Musculoskeletal Complications in Type 1 Diabetes

Abstract

OBJECTIVEThe development of periarticular thickening of skin on the hands and limited joint mobility (cheiroarthropathy) is associated with diabetes and can lead to significant disability. The objective of this study was to describe the prevalence of cheiroarthropathy in the well-characterized Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort and examine associated risk factors, microvascular complications, and the effect of former DCCT therapy (intensive [INT] vs. conventional [CONV]) on its development.RESEARCH DESIGN AND METHODSThis cross-sectional analysis was performed in 1,217 participants (95% of the active cohort) in EDIC years 18/19 after an average of 24 years of follow-up. Cheiroarthropathy—defined as the presence of any one of the following: adhesive capsulitis, carpal tunnel syndrome, flexor tenosynovitis, Dupuytren's contracture, or a positive prayer sign—was assessed using a targeted medical history and standardized physical examination. A self-administered questionnaire (Disabilities of the Arm, Shoulder and Hand [DASH]) assessed functional disability.RESULTSCheiroarthropathy was present in 66% of subjects (64% of the INT group and 68% of the CONV group; P = 0.1640) and was associated with age, sex, diabetes duration, skin intrinsic fluorescence, HbA1c, neuropathy, and retinopathy (P < 0.005 for each). DASH functional disability scores were worse among subjects with cheiroarthropathy (P < 0.0001).CONCLUSIONSCheiroarthropathy is common in people with type 1 diabetes of long duration (∼30 years) and is related to longer duration and higher levels of glycemia. Clinicians should include cheiroarthropathy in their routine history and physical examination of patients with type 1 diabetes because it causes clinically significant functional disability.

Work Disability Before and After Diabetes Diagnosis: A Nationwide Population-Based Register Study in Sweden

“…These conditions are common causes of work disability in Sweden, 27 and depression, 28 cardiovascular disease, 30 musculoskeletal disorders, 31,32 and to some extent asthma 33 have been linked with diabetes. Indication of these conditions was based on having either a medication purchase record entry or in-or outpatient hospitalization record entry, or both.…”

Relationship Between Skin Intrinsic Fluorescence—an Indicator of Advanced Glycation End Products—and Upper Extremity Impairments in Individuals With Diabetes Mellitus

“…Characteristics associated with systemic LJM include duration of diabetes [5][6][7][8]32 and the positive prayer sign; an inability to approximate the inter phalangeal joints of the fingers. 32 Therefore, inclusion criteria for the group with DM were: duration of diagnosed diabetes over 10 years or a 'positive prayer sign', and age between 40-70 years.…”

“…[1][2][3][4] Larkin et al, in a recent prospective study, reported that 66% of their 1,217 participants with Type 1 diabetes had cheiroarthropathy, defined as the presence of any one of the following: adhesive capsulitis, carpal tunnel syndrome, flexor tenosynovitis, Dupuytren's contracture or a positive prayer sign. 5 Prevalence of shoulder impairments is reported to be about 11-50% in people with DM compared to 2-20% in those without DM. [6][7][8][9] Limited joint mobility (LJM) is a systemic problem documented in the hands, shoulders, ankles and feet of people with DM.…”

“…al reports differences in skin fluorescence, glycated hemoglobin, and functional disability between groups with and without upper extremity impairments in a sample of people with Type 1 DM. 5 However, the complete set of relationships outlined in Figure 1 between AGEs, shoulder structural changes, three dimensional joint motion and upper extremity pain/disability needs to be evaluated, especially in people with Type 2 DM. Such investigation should provide insight into the mechanism and management (i.e., prevention or rehabilitation) of these upper extremity impairments in individuals with DM.…”

Contribution of comorbid conditions to the association between diabetes and disability pensions: a population-based nationwide cohort study

“…Comorbid conditions examined were depression, other psychiatric disorders, cardiovascular disease, hypertension, and musculoskeletal disorders. These conditions are common causes of work disability in Sweden (14), and depression (15,16), cardiovascular diseases (17), and musculoskeletal disorders (18,19), have also been linked with diabetes. Indication of these conditions was based on having either a medication purchase record entry or in-or out-patient hospitalization record entry, or both.…”