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Risk factors for expression and progression of limited joint mobility in insulin-dependent childhood diabetes
Insights
Limited joint mobility (LJM) affects 36% of diabetic children and is linked to disease duration and high HbA1c. Improving metabolic control before puberty may reduce LJM progression.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Rheumatology
Background:
- Limited joint mobility (LJM) is a potential complication in children with insulin-dependent diabetes mellitus.
- Understanding LJM predictors is crucial for early intervention and management strategies.
Purpose of the Study:
- To determine the prevalence of LJM in diabetic children.
- To identify predictors for LJM expression and progression.
- To assess the association between LJM and other long-term diabetic complications.
Main Methods:
- Cross-sectional study comparing 100 diabetic children (ages 2-20) with 100 non-diabetic controls.
- Assessed LJM, disease duration, glycated hemoglobin (HbA1c), pubertal stage, ketoacidosis history, and skin changes.
- Evaluated rates of peripheral neuropathy, microalbuminuria, nephropathy, and retinopathy.
Main Results:
- LJM was present in 36% of diabetic children.
- LJM correlated significantly with disease duration, longitudinal HbA1c levels, pubertal stage, ketoacidosis, and skin changes.
- All assessed long-term diabetic complications were significantly associated with LJM.
Conclusions:
- Longer disease duration and higher mean HbA1c are independent predictors of LJM in diabetic children.
- Optimizing metabolic control before puberty may mitigate LJM development and progression.
- LJM is strongly associated with other microvascular and macrovascular complications of diabetes.
Abstract:
We studied the prevalence of limited joint mobility (LJM) in 100 diabetic children and 100 non-diabetic controls. Our objective was to find possible predictors for the expression and progression of LJM and to evaluate the relationship between LJM and other long-term complications of insulin-dependent diabetes mellitus. LJM was present in 36% of diabetic patients aged 2-20 years. It was significantly related to duration of disease and longitudinal glycated haemoglobin (HbA1c) concentrations, pubertal stage, number of ketoacidosis and skin changes. Fourteen patients had peripheral neuropathy, 16 had microalbuminuria, 8 had nephropathy, and 7 had retinopathy. After matching for duration of disease, HbA1c concentrations and pubertal stage, a comparison of the complication rates was made. All long-term complications were significantly associated with LJM. Longer duration of disease and higher mean longitudinal glycated haemoglobin level are independent predictors for expression of LJM. Thus, improvement of metabolic control in diabetic patients before puberty may diminish the expression and progression of LJM.