These findings provide strong evidence that diabetes is associated with higher risk of tendinopathy. This is clinically relevant as tendinopathy may affect adherence to exercise interventions for diabetes.

Introduction An association between tendinopathy and diabetes mellitus (DM) has been noted across multiple studies; see review by.1 This review aimed to identify and synthesise all available data on this topic. Methods Nine databases were comprehensively searched for English language journal articles reporting both a tendon and diabetes related variable. Reference lists and citation tracking were used to increase the sensitivity of the search. Articles were excluded if they were: case reports, conference proceedings, animal studies or if they lacked a control group. Results The search yielded 680 papers of which 33 were included in the final review. Meta-analysis of 4 studies identified a greater prevalence of diabetes in people with tendinopathy (OR 1.37, CI 1.05, 1.80, Figure 1). Similarly, meta-analysis of 12 studies identified an increased prevalence of tendinopathy in people with DM compared to controls (OR 4.93, CI 2.93, 5.55, Figure 2). Meta-analysis of 8 studies showed that individuals who had both tendinopathy and DM had a longer duration of disease than those who had diabetes but not tendinopathy (eight studies, mean difference: 4.75 yrs, CI 3.45, 6.05, Figure 3). Abstract 85 Figure 1 Prevalence of diabetes in people with tendinopathy DM: Diabetes mellitus; T: Tendinopathy Abstract 85 Figure 2 Prevalence of tendinopathy in people with diabetes Abstract 85 Figure 3 Duration of disease in people with diabetes and tendinopathy compared to people with diabetes only Discussion The findings of this review suggest that tendinopathy should be considered in management of diabetes, particularly as duration of disease increases. This is clinically relevant as unmanaged tendinopathy can limit exercise capacity, which is an accessible means of glycaemic control in diabetes.2 In addition, management of tendinopathy can include exercise therapy to reduce pain and induce healing.3 Exercise therefore represents a mutually beneficial intervention for people suffering from DM and tendinopathy. References Abate, et al. Rheum. 2013;53:599–608 Boulé, et al. J Am Med As. 2001;286:121–1227 Cook, Purdham. Br J Sp Med. 2009;43:409–416

Introduction Type 1 diabetes mellitus (T1DM) occurs when insulin-producing cells are destroyed by an autoimmune response, resulting in hyperglycaemia. Hyperglycaemia accelerates collagen cross-linking in tendons, which can deteriorate tendon structure and predispose to tendon injury (Reddy 2003). Tendon pathology has been observed in the type 2 DM (T2DM) population (Akturk et al. 2007; Papanas et al. 2009), however little is known about T1DM and tendon pathology. This review examines whether there is an association between T1DM and lower limb tendon pathology. Methods Five databases were comprehensively searched for English language journal articles that reported on three key domains: (i) T1DM, (ii) lower limb, and (iii) tendon pathology. Reference lists of included studies or reviews were manually inspected for relevant papers. Articles were excluded if they were: case reports; animal models; conference abstracts; or did not provide T1DM data. Results The search yield of 593 papers was evaluated by title and abstract and 38 papers were read in full text. Only one article met all inclusion criteria (Figure 1). Three potentially eligible articles pooled tendon outcome data for T1DM and T2DM individuals (Bolton et al. 2005; D’Ambrogi et al. 2005; Giacomozzi et al. 2005). Original data was sought from the authors, but was no longer available. Abstract 110 Figure 1 Flowchart of study yield The one included article was a cross-sectional study that reported the prevalence of T1DM among individuals with midportion Achilles tendinopathy. This study reviewed electronic medical records from GP practices in the Netherlands, where all reasons for visit are recorded on a computerised registration system. The prevalence of T1DM in those with Achilles tendinopathy (1.8%, 95% CI, 0 to 4.5) was the same as in the general Dutch population (0.8%, CI, NA) (de Jonge et al. 2011). Discussion The main finding of this review was no difference in the prevalence of T1DM between individuals with tendinopathy and the general population. The review highlighted two other key points: (i) there is very limited published data on tendon pain or structure in T1DM, and (ii) despite profound difference in T1/T2DM pathophysiology and co-morbidities, data are commonly combined. Articles that pooled T1DM and T2DM tendon data did not meet the review inclusion criteria. An effort was made to obtain original T1DM data, which was unsuccessful. These studies found DM individuals had significantly thicker Achilles tendons (p < 0.05) (D’Ambrogi et al. 2005; Giacomozzi et al. 2005), but similar flexor hallucis longus tendon thickness (p > 0.05) (Bolton et al. 2005) compared to controls. However, the influence of T1DM on tendon structure in these studies is unknown. The interest in investigating T1DM and T2DM separately comes from the differing pathophysiological causes of DM and exposure to hyperglycaemia. Other characteristics more specific to T2DM may predispose tendons to pathological changes, such as insulin resistance (Gaida et al. 2009b), eleva...

Background Hyperglycaemia accelerates collagen cross-linking in tendons, which may manifest as an increased thickness or as an altered response to load. Type 1 diabetes mellitus (T1DM) is a unique population exhibiting hyperglycaemia independent of obesity and low physical activity. Ultrasound tissue characterisation (UTC) quantifies the structural integrity of a tendon based on the alignment of collagen, represented as echo-types (I-IV). Objective To measure achilles tendon response to a 10km run among individuals with T1DM and controls. Design In this case-control study, UTC scans were taken at day 0, 2, 4 after a 10 km run. Analysis of UTC scans was performed in a blinded fashion. Setting Social running club for people with T1DM. Participants Individuals with T1DM (n=7) were diagnosed 13±12 years ago. Control participants (n=10) had no diagnosis or family history of T1DM. Participants all regularly ran ≥5 km in a recreational capacity with an average weekly distance of 18±3 km. VISA-A scores were 94±11 (T1DM) and 94±10 (control). Risk factor assessment The independent variable was diagnosis of T1DM (yes/no). HbA1c and blood glucose were also measured. Main outcome measurements Tendon response to a 10km run measured with UTC was defined as the key outcome variable before data collection. Results Baseline structure was the same in control and T1DM groups for all UTC four echo-types (I-IV) and for anteroposterior thickness (P>.05). Furthermore, no significant differences were observed within each group in response to the run. Conclusions A novel finding that Achilles tendon baseline structure and response to a 10 km run over 4-days is the same in controls and T1DM. This suggests that T1DM individuals who are regularly physically active do not undergo the same structural changes to their Achilles tendon as previously demonstrated in the general diabetic population.

Introduction Hyperglycaemia accelerates collagen cross-linking in tendons, which may manifest as an increased thickness or as an altered response to load (Reddy 2003). Type 1 diabetes mellitus (T1DM) is a unique population exhibiting hyperglycaemia independent of obesity and low physical activity. Ultrasound tissue characterisation (UTC) quantifies the structural integrity of a tendon based on the alignment of collagen, represented as echo-types (I-IV) (van Schie et al. 2010). Recent work using UTC has shown a transient response in tendon structure at day 2 post maximal competitive load, which returns to baseline by day 4 (Docking et al. 2012; Rosengarten et al. 2014). The aim of this study was to measure Achilles tendon response to a 10km run among individuals with T1DM and controls. Methods This case-control study was performed in the setting of a social running club for people with T1DM. Participants had their Achilles tendon scanned using UTC before a 10km run (Day 0), and at Day-2 and -4 post run. Anterior-posterior (AP) diameter 2 cm proximal to the calcaneal disappearance was also determined. Participant demographics were recorded and participants completed the VISA-A questionnaire. HbA1c and blood glucose were also measured. All analysis of UTC scans was performed in a blinded fashion. As UTC data was not normally distributed, non-parametric statistical analyses were performed. A Mann-Whitney U test was used for between group Day 0 comparison of echo-types and AP thickness, and a related-sample Friedman’s test was used for within group comparison of echo-types across days. Results Seven T1DM participants (5 men, 2 women; mean ± SD age 38 ± 7 years) and ten controls (4 men, 6 women; age 33 ± 7 years) were included in the study. Participants all regularly ran ≥5km in a recreational capacity with an average weekly distance of 18 ± 3 km. VISA-A scores were 94 ± 11 (T1DM) and 94 ± 10 (control). Baseline Achilles tendon structure was the same in control and T1DM groups for all four UTC echo-types (I-IV) (Figure 1) and for AP thickness (p > 0.05). The Achilles tendon echopattern on UTC did not alter over the four-days post exercise in either group (Figure 2). Abstract 109 Figure 1 Median ± IQR for echo-types I-IV in T1DM and control group at Day 0 Abstract 109 Figure 2 Median ± IQR for echo-types I-IV for Day 0, 2 and 4 in the (A) T1DM and (B) control grou Discussion A novel finding that Achilles tendon baseline structure and response to a 10 km run over 4-days is the same in controls and T1DM. This suggests that T1DM individuals who are regularly physically active do not undergo the same structural changes to their Achilles tendon as previously demonstrated in the general diabetic population. References Docking et al. Vet J. 2012;194: 338–42 Reddy, J Orth Research. 2003;21: 738–43 Rosengarten et al. BJSM 2013–092713;Online, 2014 van Schie et al. BJSM 2010;44, 1153–9