Relationships between cardiovascular disease risk factors and Achilles tendon structural and mechanical properties in people with Type 2 Diabetes

Abstract

Background. Patients with diabetes have 44% greater risk of tendon rupture requiring hospitalisation. Despite this, in vivo research of the associations of diabetes and other cardiovascular disease risk factors on structural and mechanical properties of the Achilles tendon are sparsely studied. Methods. Inactive individuals with type 2 diabetes (n=33) underwent ultrasound and shear wave elastography imaging of their Achilles tendons bilaterally to measure thickness and shear wave velocity (SWV), an index of tendon elastic modulus. In a separate session, participants underwent assessment of body composition, cardiorespiratory fitness and blood biomarkers. Seven inactive individuals without type 2 diabetes were recruited for comparison of tendon structural and mechanical properties. Results. In participants with diabetes, free tendon SWV displayed large negative correlations with hip circumference (r=-0.67, P <0.001), waist circumference (r=-0.59, P <0.001) and body mass index (r=-0.52, P <0001), and a moderate positive correlation with VO 2 peak (r=0.34, P =0.006). SWV was lower in participants with diabetes taking statins compared to not taking statins (Free tendon: median difference 8%, P=0.004); insertion: 11%, P =0.001). Compared to the control group, the diabetes group had thicker Achilles free tendon (median difference 15%, P<0.001) and Achilles insertion (17%, P=0.006), but no differences in SWV (P=0.490 or 0.577 respectively). Conclusions. Achilles tendons from individuals with type 2 diabetes were thicker compared to inactive individuals without diabetes. Adiposity, statin use and low cardiorespiratory fitness were associated with inferior Achilles tendon mechanical properties in people with diabetes.

Ultrasound Tissue Characteristics of Diabetic Muscles and Tendons: Associations with Strength and Laboratory Blood Tests

“…In a study observing the micro-structure and morphology of the Achilles tendons of patients with long-term DM using an electron microscope, it was reported that such tendons have reduced fiber diameter, increased collagen fiber bulk density, and abnormal fiber morphology (4). These findings themselves suggest possible mechanisms underlying the findings of other reports indicating that (a) the hyperechoic appearance of diabetic muscles in ultrasound imaging correctly predicted diabetes in 70 of 79 patients (5); (b) long-term diabetes is associated with a high prevalence of chronic Achilles tendinopathy, including hypoechogenicity, entheseal thickening, and enthesophytes (2,6); and (c) diabetic tendons demonstrate inferior elasticity (Young modulus), maximum load, and stiffness levels (7,8). Theoretically, these respective muscle morphological and tendon microstructural changes are the causes of diabetic muscle force compromise, in addition to being evidence of diabetic complications in tissues with low reparative capacity.…”

Combined Treadmill Running and Insulin Therapy Favors the Stabilization of Glycemic Metabolic Parameters and Avoids Increased Achilles Tendon Rigidity in Diabetic Rats

“…Insulin combined with moderate-intensity exercise on a treadmill increased the physical fitness of DM1 animals, whereas sedentary animals exhibited decreased physical fitness regardless of IST use. Physical inactivity combined with a hyperglycemic state potentiates the chronic compli- cations of musculoskeletal (5,31) and cardiovascular (4,32) systems, which in turn can be mitigated by physical exercise (33,34). Together, that evidence reinforces the clinical benefits of physical exercise for diabetes.…”

Achilles Tendon Rupture and Dysmetabolic Diseases: A Multicentric, Epidemiologic Study

“…Hypercholesterolemia was the most common metabolic condition in our study population of patients with ATRs. Serum cholesterol is carried in various form, of which LDL cholesterol (LDL-C) is the most atherogenic [25]. Indeed, patients with high levels of total cholesterol (>200 mg/dL; 5.17 mmol) and LDL cholesterol (>100 mg/dL; 2.58 mmol) can be diagnosed with hypercholesterolemia [26].…”