Highlights
- •Of patients with type 1 diabetes for ≥45 years, 59% had frozen shoulder, with 73% affected bilaterally.
- •Patients with painful frozen shoulder had highest disability and least shoulder mobility.
- •High glycemic index was associated with severe disability and restricted shoulder mobility.
Abstract
Objectives
To compare the prevalence of shoulder disorders and self-reported shoulder disability
in patients with long-term type 1 diabetes mellitus and diabetes-free subjects; and
to explore the association between the long-term glycemic burden and shoulder disability
in the diabetes group.
Design
Cross-sectional study of shoulder diagnoses with 30 years' historical data on glycemic
burden in patients with diabetes.
Setting
Diabetics center and a university hospital.
Participants
Subjects attending the Norwegian Diabetics Center in 2015 with type 1 diabetes since
1970 or earlier were eligible (N=136). One hundred and five patients were included,
and 102 (50% women; mean age, 61.9y) completed the study together with 73 diabetes-free
subjects (55% women; mean age, 62.5y).
Interventions
Not applicable.
Main Outcome Measure
Shoulder diagnoses decided through clinical examination according to scientific diagnostic
criteria.
Results
Frozen shoulder was diagnosed in 60 (59%) patients with diabetes and 0 diabetes-free
subjects, with a lifetime prevalence of 76% in the diabetes group versus 14% in the
diabetes-free subjects. Patients with diabetes had higher disability and higher mean
QuickDASH scores (23.0±19.9) than diabetes-free subjects (8.9±12.0), with a mean difference
of −14.2 (95% confidence interval, −19.3 to −9.0) points (P<.001). We found an association between chronic hyperglycemia and QuickDASH scores,
with a 6.16-point increase in QuickDASH scores per unit increase in glycated hemoglobin
A1c (HbA1c) (P=.014).
Conclusions
The point prevalence of frozen shoulder in patients with long-lasting type 1 diabetes
was 59%, and the lifetime prevalence was 76%. The diabetes group had more shoulder
disability than diabetes-free subjects. The historical HbA1c level was associated with increased shoulder disability.
Keywords
List of abbreviations:
AGE (advanced glycation end-product), CI (confidence interval), DASH (Disabilities of Arm, Shoulder and Hand), HbA1c (glycated hemoglobin A1c)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: February 17, 2017
Footnotes
Supported by Sophies Minde Ortopedi AS, Oslo, Norway (grant no. 19/2014); Oslo Diabetes Research Center, Oslo, Norway; and The Norwegian Diabetics Center, Oslo, Norway.
Disclosures: none.
Identification
Copyright
© 2017 by the American Congress of Rehabilitation Medicine
