Limited joint mobility in subjects with insulin dependent diabetes mellitus: relationship with eye and kidney complications.

Garg, Satish K.; Chase, H. Peter; Marshall, Guillermo; Jackson, William E.; Holmes, Douglas P.; Hoops, Sandy; Harris, Sherrie

doi:10.1136/adc.67.1.96

Cited by 35 publications

(22 citation statements)

References 12 publications

(2 reference statements)

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“…A strong relationship was found between scleroderma-like skin changes and contractures of LJM, both of which are presumed to belong to the same spectrum of connective tissue abnormalities due to advanced glycosylation (13,14). There is controversy regarding the relation of LJM to the development of microvascular complications such as retinopathy and nephropathy (5,15,16). Our finding is in agreement with an extensive study on LJM that did not find any relationship to microvascular complications (17).…”

Section: Results-supporting

confidence: 93%

The Prevalence of Cutaneous Manifestations in IDDM Patients and Their Association With Diabetes Risk Factors and Microvascular Complications

et al. 1998

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Section: Results-supporting

confidence: 93%

The Prevalence of Cutaneous Manifestations in IDDM Patients and Their Association With Diabetes Risk Factors and Microvascular Complications

et al. 1998

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“…Diabetes duration has been highly significantly related to the presence of limited joint mobility in adult and pediatric studies 29 In agreement with the above studies, in the Avon study long diabetes duration characterised the groups of children with persistent microalbuminuria, impaired pupillary adaptation and limited joint mobility, while five of the nine children with multiple abnormalities had diabetes duration of >5 years. Moreover the only patient with impairment in three indices of diabetic complications had had diabetes for 10 years.…”

Section: Discussionsupporting

confidence: 70%

Prevalence of Microvascular and Neurologic Abnormalities in a Population of Diabetic Children

Karavanaki¹,

Baum²

1999

Journal of Pediatric Endocrinology and Metabolism

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One hundred and twenty-nine (87%) of a total county population of 150 eligible diabetic children together with 144 age- and sex-matched control children participated in a longitudinal, epidemiological study of the evolution of diabetic microvascular disease. At enrollment the median (range) age of the diabetic children was 12.5 (3.7-16.8) years with a median diabetes duration of 2.9 (0.1-13.4) years and a median HbAl of 11.1 (6.8-17.9)%. Two sets of measurements were made over a period of 18 months for all indices of microvascular disease, while autonomic function was studied on one occasion. Urinary albumin excretion in diabetic children was assessed from all voidings during two timed 48-h urine collections and was expressed as urinary albumin/creatinine ratios (ACR). Blood pressure (BP) was measured using a random zero sphygmomanometer. Autonomic function was assessed by pupillary adaptation in darkness, using a portable Polaroid pupillometer, and by heart rate (HR) variation recorded by dedicated computer. Vibration sensation thresholds (VST) (as indices of peripheral neuropathy) were recorded using a Biothesiometer. Limited joint mobility (LJM) was assessed by the "prayer sign". Five (3.9%) diabetic children presented raised mean ACR in more than two of four 24-h urine collections. Fourteen (10.8%) diabetic children were identified as having persistently raised BP during both study periods. Impaired HR response in one HR test was observed in 20 (15.5%) diabetic children, while ten (7.7%) diabetic children demonstrated abnormalities in two or more HR tests. Reduced pupillary adaptation in darkness was found in eight (7.9%) diabetic children. Persistent vibration sensation impairment (VST) in lower limbs was detected in eight (6.2%) diabetic children, while LJM was present in 12 (9.3%) diabetic children. Eight of the 129 diabetic children (6.2%) were found to have abnormality in two and one in three indices of microvascular and autonomic function. Six of nine children had coexistence of impaired autonomic neuropathy and nephropathy. These nine children were diagnosed at a younger age than the rest of the diabetic population (5.1 vs 8.0 yr, p=0.002). Four of nine were aged >11 yr and five of nine had had diabetes for >5 yr. Thus, a constellation of microvascular and neurological abnormalities were demonstrable in a small proportion of diabetic children, who were younger than the rest of the population at the time of onset of their disease. Longitudinal study of this population will demonstrate the clinical significance of these findings.

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“…In the large study of 375 subjects aged 7-25 years, positive correlations were described between skin involvement, severity of joint limitation, and diabetic retinopathy evaluated only through the undilated pupil (20). Another large study with 357 pediatric subjects also noted significant association of LJM with retinopathy and proteinuria (26).…”

Section: Association With Microvascular Disease (Mvd)mentioning

confidence: 92%

Limited Joint Mobility in Childhood Diabetes: Discovery, Description, and Decline

Rosenbloom

2013

The Journal of Clinical Endocrinology & Metabolism

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Context:The discovery of limited joint mobility (LJM) as the earliest clinically apparent complication of diabetes in children and adolescents nearly 40 years ago provided insights into the mechanism of diabetes complications.Results: LJM, due to periarticular connective tissue thickening and stiffness, varied from single joint involvement bilaterally to obvious hand deformity and limitation of movement of the spine. Thick, tight, waxy skin was apparent with more severe changes; biopsy indicated thickening of the dermis and epidermis with accumulation of collagen and loss of skin appendages. Substantial growth impairment was associated with all levels of LJM. Risk for microvascular disease over a 16-year period was actuarially increased nearly 4-fold by the presence of LJM. Long-term glycemic control influenced the onset of LJM; for every unit increase in average glycated hemoglobin from onset there was a 46% increase in the risk of LJM. Between 1976 -78 and 1998, the prevalence of LJM decreased from 30 to 7%, and the portion with moderate to severe changes decreased from 33 to 14%, with the disappearance of severely affected individuals. Furthermore, growth data markedly improved for those with and without LJM; 30% without LJM and 77% with LJM had been less than the 25th percentile for height, whereas the more contemporary group had 22% without LJM and 33% with LJM in this quartile. Conclusions:The elucidation of LJM as a novel and informative early complication of pediatric diabetes has provided insights into the evolution of the severe long-term complications of diabetes. The marked decrease in the frequency of LJM and statural deficit in children and youth with diabetes in the 20 years between the late 1970s and 1990s can be attributed to improved metabolic control of children and adolescents. The prevalence of LJM in a population may serve as a measure of quality of diabetes control. Discovery In the early 1970s, 3 older teenagers who had long-standing type 1 diabetes (T1D) were referred to the University of Florida pediatric diabetes clinic with striking limitation of extension and flexion of the interphalangeal (IP), metacarpophalangeal (MCP), wrist, elbow, and ankle joints-and in 2 of them, the spine-in association with short stature, thick, tight, waxy skin; delayed sexual maturation; and early microvascular complications (Figure 1) (1). Limitation appeared to be due to periarticular thickening and stiffness; radiography revealed normal joints and confirmed thickening of the periarticular tissues. These observations were followed by the description of milder manifestations in 28% of 229 campers with diabetes aged 7-18 years (2, 3). It is remarkable that these findings, particularly the more advanced changes, would not be described until more than half a century after the rescue and survival of children with T1D by insulin. DescriptionChanges were seen to begin in the MCP and proximal IP (PIP) joints of the little finger and extend radially; and in

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Limited joint mobility in subjects with insulin dependent diabetes mellitus: relationship with eye and kidney complications.

Cited by 35 publications

References 12 publications

The Prevalence of Cutaneous Manifestations in IDDM Patients and Their Association With Diabetes Risk Factors and Microvascular Complications

The Prevalence of Cutaneous Manifestations in IDDM Patients and Their Association With Diabetes Risk Factors and Microvascular Complications

Prevalence of Microvascular and Neurologic Abnormalities in a Population of Diabetic Children

Limited Joint Mobility in Childhood Diabetes: Discovery, Description, and Decline

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