Reduced Prevalence of Limited Joint Mobility in Type 1 Diabetes in a U.K. Clinic Population Over a 20-Year Period

Abstract

OBJECTIVE -Limited joint mobility (LJM), one of the earliest clinically apparent long-term complications of type 1 diabetes, is a risk marker for subsequent microvascular complications. We hypothesize that the prevalence of LJM may have decreased during the past two decades due to improved standards of glycemic control. RESEARCH DESIGN AND METHODS -A single observer performed a survey in 204consecutive patients with type 1 diabetes (106 men and 98 women, age 27 Ϯ 1 years, HbA 1c 8.3 Ϯ 0.1%, duration of diabetes 14.5 Ϯ 0.8 years, insulin dose 63 Ϯ 2 units/day). We used the same examination method and criteria for assessment of LJM as used by us in an earlier study in [1981][1982]. CONCLUSIONS -The present study confirms the hypothesis that the prevalence of LJM is lower than 20 years ago and that improved standards of glycemic control and diabetes care may have contributed to this occurrence. Joint limitation in type 1 diabetes is strongly associated with duration of diabetes. The presence of LJM remains a common and important clinical marker for subsequent microvascular disease and can be a useful clinical tool for identification of patients at increased risk. RESULTS Diabetes Care 28:658 -661, 2005L imited joint mobility (LJM), one of the earliest and most common clinical complications in type 1 diabetes, was first described by Rosenbloom in 1974 (1,2). LJM is characterized by stiffness and thickening of the periarticular connective tissue, beginning in the hand at the fifth interphalangeal joints and extending radially. It is useful to recognize this complication of type 1 diabetes because of its association with the development of microvascular complications (3).The prevalence of LJM in type 1 diabetes quoted in several studies of pediatric and adult diabetes clinics ranges from 9 to 58% (3-5). This variability depends largely upon the population studied and the way in which joint mobility is measured (6). In a previous survey of our clinic population in Belfast published in the 1980s, the prevalence of LJM was 43% (7). Many of the LJM studies were conducted before the introduction of current standards for intensive diabetes care (8). A recent survey of pediatric patients with type 1 diabetes attending diabetic camps in Florida demonstrated a reduced prevalence of LJM between 1976 and 1998 (9). This change was attributed to more intensive glucose control during the past two decades, since there is some evidence that long-term glycemic control influences the onset of this condition (9,10).The current study was designed to compare the frequency of LJM in our own U.K. clinic population across two decades. We performed a survey of patients with type 1 diabetes attending our clinics in 2002 and compared this to observations made in the same clinic in 1981-1982 (7,11). We hypothesized that the prevalence of LJM would be less in 2002, in line with improved standards for glycemic control in the intervening years.RESEARCH DESIGN AND METHODS -Patients were prospectively recruited from the diabetes clinics of the Royal...

Plantar Fascia Thickness, a Measure of Tissue Glycation, Predicts the Development of Complications in Adolescents With Type 1 Diabetes

“…Limited joint mobility, another proposed marker of tissue glycation, has been associated with microvascular disease in adolescents (6,16,17); however, the prevalence of this abnormality was low in our cohort. This finding is in keeping with recent data from the U.K. (8) and suggests that PFT is a more sensitive measure of tissue glycation.…”

“…In particular, measurement of collagen glycation obtained by skin biopsy is invasive and not applicable in routine clinical care. Limited joint mobility in the hands has been previously described as an index of tissue glycation, but its prevalence has fallen significantly in the past two decades (8). Ultrasound has recently been used to detect thickening of the plantar aponeurosis, a tissue rich in collagen and susceptible to nonenzymatic glycation, in adults with type 1 and type 2 diabetes (9,10).…”

Type 1 Diabetes Mellitus and Co-Morbidities

“…Some authors have showed that there is a clear link between upper limb musculoskeletal abnormalities and poor metabolic control (Ramchurn et al, 2009). It has been observed a reduction in frequency of LJM between the mid-70s and mid-90s in children, most likely due to the improved glucose control during this era (Infante et al, 2001;Lindsay et al, 2005).…”

“…With rare exception, LJM appears after the age of 10 years. The prevalence of LJM in T1D, evaluated in several studies ranges from 9 to 58% in paediatric and adult patients (Lindsay et al, 2005). The biochemical basis of LJM may be a consequence of changes in the connective tissue, probably due to alterations in the structural macromolecules of the extracellular matrix.…”

Development and validation of a cost–utility model for Type 1 diabetes mellitus

“…Unclear; limited evidence, only 1 study identified (Lindsay et al, 2005) Unclear; limited evidence, only 1 study identified (Lindsay et al, 2005) No Insufficient evidence that effective diabetes management reduces the risk of Type 1 diabetes mellitus Myopia Unclear; limited evidence, only 1 study identified (Jacobsen et al, 2008) Unclear; limited evidence, only 1 study identified (Jacobsen et al, 2008) No Insufficient evidence that effective diabetes management reduces the risk of Type 1 diabetes mellitus…”