title: Plantar fascia thickness is longitudinally associated with retinopathy and renal dysfunction: a prospective study from adolescence to adulthood.
abstract: OBJECTIVE
  The aim was to study the longitudinal relationship between plantar fascia thickness (PFT) as a measure of tissue glycation and microvascular (MV) complications in young persons with type 1 diabetes (T1DM).
  
  
  METHODS
  We conducted a prospective longitudinal cohort study of 152 (69 male) adolescents with T1DM who underwent repeated MV complications assessments and ultrasound measurements of PFT from baseline (1997-2002) until 2008. Retinopathy was assessed by 7-field stereoscopic fundal photography and nephropathy by albumin excretion rate (AER) from three timed overnight urine specimens. Longitudinal analysis was performed using generalized estimating equations (GEE).
  
  
  RESULTS
  Median (interquartile range) age at baseline was 15.1 (13.4-16.8) years, and median follow-up was 8.3 (7.0-9.5) years, with 4 (3-6) visits per patient. Glycemic control improved from baseline to final visit [glycated hemoglobin (HbA1c) 8.5% to 8.0%, respectively; p = .004]. Prevalence of retinopathy increased from 20% to 51% (p < .001) and early elevation of AER (>7.5 μg/min) increased from 26% to 29% (p = .2). A greater increase in PFT (mm/year) was associated with retinopathy at the final assessment (ΔPFT 1st vs. 2nd-4th quartiles, χ(2) = 9.87, p = .02). In multivariate GEE, greater PFT was longitudinally associated with retinopathy [odds ratio (OR) 4.6, 95% confidence interval (CI) 2.0-10.3] and early renal dysfunction (OR 3.2, CI 1.3-8.0) after adjusting for gender, blood pressure standard deviation scores, HbA1c, and total cholesterol.
  
  
  CONCLUSIONS
  In young people with T1DM, PFT was longitudinally associated with retinopathy and early renal dysfunction, highlighting the importance of early glycemic control and supporting the role of metabolic memory in MV complications. Measurement of PFT by ultrasound offers a noninvasive estimate of glycemic burden and tissue glycation.
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.
authors.forename: Paul Z
authors.initials: PZ
authors.lastname: Benitez-Aguirre
authors.forename: Maria E
authors.initials: ME
authors.lastname: Craig
authors.forename: Alicia J
authors.initials: AJ
authors.lastname: Jenkins
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Gallego
authors.forename: Janine
authors.initials: J
authors.lastname: Cusumano
authors.forename: Anthony C
authors.initials: AC
authors.lastname: Duffin
authors.forename: Stephen
authors.initials: S
authors.lastname: Hing
authors.forename: Kim C
authors.initials: KC
authors.lastname: Donaghue
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000375:Aging; D000419:Albuminuria / Q000453:epidemiology / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure; D015992:Body Mass Index; D016009:Chi-Square Distribution; D002784:Cholesterol / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000097:blood / Q000453:epidemiology* / Q000473:pathology / Q000503:physiopathology; D005205:Fascia / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging / Q000473:pathology*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D009517:New South Wales / Q000453:epidemiology; D016017:Odds Ratio; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D015415:Biomarkers; D002784:Cholesterol; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human