Reduced prevalence of limited joint mobility in type 1 diabetes in a U.K. clinic population over a 20-year period.
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.


METHODS
A single observer performed a survey in 204 consecutive patients with type 1 diabetes (106 men and 98 women, age 27 +/- 1 years, HbA(1c) 8.3 +/- 0.1%, duration of diabetes 14.5 +/- 0.8 years, insulin dose 63 +/- 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.


RESULTS
The prevalence of LJM has fallen from 43 to 23% between the 1980s and 2002 (P < 0.0001). The relative risk for LJM in 2002 compared with the 1981-1982 cohort was 0.53 (0.40 < RR < 0.72, P < 0.0001). The prevalence of LJM was increased with longer duration of diabetes (<10 years, 13%; 10-20 years, 19%; 20-29 years, 30%; >30 years, 65%; P < 0.001). The relative risk for those with a mean HbA(1c) <7% in 2002 was 0.3 (0.1 < RR < 1.2, P = 0.05) when compared with those with mean HbA(1c) >7%.


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.
Lindsay
John R
JR
Regional Centre for Endocrinology and Diabetes, Royal Victoria Hospital, Grosvenor Rd., Belfast, BT12 6BA U.K.
Kennedy
Laurence
L
Atkinson
A Brew
AB
Bell
Patrick M
PM
Carson
Dennis J
DJ
McCance
David R
DR
Hunter
Steven J
SJ
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007593:Joint Instability / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D015995:Prevalence; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
D001786:Blood Glucose; D006442:Glycated Hemoglobin