title: High Prevalence of Achilles Tendon Enthesopathic Changes in Patients with Type 2 Diabetes Without Peripheral Neuropathy.
abstract: BACKGROUND
  Metabolic disorders are known to alter the mechanical properties of tendons. We sought to evaluate the prevalence of asymptomatic Achilles tendon enthesopathic changes in patients with type 2 diabetes mellitus (T2DM) without peripheral neuropathy.
  
  
  METHODS
  We recruited 43 patients with T2DM and 40 controls. Neuropathy was excluded with the Michigan Neuropathy Scoring Instrument. Bilateral ultrasonography of the Achilles tendon enthesis was performed.
  
  
  RESULTS
  Patients with T2DM had a higher prevalence of hypoechogenicity (26.7% versus 2.5%; P = .0001), entheseal thickening (24.4% versus 8.7%; P = .007), and enthesophytes (74.4% versus 57.5%; P = .02). No differences were found in the number of patients with erosions (1.2% versus 0%; P > .99), cortical irregularities (11.6% versus 3.7%; P = .09), bursitis (5.8% versus 3.7%; P = .72), or tears (2.3% versus 1.2%; P > .99). The mean ± SD sum of abnormalities was higher in patients with T2DM (1.5 ± 1.1 versus 0.7 ± 0.6; P < .0001), as was the percentage of bilateral involvement (72.1% versus 45.0%; P = .01). Mean ± SD thickness did not differ between patients and controls (4.4 ± 1.1 mm versus 4.2 ± 0.8 mm; P = .07).
  
  
  CONCLUSIONS
  According to our data, there is an elevated prevalence of asymptomatic Achilles tendon enthesopathic changes in patients with T2DM independent of peripheral neuropathy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Ursini
authors.forename: Franco
authors.initials: F
authors.lastname: Arturi
authors.forename: Salvatore
authors.initials: S
authors.lastname: D'Angelo
authors.forename: Lewa
authors.initials: L
authors.lastname: Amara
authors.forename: Kassandra
authors.initials: K
authors.lastname: Nicolosi
authors.forename: Emilio
authors.initials: E
authors.lastname: Russo
authors.forename: Saverio
authors.initials: S
authors.lastname: Naty
authors.forename: Caterina
authors.initials: C
authors.lastname: Bruno
authors.forename: Giovambattista
authors.initials: G
authors.lastname: De Sarro
authors.forename: Ignazio
authors.initials: I
authors.lastname: Olivieri
authors.forename: Rosa Daniela
authors.initials: RD
authors.lastname: Grembiale
mesh_terms: D000125:Achilles Tendon / Q000000981:diagnostic imaging / Q000473:pathology*; D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000000981:diagnostic imaging / Q000453:epidemiology; D018450:Disease Progression; D000070676:Enthesopathy / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010523:Peripheral Nervous System Diseases / Q000453:epidemiology / Q000503:physiopathology; D015995:Prevalence; D011379:Prognosis; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler