Skin-fold thickness and nail-fold capillaries in diabetics: relationship to limited joint mobility and retinopathy

Sclerodactyly and Diabetic Complications among Egyptian Adolescent Type 1 Diabetic Patient

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.

The diabetic hand: a forgotten complication?

The manifestations of diabetes in the hand were much discussed in the 1970s and 1980s. The present review aims to revisit the diabetic hand and to discuss the pathology of the hand that may be clinically important in diabetic patients. In the strict sense of the term, the "diabetic hand" encompasses the three most widely studied conditions which have traditionally been associated with diabetes, namely limited joint mobility, Dupuytren's contracture and trigger finger. There is evidence that these entities are significantly more frequent in patients with diabetes and also that they may be associated with diabetes duration, poor metabolic control and presence of microvascular complications. In a more general sense, though, there are other conditions affecting the hands, which also occur more frequently in diabetes. From a practical point of view, increased alertness both for neuropathic hand ulcers in patients with profound neuropathy and for diabetic hand infections is absolutely necessary. Recently, reduced hand strength is beginning to be recognized as a further complication of diabetes. Thus, the hand may reveal substantial pathology in diabetes, and ideally, clinical examination should not ignore it.

Dermatoglyphics in insulin-dependent diabetic patients with limited joint mobility

Hand and palm dermatoglyphics were studied in 158 insulin-dependent diabetic children and adolescents [85 with limited joint mobility (LJM) and 73 without]. The findings in this group were compared with those in 400 control subjects, with a similar racial distribution. The main dermatoglyphics alterations found in diabetic patients with LJM, as compared with non-LJM diabetic patients and controls, may be summarized as follows: (a) decrease in digital total ridges count (TRC); (b) higher frequency in the number of arches; (c) decrease in the sum of a line and cubital loops, particularly in the women; (d) increase in the number of t'-axial triradii. These alterations suggest a genetic aetiology of this complication. Further studies are recommended in order to provide more insight into the origin of this disorder.

Limited joint mobility in insulin dependent childhood diabetes

Limited joint mobility (LJM), beginning typically in the fifth finger and moving radially, affecting interphalangeal, metacarpal-phalangeal, and large joints, is the earliest clinically apparent complication of diabetes in childhood and adolescence. It is painless and not disabling. Approximately 50% of post-adolescent patients with more than 5 years duration of diabetes are affected, with age being more important than duration of diabetes, as is the case with other complications. Growth failure is more frequent in the presence of LJM, although correlations with diabetic control have not been found. Variations in frequency in various reports, including high prevalence in controls or relatives, appear to be related to the quality of the examination; simple inspection with hands pressed flat on the table top or together in the prayer position is inadequate; passive extension must be performed. Although differential diagnosis from other conditions causing limitation of the fingers in diabetes would appear simple, LJM has been confused with other conditions which can be distinguished by the presence of pain or paresthesias, neurologic findings, disability, finger-locking, swelling, muscle atrophy, palmar skin or fascial thickening, absence of typical distribution, calcification of the vessels and, particularly, the age group affected. That the periarticular thickening found on examination and demonstrated on roentgenograms reflects generalized abnormalities is suggested by association with thick tight waxy skin, decreased pulmonary function, and association with retinopathy, nephropathy, and neuropathy, independently of duration of diabetes.(ABSTRACT TRUNCATED AT 250 WORDS)