title: Creatine kinase elevation, lactacidemia, and metabolic myopathy in adult patients with diabetes mellitus.
abstract: OBJECTIVE
  To determine the frequency of elevated creatine kinase (CK) levels among patients with diabetes mellitus and to determine how often elevated CK is attributable to primary myopathy.
  
  
  METHODS
  In this prospective study, we investigated how often CK, aspartate amino-transferase, alanine aminotransferase, and resting lactate were elevated among consecutive diabetic patients attending our clinic. Those with elevated CK values were offered a neurologic workup.
  
  
  RESULTS
  Ninety-nine patients with diabetes mellitus, aged 19 to 87 years, were assessed between May 2008 and April 2010. Seven patients had type 1 diabetes and 92 patients had type 2 diabetes. CK, aspartate aminotransferase, alanine aminotransferase, and resting lactate were elevated in 19 of 99, 25 of 99, 22 of 99, and 24 of 98 patients, respectively. Eleven of 19 patients with increased CK were self-injecting insulin. Ten of 24 patients with elevated serum lactate took metformin. Seven of 19 patients with elevated CK consented to neurologic workup. Two of the 7 had elevated resting lactate. In all 7 patients, the findings from neurologic investigation were indicative of a metabolic defect and further diagnostic evaluation was recommended.
  
  
  CONCLUSIONS
  In diabetic patients attending our clinic, elevated CK levels occur in one-fifth and lactacidemia occurs in one-quarter. Elevated CK levels are attributable to a primary metabolic myopathy in most cases. Elevated CK levels in the setting of diabetes mellitus require further neurologic evaluation.
authors.affiliation: First Medical Department, Danube University Krems, Vienna, Austria.
authors.forename: Marlies
authors.initials: M
authors.lastname: Frank
authors.forename: Josef
authors.initials: J
authors.lastname: Finsterer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001317:Austria / Q000453:epidemiology; D015331:Cohort Studies; D003402:Creatine Kinase / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D019344:Lactic Acid / Q000097:blood*; D008875:Middle Aged; D009135:Muscular Diseases / Q000139:chemically induced / Q000150:complications* / Q000453:epidemiology; D011446:Prospective Studies; D012646:Self Administration / Q000009:adverse effects; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin; D019344:Lactic Acid; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D003402:Creatine Kinase