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Br J Sports Med. 2015 Aug;49(15):995-9. doi: 10.1136/bjsports-2014-093696. Epub 2015 Jan 13.

Achilles tendons in people with type 2 diabetes show mildly compromised structure: an ultrasound tissue characterisation study.

Author information

1
Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
2
MOVEFIT-Sports Medicine, Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands.
3
Diabeter, Center for Pediatric and Adolescent Diabetes Care and -Research, Rotterdam, The Netherlands.
4
Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, The Netherlands Department Scientific Research, UTC Imaging, Stein, The Netherlands.

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.

TRIAL REGISTRATION NUMBER:

NTR2209.

KEYWORDS:

Achilles; Diabetes; Ultrasound

PMID:
25586910
DOI:
10.1136/bjsports-2014-093696
[Indexed for MEDLINE]

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