermatologic manifestations of diabetes mellitus: a review. Endocrinol Metab Clin North Am 2013; 42:869-98. [PMID: 24286954 DOI: 10.1016/j.ecl.2013.07.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Diabetes mellitus affects every organ of the body including the skin. Certain skin manifestations of diabetes are considered cutaneous markers of the disease, whereas others are nonspecific conditions that occur more frequently among individuals with diabetes compared with the general population. Diabetic patients have an increased susceptibility to some bacterial and fungal skin infections, which account, in part, for poor healing. Skin complications of diabetes provide clues to current and past metabolic status. Recognition of cutaneous markers may slow disease progression and ultimately improve the overall prognosis by enabling earlier diagnosis and treatment.
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Pandey A, Usman K, Reddy H, Gutch M, Jain N, Qidwai S. Prevalence of hand disorders in type 2 diabetes mellitus and its correlation with microvascular complications. Ann Med Health Sci Res 2013; 3:349-54. [PMID: 24116312 PMCID: PMC3793438 DOI: 10.4103/2141-9248.117942] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: Physicians have long recognized the association between diabetes mellitus and several pathologic conditions of the hand. The most commonly recognized maladies are limited joint mobility (LJM), Dupuytren's disease (DD), trigger finger (TF), and carpal tunnel syndrome (CTS). Incidence of these hand disorders has increased in the setting of diabetes. Collectively, these are described as diabetic hand syndrome. Aim: The aims were to find out the prevalence of hand disorders in diabetic patients, and to study the relation of these hand disorders with microvascular complications. Subjects and Methods: This is an observational cross-sectional case-control study done over a period of 1 year Patients of type 2 DM, of age < 65 years, who visited Gandhi Memorial Hospital, Lucknow were enrolled and were described as cases. Age- and sex-matched nondiabetic individuals were taken in the control group. The data were analyzed using software SPSS. SPSS Inc. Released 2008. SPSS Statistics for Windows, Version 17.0. Chicago: SPSS Inc. Means and standard deviations were computed; the Student t-test and Chi-square (χ2) test were used as appropriate. Results: A total of 400 subjects were studied, 200 each in the case and control groups. Of total 200 diabetic patients, 30% (60/200) patients had neuropathy, 37.5% (75/200) had nephropathy, and 44.5% (89/200) patients had retinopathy. In the study population, 67% patients were having one or more hand disorders, in which LJM was found in 40.5% (81/200) patients, DD was found in 19% (38/200) patients, TF in 16.5% (33/200), and CTS in 14% (28/200) patients. Conclusions: This study shows a high prevalence of hand disorders in diabetic patients and also correlates with the duration of type 2 DM, LJM being the most common hand disorder and more common in patients who have microvascular complications.
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Affiliation(s)
- A Pandey
- Department of Medicine, King George Medical University, Lucknow, India
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Abstract
Diabetes is a common disease in Germany. Due to diabetes-associated end-organ disease, such as large and small vessel disease and neuropathy, diabetic patients require more intense anesthesia care during the perioperative phase. An in-depth and comprehensive medical history focusing on hemodynamic alterations, gastroparesis, neuropathy and stiff joint syndrome is a cornerstone of perioperative care and may affect outcome of diabetes patients more than specific anesthetic medications or the anesthetic procedure. Intraoperative anesthetic care needs to focus on preservation of hemodynamic stability, perioperative infection control and maintenance of glucose homeostasis. Whereas some years ago strict glucose control by aggressive insulin therapy was adamantly advocated, the results of recent studies have put the risk of such therapeutic algorithms into perspective. Therefore, optimized perioperative care of diabetic patients consists of setting a predefined targeted blood glucose level, evidence-based therapeutic approaches to reach that goal and finally adequate and continuous monitoring and amendment of the therapeutic approach if required.
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Diabetic cheiroarthropathy: a case report and review of the literature. Case Rep Endocrinol 2013; 2013:257028. [PMID: 23762663 PMCID: PMC3671228 DOI: 10.1155/2013/257028] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 04/27/2013] [Indexed: 11/17/2022] Open
Abstract
Diabetes mellitus is associated with a wide variety of rheumatologic manifestations which can significantly affect a patient's quality of life. One of these manifestations includes diabetic cheiroarthropathy (DCA) which affects the hands. We review a case of a 28-year-old female patient with type 1 diabetes mellitus who was diagnosed with DCA after complaining of limited movements of all joints in her hands and tightening of the skin. We examine how the diagnosis was made, the treatment administered, and the successful clinical outcome. Clinicians should be able to identify and treat this affliction. The diagnosis is mainly clinical. It is imperative to remember that the presence of DCA carries with it a significant relationship with microvascular disease.
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