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

Niels Gunnar Juel; Jens Ivar Brox; Cathrine Brunborg; Kristine Bech Holte; Tore Julsrud Berg

doi:10.1016/j.apmr.2017.01.020

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

Arch Phys Med Rehabil. 2017 Aug;98(8):1551-1559. doi: 10.1016/j.apmr.2017.01.020. Epub 2017 Feb 17.

Authors

Niels Gunnar Juel¹, Jens Ivar Brox², Cathrine Brunborg³, Kristine Bech Holte⁴, Tore Julsrud Berg⁵

Affiliations

¹ Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway. Electronic address: n_gj@hotmail.com.
² Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
³ Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
⁴ Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
⁵ Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; The Norwegian Diabetics Center, Oslo, Norway.

PMID: 28219686
DOI: 10.1016/j.apmr.2017.01.020

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 A_1c (HbA_1c) (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 HbA_1c level was associated with increased shoulder disability.

Keywords: Diabetes mellitus, type 1; Hemoglobin A, glycosylated; Pain; Rehabilitation; Shoulder.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Aged, 80 and over
Blood Glucose
Bursitis / epidemiology*
Cross-Sectional Studies
Diabetes Mellitus, Type 1 / epidemiology*
Female
Glycated Hemoglobin
Humans
Male
Middle Aged
Muscle Strength
Norway
Persons with Disabilities / statistics & numerical data
Prevalence
Range of Motion, Articular

Substances

Blood Glucose
Glycated Hemoglobin