liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Upper extremity impairments in type 1 diabetes with long duration: common problems with great impact on daily life
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Endocrinology.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Rheumatology.
Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Medicine and Health Sciences.
Show others and affiliations
2019 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 41, no 6, p. 633-640Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To investigate the prevalence, activity limitations and potential risk factors of upper extremity impairments in type 1 diabetes in comparison to controls.

METHODS: In a cross-sectional population-based study in the southeast of Sweden, patients with type 1 diabetes <35 years at onset, duration ≥20 years, <67 years old and matched controls were invited to answer a questionnaire on upper extremity impairments and activity limitations and to take blood samples.

RESULTS: Seven hundred and seventy-three patients (ages 50 ± 10 years, diabetes duration 35 ± 10 years) and 708 controls (ages 54 ± 9 years) were included. Shoulder pain and stiffness, hand paraesthesia and finger impairments were common in patients with a prevalence of 28-48%, which was 2-4-folds higher than in controls. Compared to controls, the patients had more bilateral impairments, often had coexistence of several upper extremity impairments, and in the presence of impairments, reported more pronounced activity limitations. Female gender (1.72 (1.066-2.272), p = 0.014), longer duration (1.046 (1.015-1.077), p = 0.003), higher body mass index (1.08 (1.017-1.147), p = 0.013) and HbA1c (1.029 (1.008-1.05), p = 0.007) were associated with upper extremity impairments.

CONCLUSIONS: Compared to controls, patients with type 1 diabetes have a high prevalence of upper extremity impairments, often bilateral, which are strongly associated with activity limitations. Recognising these in clinical practise is crucial, and improved preventative, therapeutic and rehabilitative interventions are needed. Implications for rehabilitation Upper extremity impairments affecting the shoulder, hand and fingers are common in patients with type 1 diabetes, the prevalence being 2-4-fold higher compared to non-diabetic persons. Patients with diabetes type 1 with upper extremity impairments have more pronounced limitations in daily activities compared to controls with similar impairments. Recognising upper extremity impairments and activity limitations are important and improved preventive, therapeutic and rehabilitation methods are needed.

Place, publisher, year, edition, pages
Taylor & Francis, 2019. Vol. 41, no 6, p. 633-640
Keywords [en]
Dupuytren’s disease, Type 1 diabetes, carpal tunnel syndrome, frozen shoulder, trigger finger disorder
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:liu:diva-144020DOI: 10.1080/09638288.2017.1397202ISI: 000461521100002PubMedID: 29105514Scopus ID: 2-s2.0-85033477270OAI: oai:DiVA.org:liu-144020DiVA, id: diva2:1170432
Note

Funding agencies: Medical Research Council of Southeast Sweden (FORSS); County council of Region Ostergotland, Sweden; Stiftelseforvaltningen of Region Ostergotland, Sweden

Available from: 2018-01-03 Created: 2018-01-03 Last updated: 2020-03-24Bibliographically approved
In thesis
1. Upper extremity impairments in type 1 diabetes in comparison to matched controls without diabetes: associations to the IGF-system, metabolic factors, disability and quality of life
Open this publication in new window or tab >>Upper extremity impairments in type 1 diabetes in comparison to matched controls without diabetes: associations to the IGF-system, metabolic factors, disability and quality of life
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Compared with the general population, people with type 1 diabetes (T1D) more often exhibit pathological alterations in musculoskeletal tissue (impairments). Some of these impairments involve the upper extremities, i.e., the shoulders, hands, and fingers. Although present in diabetes, these complications are underdiagnosed and not actively searched for during routine clinical examinations. Furthermore, much is still unclear about these impairments, specifically regarding their etiology, risk factors, and consequences on daily life activities and quality of life. The growth hormone (GH)/insulinlike growth factor (IGF)-system is known to be affected in diabetes, but whether this is involved in upper extremity impairments (UEIs) is unclear. The aim of this thesis was to describe the prevalence of UEIs in patients with diabetes compared with controls. Furthermore, we aimed to search for risk factors of UEIs, and elucidate the impact of UEIs on daily life activities and health-related quality of life (HRQOL). We used two cohorts; the LedIG cohort (papers I–III), a large population-based study in which all patients with a long duration of T1D (>20 years), aged <67 years, living in the south-east region of Sweden were invited to participate, as well as matched controls without diabetes. This study was based on questionnaires as well as blood samples from the participants. The last paper (IV) included a smaller cohort (n=69) of patients with T1D, who both completed a questionnaire and were the subjects of a clinical examination.

Paper I: The UEIs were common in diabetes, with a prevalence of up to 48%. Hand paresthesia was the most common impairment, followed by shoulder pain and stiffness. The prevalence of UEIs was 2–4 times higher in patients than in controls and was associated with more activity limitations. Risk factors were heterogeneous for the different UEIs and included female sex, increasing age, longer duration of diabetes, and poor glycemic control.

Paper II: The GH-IGF-axis is important for the growth and function of musculoskeletal tissues. We examined differences in the IGF system between patients with T1D on subcutaneous insulin treatment and controls. We found lower levels of IGF-I and insulinlike growth factor-binding protein (IGFBP)-3 and higher levels of GH and IGFBP-1 in patients with T1D than in controls. The largest difference was found in IGFBP-1, and this probably reflected insulin deficiency. The IGF-I levels were increased with increasing insulin doses. However, even at very high insulin doses (>1 U/kg) the IGF-I Z-score was subnormal, indicating that IGF-I cannot be normalized by subcutaneous insulin treatment. Residual endogenous insulin secretion counteracted these alterations. Furthermore, we investigated possible relationships between UEIs and IGF-I, and found no association.

Paper III: The HRQOL was lower in patients with T1D than in controls. Patients with shoulder impairments, hand paresthesia, and hand stiffness, but not finger impairments, had lower HRQOL scores than patients without these impairments. The patients with T1D showed a higher frequency of sick leave than controls, and a common reason for this was musculoskeletal impairments.

Paper IV: In addition to the self-reported UEIs, the prevalence of UEIs was also investigated by clinical examination. Clinical UEIs were found in 65% of the participants, with shoulder test (hands against back), prayer sign test, and the Phalen’s and Tinel’s tests being most prevalent. We compared self-reported UEIs to clinical UEIs and found that self-reported impairments were associated with clinical examination. We also found that self-reported shoulder impairments, reduced hand strength, and previous surgery for carpal tunnel syndrome and trigger finger were associated with several other UEIs.

In current diabetic care, there is no established routine to capture UEIs, as opposed to other known diabetes complications. We show that UEIs are more common in patients with T1D than in controls, and that they are related to impaired HRQOL and daily life activity limitations. Clinical routines including self-reported UEIs, e.g. shoulder stiffness and reduced hand strength, might be used to identify patients with UEIs in need of clinical investigation, enhanced preventive and therapeutic strategies, as well as rehabilitative interventions.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2020. p. 58
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1728
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:liu:diva-164550 (URN)9789179299125 (ISBN)
Public defence
2020-04-24, 09:00 (Swedish)
Opponent
Supervisors
Funder
Region ÖstergötlandMedical Research Council of Southeast Sweden (FORSS), FORSS- 155831, FORSS-312821 and FORSS-795171
Note

Ytterligare forskningsfinansiärer: Stiftelseförvaltningen(LIO-483521), Forsknings-ALF (LIO-608721, LIO-690101, LIO-795171)

Available from: 2020-03-24 Created: 2020-03-24 Last updated: 2020-03-31Bibliographically approved

Open Access in DiVA

fulltext(1734 kB)160 downloads
File information
File name FULLTEXT01.pdfFile size 1734 kBChecksum SHA-512
7eef1ae0582145a847c8ce3e2c8d56a48a923c35e232d2d0fe05b224bf62bf12d971816aceec646aaaa8c4970edb24eab7d719e3b7c7106d8d1b335f037197ee
Type fulltextMimetype application/pdf

Other links

Publisher's full textPubMedScopus

Authority records BETA

Bachrach-Lindström, MargaretaArnqvist, Hans

Search in DiVA

By author/editor
Gutefeldt, KerstinHedman, Christina AThyberg, Ingrid S MBachrach-Lindström, MargaretaArnqvist, HansSpångeus, Anna
By organisation
Division of Cardiovascular MedicineFaculty of Medicine and Health SciencesDepartment of Infectious DiseasesDepartment of EndocrinologyDivision of Neuro and Inflammation ScienceDepartment of RheumatologyDivision of Nursing Science
In the same journal
Disability and Rehabilitation
Endocrinology and Diabetes

Search outside of DiVA

GoogleGoogle Scholar
Total: 160 downloads
The number of downloads is the sum of all downloads of full texts. It may include eg previous versions that are now no longer available

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 326 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf