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

Abstract

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.

Relationship of shoulder activity and skin intrinsic fluorescence with low level shoulder pain and disability in people with type 2 diabetes

“…The results of the current study are in agreement with prior studies showing high SIF levels and reduced joint mobility in participants with T2DM (Conway et al, 2011; Larkin et al, 2014; Shah et al, 2015) and documents reduced magnitude and duration of shoulder activity in those with diabetes compared to controls. In addition, we found that duration of shoulder activity was associated with reported shoulder pain and disability, but in the opposite direction that we expected.…”

“…SIF measures were obtained using the SCOUT DS skin fluorescence spectrometer (VeraLight, Albuquerque, New Mexico) (Conway et al, 2011; Shah et al, 2015). Participants were seated while their left volar forearm was positioned on the SCOUT DS.…”

“…Intrinsic fluorescence correction equations were used as described previously (Conway et al, 2011). The resulting SIF were integrated and reported in arbitrary units (AU) (Conway et al, 2011; Shah et al, 2015). …”

“…People with T2DM are 1.7–2.1 times as likely to report musculoskeletal pain compared to those without diabetes (Molsted, Tribler, & Snorgaard, 2012). In addition, we previously reported that 63% of patients with T2DM attending a Diabetes Clinic had shoulder pain or disability as measured with the Shoulder Pain and Disability Index (SPADI) (Shah et al, 2015). …”

“…The positive prayer sign (Al-Homood, 2013; Cagliero, Apruzzese, Perlmutter, & Nathan, 2002; Rosenbloom AI et al, 1981) in the hands is the most visible of numerous joints with limited mobility (Abate et al, 2011; Delbridge et al, 1988; Mueller, Diamond, Delitto, & Sinacore, 1989; Schulte, Roberts, Zimmerman, Ketler, & Simon, 1993; Shah, Clark, McGill, Lang, & Mueller, 2015). Decreased mobility in the shoulder joint (Abate et al, 2011; Schulte et al, 1993; Shah et al, 2015) occurs insidiously, and the relationship between skin intrinsic florescence (SIF), a surrogate AGE measure, and self-reported shoulder disability has been as high as r=.51 (p=0.009) in people with T2DM (Shah et al, 2015). …”