title: Achilles tendons in people with type 2 diabetes show mildly compromised structure: an ultrasound tissue characterisation study.
abstract: BACKGROUND
  Musculotendinous overuse injuries are prevalent in people with type 2 diabetes. Non-enzymatic glycosylation of collagen resulting in tendon stiffening may play a role. In this case-control study we determined whether patients with diabetes had poorer ultrasonographic structure in their Achilles tendons compared to age-matched controls.
  
  
  METHODS
  People with type 1 diabetes or type 2 diabetes, and age-matched controls, had computerised ultrasound tissue characterisation of both Achilles tendons. In contiguous ultrasonographic images of the tendon, echopatterns were quantified and categorised into four echo-types. Tendon abnormality was quantified as sum of echo-types III+IV. Furthermore, skin autofluorescence (AF) of the forearm (AF-value) was gathered.
  
  
  RESULTS
  Twenty four type 2 diabetes patients, 24 controls, 24 type 1 diabetes patients and 20 controls were included. AF-value was higher in type 1 diabetes (1.55±0.17) than in their controls (1.39±0.18, p<0.001) and in type 2 diabetes (2.28±0.38) compared to their controls (1.84±0.32, p<0.001) Achilles tendons of type 2 diabetes patients contained more echo-types III+IV (14.1±7.9%) than matched controls (8.0±5.4%, p<0.001). There was a trend towards a difference in echo-types III+IV between type 1 diabetes patients (9.5±5.3%) and their controls (6.5±3.7%, p=0.055). In a stepwise linear regression analysis, body mass index (BMI) was moderately associated with tendon abnormality in patients with diabetes and controls (β=0.393, p<0.001).
  
  
  CONCLUSIONS
  Type 2, and possibly type 1, diabetes patients showed poorer ultrasonographic Achilles tendon structure that may be a risk factor for tendinopathy. Although markers for accumulation of advanced glycation end products were elevated in both diabetes populations, only BMI was associated with these abnormalities.
  
  
  BACKGROUND
  NTR2209.
authors.affiliation: Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Suzan
authors.initials: S
authors.lastname: de Jonge
authors.affiliation: MOVEFIT-Sports Medicine, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Robert
authors.initials: R
authors.lastname: Rozenberg
authors.affiliation: MOVEFIT-Sports Medicine, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vieyra
authors.affiliation: MOVEFIT-Sports Medicine, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Henk J
authors.initials: HJ
authors.lastname: Stam
authors.affiliation: Diabeter, Center for Pediatric and Adolescent Diabetes Care and -Research, Rotterdam, The Netherlands.
authors.forename: Henk-Jan
authors.initials: HJ
authors.lastname: Aanstoot
authors.affiliation: Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
authors.forename: Harrie
authors.initials: H
authors.lastname: Weinans
authors.affiliation: Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands Department Scientific Research, UTC Imaging, Stein, The Netherlands.
authors.forename: Hans T M
authors.initials: HT
authors.lastname: van Schie
authors.affiliation: MOVEFIT-Sports Medicine, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
authors.forename: Stephan F E
authors.initials: SF
authors.lastname: Praet
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging* / Q000293:injuries / Q000473:pathology; D000328:Adult; D016022:Case-Control Studies; D012090:Cumulative Trauma Disorders / Q000209:etiology / Q000473:pathology; D003922:Diabetes Mellitus, Type 1 / Q000473:pathology*; D003924:Diabetes Mellitus, Type 2 / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000209:etiology / Q000473:pathology; D052256:Tendinopathy / Q000000981:diagnostic imaging* / Q000473:pathology; D014463:Ultrasonography
keywords: Achilles; Diabetes; Ultrasound