Musculoskeletal complications in type 1 diabetes.
OBJECTIVE
The development of periarticular thickening of skin on the hands and limited joint mobility (cheiroarthropathy) is associated with diabetes and can lead to significant disability. The objective of this study was to describe the prevalence of cheiroarthropathy in the well-characterized Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) cohort and examine associated risk factors, microvascular complications, and the effect of former DCCT therapy (intensive [INT] vs. conventional [CONV]) on its development.


METHODS
This cross-sectional analysis was performed in 1,217 participants (95% of the active cohort) in EDIC years 18/19 after an average of 24 years of follow-up. Cheiroarthropathy-defined as the presence of any one of the following: adhesive capsulitis, carpal tunnel syndrome, flexor tenosynovitis, Dupuytren's contracture, or a positive prayer sign-was assessed using a targeted medical history and standardized physical examination. A self-administered questionnaire (Disabilities of the Arm, Shoulder and Hand [DASH]) assessed functional disability.


RESULTS
Cheiroarthropathy was present in 66% of subjects (64% of the INT group and 68% of the CONV group; P = 0.1640) and was associated with age, sex, diabetes duration, skin intrinsic fluorescence, HbA1c, neuropathy, and retinopathy (P < 0.005 for each). DASH functional disability scores were worse among subjects with cheiroarthropathy (P < 0.0001).


CONCLUSIONS
Cheiroarthropathy is common in people with type 1 diabetes of long duration (∼30 years) and is related to longer duration and higher levels of glycemia. Clinicians should include cheiroarthropathy in their routine history and physical examination of patients with type 1 diabetes because it causes clinically significant functional disability.
Massachusetts General Hospital Diabetes Research Center, Harvard University, Boston, MA mlarkin1@partners.org.
Mary E
ME
Larkin
Mt. Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.
Annette
A
Barnie
The Biostatistics Center, The George Washington University, Rockville, MD.
Barbara H
BH
Braffett
The Biostatistics Center, The George Washington University, Rockville, MD.
Patricia A
PA
Cleary
The Biostatistics Center, The George Washington University, Rockville, MD.
Lisa
L
Diminick
University of Western Ontario, London, Ontario, Canada.
Judy
J
Harth
Yale School of Medicine, Yale University, New Haven, CT.
Patricia
P
Gatcomb
Joslin Diabetes Center, Boston, MA.
Ellen
E
Golden
Division of Diabetes, Endocrinology, & Metabolism, Vanderbilt University, Nashville, TN.
Janie
J
Lipps
Department of Medicine, University of California San Diego, La Jolla, CA.
Gayle
G
Lorenzi
Massachusetts General Hospital Diabetes Research Center, Harvard University, Boston, MA.
Carol
C
Mahony
Massachusetts General Hospital Diabetes Research Center, Harvard University, Boston, MA.
David M
DM
Nathan
D000328:Adult; D001786:Blood Glucose; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007592:Joint Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000453:epidemiology* / Q000209:etiology / Q000503:physiopathology; D015995:Prevalence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors
D001786:Blood Glucose