Muscle compromise in diabetes

Abstract

Muscle compromise associated with diabetes includes muscle infarction, myositis, pyomyositis, and abscess formation. These conditions may also be seen in various other conditions, such as trauma, alcoholism, neoplasia, vasculopathy, HIV infection, and other immunocompromised states and hemoglobinopathies. Due to recent advances in imaging technology, these entities are readily detected and treated at an earlier stage. Different diagnostic modalities may be used, particularly magnetic resonance imaging (MRI), which is best for soft-tissue pathologies. Muscle infarction appears with acute edema and inflammatory changes on T1- and T2-weighted images, enhancing peripherally postcontrast, and nonenhancing central areas suggestive of necrosis, lacking focal fluid collections. The latter feature may help to exclude abscesses, as these mostly present with fluid collections. Pyomyositis in its early period demonstrates ill-defined muscle enlargement with increased signal on T2-weighted images. Myositis shows no signal changes or mild hypointensity on T1-weighted images, but diffuse hyperintensity on T2-weighted images, with no or minimal enhancement following intravenous contrast media. Recognition of these pathologies is important, since management approaches vary depending on the etiology of the muscle involvement and overall status of the patient.

Idiopathic inflammatory myositis is associated with a high incidence of hypertension and diabetes mellitus

“…The exceedingly high prevalence of hypertension (62%) and diabetes mellitus (29%) in IIM has not been previously described. Muscle infarction, pyomyositis, and abscess formation are the better‐recognised muscular complications of diabetes but myositis has also been described 8 . Diabetes was present in 4.2% of 24 patients with PM/DM 9 and in 8/40 patients with IBM 10 .…”

Stepwise Approach to Myopathy in Systemic Disease

“…CT or MRI can demonstrate focal abnormalities in the affected muscle. Diagnosis by imaging is preferable to muscle biopsy, if possible (Yildirim Donmez and Feldman, 2008). …”

Muscle changes in patients with diabetes and chronic exertional compartment syndrome before and after treatment with fasciotomy

“…Indeed, during the measuring procedure, some diabetic patients reached such high IMP that there was a theoretical risk of progression to acute compartment syndrome. Spontaneous diabetic muscle infarction has been diagnosed, especially in women with multiple diabetes complications . Thus, preexisting CECS in diabetic patients may be the origin of serious muscle damage.…”