Limited joint mobility in type 1 diabetic patients: associations with microangiopathy and subclinical macroangiopathy are different in men and women.
OBJECTIVE
To study the relationship of limited joint mobility (LJM) in type 1 diabetic patients with microvascular complications, hypertension, and early atherosclerosis and to determine whether sex has an influence on possible associations.


METHODS
A total of 335 consecutive unselected patients (191 women and 144 men), aged 14-40 years, were studied for LJM, retinopathy, nephropathy (stages III and IV), and hypertension. Standard laboratory tests were performed; the intima-media thickness (IMT) of the carotid arteries, which reflects the extent of early atherosclerosis, was measured by high-resolution ultrasound, and plaques were identified.


RESULTS
The frequency of LJM was 33.7% (29.8% in women and 38.9% in men). Subjects with LJM had a longer diabetes duration (P < 0.001) than those without (women 16.7 +/- 9.1 vs. 10.3 +/- 6.0 years; men 15.0 +/- 9.0 vs. 9.4 +/- 6.3 years). Age, HbA1c, lipids, and systolic/diastolic blood pressure were not different between men and women with or without LJM. Men with LJM had a higher albumin excretion rate (37.1 vs. 13.1 microg/min, P < 0.05) than those without LJM and showed a higher risk of proteinuria (odds ratio 1.8, 95% CI 1.2-2.7; P < 0.05), retinopathy (2.4, 1.7-3.5; P < 0.001), and hypertension (1.7, 1.2-2.6; P < 0.05). The occurrence of these complications was not different between women with and without LJM, but only women with LJM had a greater IMT (0.59 +/- 0.13 vs. 0.55 +/- 0.10 mm, P < 0.05) and a higher risk of plaques (odds ratio 2.1, 95% CI 1.3-3.4; P < 0.05) than women without LJM. In a multiple logistic regression analysis, adjusted for age and diabetes duration, male sex independently predicted the presence of LJM. Moreover, LJM proved to be an independent predictor of retinopathy in men only.


CONCLUSIONS
LJM is an indicator of microvascular disease in men, and LJM is associated with early macrovascular disease in women.
Frost
D
D
Third Department of Medicine, Bürgerhospital Stuttgart, Germany. dfrost@buergerhospital.de
Beischer
W
W
D000293:Adolescent; D000328:Adult; D000419:Albuminuria; D001161:Arteriosclerosis / Q000209:etiology; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000150:complications / Q000503:physiopathology*; D003928:Diabetic Nephropathies / Q000150:complications; D003930:Diabetic Retinopathy / Q000150:complications; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D007596:Joints / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D011446:Prospective Studies; D011507:Proteinuria; D016059:Range of Motion, Articular; D012307:Risk Factors; D012727:Sex Characteristics; D013997:Time Factors