Plantar fascia thickness, a measure of tissue glycation, predicts the development of complications in adolescents with type 1 diabetes.
OBJECTIVE
Direct measurement of collagen glycation requires skin biopsy, which is invasive. We hypothesized that measurement of plantar fascia thickness (PFT) by ultrasound is an alternative index of tissue glycation and a marker of microvascular disease.


METHODS
This was a prospective longitudinal study of microvascular complications in 344 adolescents with type 1 diabetes, whose PFT was assessed by ultrasound at baseline. Retinopathy was assessed by seven-field fundal photography, albumin excretion rate (AER) measured from three consecutive timed overnight urine specimens, autonomic neuropathy by pupillometry and cardiovascular tests, and peripheral neuropathy by vibration and thermal thresholds. Longitudinal analysis was performed using generalized estimating equations with baseline PFT, duration, and A1C as explanatory variables.


RESULTS
At first assessment, median (interquartile range) age was 15.1 (13.5-17.2) years and diabetes duration was 8.5 (6.0-11.5) years. Median follow up was 3.2 (2.1-4.5) years with a median of 4 (2-13) complications assessments per patient. In multivariate analysis, baseline PFT (abnormal in 132 subjects, 38%) predicted subsequent development of retinopathy (odds ratio 2.4 [95% CI 1.1-5.0]), elevated AER (2.24 [1.05-5.11]), peripheral neuropathy (2.3 [1.2-4.41]), and autonomic neuropathy (4.94 [2.46-9.91]). Limited joint mobility was present in only 4%.


CONCLUSIONS
PFT is a significant predictor of the subsequent development of complications in type 1 diabetes, suggesting that glycation and oxidation of collagen in soft tissues may be independent risk factors for microvascular complications.
Craig
Maria E
ME
Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, New South Wales, Australia. mariac@chw.edu.au
Duffin
Anthony C
AC
Gallego
Patricia H
PH
Lam
Albert
A
Cusumano
Janine
J
Hing
Stephen
S
Donaghue
Kim C
KC
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D000419:Albuminuria / Q000453:epidemiology; D003094:Collagen / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000473:pathology; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000473:pathology; D003929:Diabetic Neuropathies / Q000453:epidemiology; D003930:Diabetic Retinopathy / Q000453:epidemiology; D036981:Fasciitis, Plantar / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006031:Glycosylation; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011237:Predictive Value of Tests; D012307:Risk Factors; D014463:Ultrasonography
D003094:Collagen