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Phatak S, Mahadevkar P, Chaudhari KS, Chakladar S, Jain S, Dhadge S, Jadhav S, Shah R, Bhalerao A, Patil A, Ingram JL, Goel P, Yajnik CS. Quantification of joint mobility limitation in adult type 1 diabetes. Front Endocrinol (Lausanne) 2023; 14:1238825. [PMID: 38027132 PMCID: PMC10657982 DOI: 10.3389/fendo.2023.1238825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Aims Diabetic cheiroarthropathies limit hand mobility due to fibrosis and could be markers of a global profibrotic trajectory. Heterogeneity in definitions and lack of a method to measure it complicate studying associations with organ involvement and treatment outcomes. We measured metacarpophalangeal (MCP) joint extension as a metric and describe magnetic resonance (MR) imaging determinants of MCP restriction. Methods Adults with type 1 diabetes were screened for hand manifestations using a symptom questionnaire, clinical examination, and function [Duruoz hand index (DHI) and grip strength]. Patients were segregated by mean MCP extension (<20°, 20°-40°, 40°-60°, and >60°) for MR imaging (MRI) scanning. Patients in the four groups were compared using ANOVA for clinical features and MRI tissue measurements (tenosynovial, skin, and fascia thickness). We performed multiple linear regression for determinants of MCP extension. Results Of the 237 patients (90 men), 79 (33.8%) with cheiroarthropathy had MCP extension limitation (39° versus 61°, p < 0.01). Groups with limited MCP extension had higher DHI (1.9 vs. 0.2) but few (7%) had pain. Height, systolic blood pressure, and nephropathy were associated with mean MCP extension. Hand MRI (n = 61) showed flexor tenosynovitis in four patients and median neuritis in one patient. Groups with MCP mobility restriction had the thickest palmar skin; tendon thickness or median nerve area did not differ. Only mean palmar skin thickness was associated with MCP extension angle on multiple linear regression. Conclusion Joint mobility limitation was quantified by restricted mean MCP extension and had structural correlates on MRI. These can serve as quantitative measures for future associative and interventional studies.
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Affiliation(s)
- Sanat Phatak
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Pranav Mahadevkar
- Department of Musculoskeletal Radiology, Star Imaging and Research Centre, Pune, India
| | | | - Shreya Chakladar
- Department of Biology, Indian Institute of Science Education and Research, Pune, India
| | - Swasti Jain
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Smita Dhadge
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Sarita Jadhav
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Rohan Shah
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Aboli Bhalerao
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Anupama Patil
- Department of Musculoskeletal Radiology, Star Imaging and Research Centre, Pune, India
| | - Jennifer L. Ingram
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Pranay Goel
- Department of Biology, Indian Institute of Science Education and Research, Pune, India
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Paul A, Gnanamoorthy K. The Association of Diabetic Cheiroarthropathy With Microvascular Complications of Type 2 Diabetes Mellitus: A Cross-Sectional Study. Cureus 2023; 15:e36701. [PMID: 37113343 PMCID: PMC10129041 DOI: 10.7759/cureus.36701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 03/29/2023] Open
Abstract
Introduction Diabetic cheiroarthropathy (DCA), also known as the syndrome of limited joint mobility (LJM), is among the most underdiagnosed complications of diabetes mellitus (DM). Although not severe, it can hamper the day-to-day activities of the patient and significantly reduce the quality of life. It is hypothesized to be due to increased glycation of collagen around joints. The objective of our study was to examine the association of diabetic cheiroarthropathy with microvascular complications of type 2 diabetes mellitus. Methods The study was conducted on 251 previously diagnosed cases of type 2 DM. Patients with previous contractures due to any other cause, who are diagnosed cases of rheumatoid arthritis and scleroderma, and other risk factors such as cardiac or renal disease were excluded from the study. All subjects were subjected to a detailed clinical history including a past history, thorough physical examination, prayer test, tabletop sign, and passive extension of fingers. Patients who are diagnosed with diabetic cheiroarthropathy were then screened for microalbuminuria, fundus examination, and monofilament test and clinical examination to look for the presence of microvascular complications. Results Out of the 251 patients, 46 (18.3%) were found to have diabetic cheiroarthropathy. Fifteen (34.9%) cheiroarthropathy patients had neuropathy compared to 14.9% without diabetic cheiroarthropathy, which was statistically significant. We found that there was an increased incidence of diabetic neuropathy in subjects with cheiroarthropathy. Thirty (35.7%) patients with diabetic cheiroarthropathy had diabetic retinopathy compared to 9.6% without diabetic cheiroarthropathy. Twenty-six (26.8%) patients with diabetic cheiroarthropathy had diabetic nephropathy compared to 13% without diabetic cheiroarthropathy. We identified from our study that patients with diabetic cheiroarthropathy had an increased risk of developing microvascular complications. Conclusion There is an increased prevalence of diabetic nephropathy, diabetic neuropathy, and diabetic retinopathy in patients with diabetic cheiroarthropathy. The presence of diabetic cheiroarthropathy hence warrants better control of the patient's glycemic status to prevent further deterioration of diabetes-related complications.
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Fröhlich-Reiterer E, Elbarbary NS, Simmons K, Buckingham B, Humayun KN, Johannsen J, Holl RW, Betz S, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:1451-1467. [PMID: 36537532 DOI: 10.1111/pedi.13445] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado, USA
| | - Bruce Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University Medical Center, Stanford, California, USA
| | - Khadija N Humayun
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jesper Johannsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Shana Betz
- Parent/Advocate for people with diabetes, Markham, Canada
| | - Farid H Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Hastings MK, Jeong HJ, Sorensen CJ, Zellers JA, Chen L, Bohnert KL, Snozek D, Mueller MJ. Relationships within and between lower and upper extremity dysfunction in people with diabetes. Foot (Edinb) 2020; 44:101680. [PMID: 32679515 PMCID: PMC7483835 DOI: 10.1016/j.foot.2020.101680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/22/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Diabetes mellitus (DM) is associated with systemic musculoskeletal system impairments suggesting concurrent development of lower and upper extremity musculoskeletal problems. This study aims to examine relationships between lower and upper extremity function in people with DM. METHODS Sixty people with type 2 DM and peripheral neuropathy [mean (standard deviation); 67(6) years old, DM duration 14(10) yrs] completed the following measures: 1) Self-reports of function: Foot and Ankle Ability Measure (FAAM; higher = better function) and Shoulder Pain and Disability Index (SPADI; lower = better function), 2) Range of motion (goniometry): ankle dorsiflexion and shoulder flexion, and 3) Strength: unilateral heel rise power (UHR, 3D kinetics) and hand grip dynamometry. Pearson correlations examined associations between lower and upper extremity measures, p < .05. RESULTS Forty of 60 (67%) reported pain/disability in both the foot/ankle and shoulder and 95% of study participants had some limitation in foot or shoulder function. Significant between extremity correlations: FAAM and SPADI (r = -0.39), ankle dorsiflexion and shoulder flexion range of motion (r = 0.35), and UHR and hand grip strength (r = 0.40). Significant within extremity correlations: FAAM and UHR (r = .47) and SPADI with shoulder flexion (r = -0.44). CONCLUSION Upper and lower extremity inter- and intra-relationships indicate systemic musculoskeletal impairments in people with DM. Healthcare practitioners should consider the potential for concurrent and disabling musculoskeletal problems in people with DM.
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Affiliation(s)
- Mary K. Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108
| | - Hyo-Jung Jeong
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108
| | - Christopher J. Sorensen
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis MO 63108
| | - Jennifer A. Zellers
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108,Bernard Becker Medical Library, Washington University School of Medicine, St. Louis MO 63108,Division of Biostatistics, Washington University School of Medicine, St. Louis MO 63110
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine, St. Louis MO 63110
| | - Kathryn L. Bohnert
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108
| | - Darrah Snozek
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108
| | - Michael J. Mueller
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108
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Gokcen N, Cetinkaya Altuntas S, Coskun Benlidayi I, Sert M, Nazlican E, Sarpel T. An overlooked rheumatologic manifestation of diabetes: diabetic cheiroarthropathy. Clin Rheumatol 2019; 38:927-932. [PMID: 30712127 DOI: 10.1007/s10067-019-04454-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/05/2019] [Accepted: 01/23/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The objectives of the study were to analyze the clinical characteristic of diabetic cheiroarthropathy (DCA) in patients with type 1 diabetes mellitus (DM), type 2 DM, and prediabetes and to evaluate the frequency of DCA among groups. METHOD The cross-sectional study was conducted at the Division of Endocrinology and Metabolism outpatient clinic over a 14-month period. A total of 239 patients (160 female, 79 male), who had type 1 DM, type 2 DM, and prediabetes, were enrolled. The demographics, clinical variables, and laboratory outcomes were recorded. Diabetic cheiroarthropathy was defined according to physical examination. The functional disability of patients with DCA was assessed by the self-administered questionnaire (disabilities of the arm, shoulder and hand-DASH). RESULTS Diabetic cheiroarthropathy was determined in 35.1% of all patients. The frequency of DCA was higher in patients with prediabetes (x2 = 0.009, post hoc power = 0.794). According to the logistic regression analysis, prediabetes (OR = 4.52, 95% CI 2.16-9.47, p < 0.001), presence of polyneuropathy (OR = 3.82, 95% CI 1.61-9.07, p = 0.002), and fasting glucose level (OR = 1.01, 95% CI 1.00-1.01, p = 0.004) found as the most effective risk factors in determining DCA. DASH disability scores were significantly higher in prediabetic patients than that in type 2 DM group (p = 0.021). CONCLUSION High frequency of DCA and impaired hand function are observed in prediabetic patients. Musculoskeletal manifestations can emerge as an early sign of diabetic status. Also, people who suffer from hand involvement should be examined for diabetes along with rheumatologic diseases.
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Affiliation(s)
- Neslihan Gokcen
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - Seher Cetinkaya Altuntas
- Department of Internal Medicine, Division of Endocrinology, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Ilke Coskun Benlidayi
- Department of Physical Medicine and Rehabilitation, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Murat Sert
- Department of Internal Medicine, Division of Endocrinology, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Ersin Nazlican
- Department of Public Health, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Tunay Sarpel
- Department of Physical Medicine and Rehabilitation, Cukurova University, Faculty of Medicine, Adana, Turkey
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