Upper extremity impairments in type 1 diabetes with long duration; common problems with great impact on daily life

Disability and Rehabilitation

Hedman

Thyberg

et al. 2020

Self Cite

Section: Questionnairementioning

confidence: 99%

Low health-related quality of life is strongly linked to upper extremity impairments in type 1 diabetes with a long duration

Disability and Rehabilitation

Hedman

Thyberg

et al. 2020

Self Cite

“…The prevalence of shoulder, hand, and finger impairments was 2-4 times higher in patients compared with controls, which was statistically significant for all investigated impairments ( Figure 4) 87 . One in five patients (21%) reported the absence of any of the five impairments or previous surgery.…”

Section: Prevalence Of Upper Extremity Impairmentsmentioning

confidence: 82%

Upper extremity impairments in type 1 diabetes in comparison to matched controls without diabetes : associations to the IGF-system, metabolic factors, disability and quality of life

Linköping University Medical Dissertations

2020

Self Cite

Compared with the general population, people with type 1 diabetes (T1D) more often exhibit pathological alterations in musculoskeletal tissue (impairments). Some of these impairments involve the upper extremities, i.e., the shoulders, hands, and fingers. Although present in diabetes, these complications are underdiagnosed and not actively searched for during routine clinical examinations. Furthermore, much is still unclear about these impairments, specifically regarding their etiology, risk factors, and consequences on daily life activities and quality of life. The growth hormone (GH)/insulinlike growth factor (IGF)-system is known to be affected in diabetes, but whether this is involved in upper extremity impairments (UEIs) is unclear. The aim of this thesis was to describe the prevalence of UEIs in patients with diabetes compared with controls. Furthermore, we aimed to search for risk factors of UEIs, and elucidate the impact of UEIs on daily life activities and health-related quality of life (HRQOL). We used two cohorts; the LedIG cohort (papers I-III), a large population-based study in which all patients with a long duration of T1D (>20 years), aged <67 years, living in the southeast region of Sweden were invited to participate, as well as matched controls without diabetes. This study was based on questionnaires as well as blood samples from the participants. The last paper (IV) included a smaller cohort (n=69) of patients with T1D, who both completed a questionnaire and were the subjects of a clinical examination. Paper I: The UEIs were common in diabetes, with a prevalence of up to 48%. Hand paresthesia was the most common impairment, followed by shoulder pain and stiffness. The prevalence of UEIs was 2-4 times higher in patients than in controls and was associated with more activity limitations. Risk factors were heterogeneous for the different UEIs and included female sex, increasing age, longer duration of diabetes, and poor glycemic control. Paper II: The GH-IGF-axis is important for the growth and function of musculoskeletal tissues. We examined differences in the IGF system between patients with T1D on subcutaneous insulin treatment and controls. We found lower levels of IGF-I and insulinlike growth factor-binding protein (IGFBP)-3 and higher levels of GH and IGFBP-1 in patients with T1D than in controls. The largest difference was found in IGFBP-1, and this probably reflected insulin deficiency. The IGF-I levels were increased with increasing insulin doses. However, even at very high insulin doses (>1 U/kg) the IGF-I Z-score was subnormal, indicating that IGF-I cannot be normalized by subcutaneous insulin treatment. Residual endogenous insulin secretion counteracted these alterations. SF-36 Short Form Health Survey T1D Type 1 diabetes UEI(s) Upper extremity impairment(s) Insulin and its impact on the IGF system Under normal physiological conditions, insulin produced by the pancreas reaches the liver directly through the portal vein, thereby exposing the liver to much higher concentrations of insulin ...

“…All patients in the area were identified using the local diabetes registers and were invited to participate by a postal letter with a questionnaire enclosed. The questionnaire used has been described in detail in a previous publication, but in brief included self‐reported total daily insulin doses and method of administration, that is subcutaneously by either multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Furthermore, background data such as weight, length, age, sex and age at diabetes onset as well as questions on presence of UEI including shoulder impairment (defined as pain and stiffness in shoulder), hand paraesthesia (defined as tingling or loss of sensation in the hand), hand stiffness (defined as stiffness in hand or forearm), finger locking (defined as finger locking in flexed position) and finger extend (defined as difficulty to extend one or several fingers) were included.…”

Section: Methodsmentioning

confidence: 99%

“…Patients with T1D are commonly affected by upper extremity impairments (UEI) as stenosing tendovaginitis (trigger finger), carpal tunnel syndrome, limited joint mobility, Dupuytren's contracture and adhesive capsulitis (frozen shoulder) . In a population‐based cohort of patients with T1D and long diabetes duration, we recently reported that UEI are several folds more common and strongly associated with activity limitations in comparison with nondiabetic controls . The GH/IGF‐1 axis is involved in the regulation of the musculoskeletal system and connective tissue metabolism and both GH excess and GH deficiency have negative effects .…”

Section: Introductionmentioning

confidence: 99%

“…12 In a population-based cohort of patients with T1D and long diabetes duration, we recently reported that UEI are several folds more common and strongly associated with activity limitations in comparison with nondiabetic controls. 13 The GH/IGF-1 axis is involved in the regulation of the musculoskeletal system and connective tissue metabolism and both GH excess and GH deficiency have negative effects. [14][15][16] We therefore hypothesized that the UEI could be due to a dysregulated GH-IGF-1 axis.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Dysregulated growth hormone‐insulin‐like growth factor‐1 axis in adult type 1 diabetes with long duration

Hedman

Thyberg

et al. 2018

Clinical Endocrinology

Self Cite