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Very High Prevalence of Frozen Shoulder in Patients With Type 1 Diabetes of ≥45 Years' Duration: The Dialong Shoulder Study

Published:February 17, 2017DOI:https://doi.org/10.1016/j.apmr.2017.01.020

      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)
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