Effects of Type II Diabetes Mellitus on Tendon Homeostasis and Healing

Abstract

Over 300,000 tendon repairs are performed annually in the United States to repair damage to tendons as a result of either acute trauma or chronic tendinopathy. Individuals with type II diabetes mellitus (T2DM) are four times more likely to experience tendinopathy, and up to five times more likely to experience a tendon tear or rupture than non‐diabetics. As nearly 10% of the US population is diabetic, with an additional 33% pre‐diabetic, this is a particularly problematic health care challenge. Tendon healing in general is challenging and often unsatisfactory due to the formation of mechanically inferior scar‐tissue rather than regeneration of native tendon structure. In T2DM tendons, there is evidence of an amplified scar tissue response, which may be associated with the increased the risk of rupture or impaired restoration of range of motion. Despite the dramatic effect of T2DM on tendon function and outcomes following injury, there are few therapies available to promote improved healing in these patients. Several recent studies have enhanced our understanding of the pro‐inflammatory environment of T2DM healing and have assessed potential treatment approaches to mitigate pathological progression in pre‐clinical models of diabetic tendinopathy. This review discusses the current state of knowledge of diabetic tendon healing from molecular to mechanical disruptions and identifies promising approaches and critical knowledge gaps as the field moves toward identification of novel therapeutic strategies to maintain or restore tendon function in diabetic patients. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:13–22, 2020

EGR1 Transcription Factor is a Multifaceted Regulator of Matrix Production in Tendons and Other Connective Tissues

“…Type II diabetes mellitus (T2DM) is associated with high risk of tendinopathy or tendon tears, reviewed recently in [137,138]. Various T2DM rodent models, which cannot be dissociated from obese mouse models, display tendons with decreased collagen content, ECM disorganization, and impaired mechanical properties, reviewed in [138]. T2DM also impairs the healing process following tendon injury and amplifies the fibrotic process during healing, leading to scarred tendons.…”

Clinical and Structural Outcomes After Rotator Cuff Repair in Patients With Diabetes: A Meta-analysis

“… 38 As nearly 10% of the United States population is diabetic, with an additional 33% being prediabetic, this is a particularly problematic health care challenge. 57 …”

“…38 As nearly 10% of the United States population is diabetic, with an additional 33% being prediabetic, this is a particularly problematic health care challenge. 57 Several studies have suggested that diabetes can affect tendon repair outcomes. Using a diabetic tendinopathy model in animals, it has been recognized that alterations in inflammatory, angiogenic, and proliferative processes may be responsible.…”

Komplikasi Muskuloskeletal pada Pasien Diabetes Melitus

“…DM tipe 2 mempercepat perkembangan dan keparahan osteoartritis (Mooney et al, 2011;Schett et al, 2013), dan juga meningkatkan risiko patah tulang (Moseley, 2012). Selain efeknya pada kartilago dan tulang, DMT2 juga merusak homeostasis tendon dan perbaikan setelah cedera akut (Nichols et al, 2020). Dalam teori lain, dikatakan bahwa neuropati motorik akibat perubahan keseimbangan mekanis antara otot ekstrinsik dan intrinsik kaki dapat menyebabkan deformitas muskuloskeletal.…”