Human Achilles tendon glycation and function in diabetes

Area of Science:

• Biomedical Engineering
• Diabetology
• Orthopedics

Background:

• Diabetic foot ulcers are a significant complication, potentially linked to collagen glycation and increased tissue stiffness.
• Glycemic control may influence biomechanical properties of connective tissues, affecting gait and foot health.

Purpose of the Study:

• To investigate the relationship between collagen glycation, Achilles tendon stiffness, and plantar pressure in diabetic patients.
• To compare these parameters between well-controlled, poorly-controlled diabetic patients, and healthy controls.

Main Methods:

• Assessment of skin collagen cross-linking (lysylpyridinoline, hydroxylysylpyridinoline, pentosidine).
• Measurement of Achilles tendon material stiffness using biomechanical testing.
• Analysis of plantar pressure distribution (forefoot/rearfoot peak pressure ratio).

Main Results:

• No significant differences in collagen cross-linking or tendon stiffness were found between well-controlled and poorly-controlled diabetic groups.
• Diabetic patients (pooled groups) showed significantly higher skin collagen cross-linking (136-80% for L/H, 55% for pentosidine) and Achilles tendon stiffness (54%) compared to controls.
• Diabetic patients exhibited a higher forefoot/rearfoot peak plantar pressure ratio (33%).

Conclusions:

• Diabetes, irrespective of glycemic control level in this study, is associated with increased Achilles tendon material stiffness and skin collagen cross-linking.
• Elevated tissue stiffness and altered plantar pressure distribution in diabetic patients may contribute to the pathogenesis of diabetic foot ulcers.