Niels Gunnar Juel, MD
Archives of Physical Medicine and Rehabilitation
Highlights
- •59% of patients with type 1 diabetes over 45 years had frozen shoulder, 73% bilaterally.
- •Patients with painful frozen shoulder had highest disability and least shoulder mobility.
- •High glycemic index was associated severe disability and restricted shoulder mobility.
Abstract
Objective
To compare the prevalence of shoulder disorders and self-reported shoulder disability in patients with long-term type 1 diabetes mellitus and diabetes-free controls and explore the association between the long-term glycemic burden and shoulder disability in the diabetes group.
Design
A cross-sectional study of shoulder diagnoses with 30 years’ historical data on glycemic burden in the diabetes patients.
Setting
Questionnaires, interviews and medical records were collected at the Norwegian Diabetics Center (NDC). A clinical examination and shoulder x-rays were performed at Oslo university hospital.
Participants
In 2015 136 patients attended NDC with type 1 diabetes since 1970 or earlier. All subjects were invited and 105 patients were included. 102 patients (50% women), mean age 61.9 years and 73 diabetes-free controls (55% women), mean age 62.5 years completed the study.
Interventions
Not applicable.
Main Outcome Measures
Shoulder diagnoses decided through clinical examination according to scientific diagnostic criteria.
Results
Frozen shoulder was diagnosed in 60 (59%) patients with diabetes and 0 controls with a lifetime prevalence of 76% in the diabetes group versus 14% in controls. Diabetes patients had higher disability, QuickDASH score (SD) 23.0 (19.9) than controls 8.9 (12.0), with a mean difference (95% CI) of -14.2 (–19.3 to -9.0) points, P < .001. We found an association between chronic hyperglycemia and QuickDASH score, with a 6.16 point increase in QuickDASH per unit increase in 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 controls. The historical HbA1c level was associated with increased shoulder disability.