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BMC Musculoskeletal Disorders
Published in: BMC Musculoskeletal Disorders 1/2015

Open Access 01-12-2015 | Research article

Does type 1 diabetes mellitus affect Achilles tendon response to a 10 km run? A case control study

Authors: Andrea M. Y. Wong, Sean I. Docking, Jill L. Cook, James E. Gaida

Published in: BMC Musculoskeletal Disorders | Issue 1/2015

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Abstract

Background

Achilles tendon structure deteriorates 2-days after maximal loading in elite athletes. The load-response behaviour of tendons may be altered in type 1 diabetes mellitus (T1DM) as hyperglycaemia accelerates collagen cross-linking. This study compared Achilles tendon load-response in participants with T1DM and controls.

Methods

Achilles tendon structure was quantified at day-0, day-2 and day-4 after a 10 km run. Ultrasound tissue characterisation (UTC) measures tendon structural integrity by classifying pixels as echo-type I, II, III or IV. Echo-type I has the most aligned collagen fibrils and IV has the least.

Results

Participants were 7 individuals with T1DM and 10 controls. All regularly ran distances greater than 5 km and VISA-A scores indicated good tendon function (T1DM = 94 ± 11, control = 94 ± 10). There were no diabetic complications and HbA1c was 8.7 ± 2.6 mmol/mol for T1DM and 5.3 ± 0.4 mmol/mol for control groups. Baseline tendon structure was similar in T1DM and control groups – UTC echo-types (I-IV) and anterior-posterior thickness were all p > 0.05. No response to load was seen in either T1DM or control group over the 4-days post exercise.

Conclusion

Active individuals with T1DM do not have a heightened Achilles tendon response to load, which suggests no increased risk of tendon injury. We cannot extrapolate these findings to sedentary individuals with T1DM.
Literature
1.
American Diabetes Association. Therapy For Diabetes Mellitus And Related Disorders. 5th ed. Virginia: American Diabetes Association; 2009.
2.
Australian Institute of Health and Welfare. Australia’s health 2010, Australia’s health series no. 12. Cat. no. AUS 122. 2010.
3.
4.
5.
Smellie WS, Wilson D, McNulty CA, Galloway MJ, Spickett GA, Finnigan DI, et al. Best practice in primary care pathology: review 1. J Clin Pathol. 2005;58(10):1016–24.CrossRefPubMedPubMedCentral
6.
The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993;329(14):977–86.CrossRef
7.
Casey G. Type 1 diabetes and insulin therapy. Kai Tiaki: Nursing New Zealand. 2012;18(3):20.
8.
Porte Jr D, Schwartz MW. Diabetes complications: why is glucose potentially toxic? Science. 1996;272(5262):699–700.CrossRefPubMed
9.
Selvin E, Marinopoulos S, Berkenblit G, Rami T, Brancati FL, Powe NR, et al. Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus. Ann Intern Med. 2004;141(6):421–31.CrossRefPubMed
10.
Vithian K, Hurel S. Microvascular complications: pathophysiology and management. Clin Med. 2010;10(5):505–9.CrossRef
11.
Morrison WB, Ledermann HP. Work-up of the diabetic foot. Radiol Clin North Am. 2002;40(5):1171–92.CrossRefPubMed
12.
James VJ, Delbridge L, McLennan SV, Yue DK. Use of X-ray diffraction in study of human diabetic and aging collagen. Diabetes. 1991;40(3):391–4.CrossRefPubMed
13.
Reddy GK. Glucose-mediated in vitro glycation modulates biomechanical integrity of the soft tissues but not hard tissues. J Orthop Res. 2003;21(4):738–43.CrossRefPubMed
14.
Ranger TA, Wong AMY, Cook JL, Gaida JE. Is there an association between tendinopathy and diabetes mellitus? A systematic review with meta-analysis. Br J Sports Med. 2015. doi: 10.​1136/​bjsports-2015-094735. In press.
15.
D’Ambrogi E, Giacomozzi C, Macellari V, Uccioli L. Abnormal foot function in diabetic patients: the altered onset of Windlass mechanism. Diabet Med. 2005;22(12):1713–9.CrossRefPubMed
16.
Giacomozzi C, D’Ambrogi E, Uccioli L, Macellari V. Does the thickening of Achilles tendon and plantar fascia contribute to the alteration of diabetic foot loading? Clin Biomech (Bristol, Avon). 2005;20(5):532–9.CrossRef
17.
de Jonge S, van den Berg C, de Vos RJ, van der Heide HJ, Weir A, Verhaar JA, et al. Incidence of midportion Achilles tendinopathy in the general population. Br J Sports Med. 2011;45(13):1026–8.CrossRefPubMed
18.
Wong AMY, Docking SI, Cook JL, Gaida JE. Is Type 1 Diabetes Mellitus Associated With Lower Limb Tendon Pathology? A Systematic Review. Br J Sports Med. 2014;48 Suppl 2:A71–2.CrossRef
19.
Komatsu MR, Andriolo RB, Atallah AN, Oliveira MM, Dib SA. Physical exercise for type 1 diabetes mellitus. Cochrane Database Syst Rev. 2010;2:CD008384.
20.
Hootman JM, Macera CA, Ainsworth BE, Addy CL, Martin M, Blair SN. Epidemiology of musculoskeletal injuries among sedentary and physically active adults. Med Sci Sports Exerc. 2002;34(5):838–44.CrossRefPubMed
21.
22.
van Schie HT, de Vos RJ, de Jonge S, Bakker EM, Heijboer MP, Verhaar JA, et al. Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach. Br J Sports Med. 2010;44(16):1153–9.CrossRefPubMed
23.
Docking S, Daffy J, van Schie HT, Cook JL. Tendon structure changes after maximal exercise in the Thoroughbred horse: use of ultrasound tissue characterisation to detect in vivo tendon response. Vet J. 2012;194(3):338–42.CrossRefPubMed
24.
Rosengarten SD, Cook JL, Bryant AL, Cordy JT, Daffy J, Docking SI. Australian football players’ Achilles tendons respond to game loads within 2 days: an ultrasound tissue characterisation (UTC) study. Br J Sports Med. 2015;49(3):183–7.
25.
Bosch G, Rene van Weeren P, Barneveld A, van Schie HT. Computerised analysis of standardised ultrasonographic images to monitor the repair of surgically created core lesions in equine superficial digital flexor tendons following treatment with intratendinous platelet rich plasma or placebo. Vet J. 2011;187(1):92–8.CrossRefPubMed
26.
van Schie HT, Bakker EM, Cherdchutham W, Jonker AM, van de Lest CH, van Weeren PR. Monitoring of the repair process of surgically created lesions in equine superficial digital flexor tendons by use of computerized ultrasonography. Am J Vet Res. 2009;70(1):37–48.CrossRefPubMed
27.
van Schie HT, Bakker EM, Jonker AM, van Weeren PR. Computerised ultrasonographic tissue characterisation of equine superficial digital flexor tendons by means of stability quantification of echo patterns in contiguous transverse ultrasonographic images. Am J Vet Res. 2003;64:366–75.CrossRefPubMed
28.
Lenters-Westra E, Slingerland RJ. Six of eight hemoglobin A1c point-of-care instruments do not meet the general accepted analytical performance criteria. Clin Chem. 2010;56(1):44–52.CrossRefPubMed
29.
Robinson JM, Cook JL, Purdam C, Visentini PJ, Ross J, Maffulli N, et al. The VISA-A questionnaire: a valid and reliable index of the clinical severity of Achilles tendinopathy. Br J Sports Med. 2001;35(5):335–41.CrossRefPubMedPubMedCentral
30.
Alfredson H, Lorentzon R. Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports Med. 2000;29(2):135–46.CrossRefPubMed
31.
Rolf C, Movin T. Etiology, histopathology, and outcome of surgery in achillodynia. Foot Ankle Int. 1997;18(9):565–9.CrossRefPubMed
32.
Akturk M, Ozdemir A, Maral I, Yetkin I, Arslan M. Evaluation of Achilles tendon thickening in type 2 diabetes mellitus. Exp Clin Endocrinol Diabetes. 2007;115(2):92–6.CrossRefPubMed
33.
Papanas N, Courcoustsakis N, Papatheodorou K, Daskalogiannakis G, Maltezos E, Prassopoulos P. Achilles tendon volume in type 2 Diabetic Patients with or without Peripheral Neuropathy: MRI Study. Exp Clin Endocrinol Diabetes. 2009;117:645–8.CrossRefPubMed
34.
Kallinen M, Suominen H. Ultrasonographic measurements of the Achilles tendon in elderly athletes and sedentary men. Acta Radiol. 1994;35(6):560–3.CrossRefPubMed
35.
Sayana MK, Maffulli N. Eccentric calf muscle training in non-athletic patients with Achilles tendinopathy. J Sci Med Sport. 2007;10(1):52–8.CrossRefPubMed
36.
Bolton NR, Smith KE, Pilgram TK, Mueller MJ, Bae KT. Computed tomography to visualize and quantify the plantar aponeurosis and flexor hallucis longus tendon in the diabetic foot. Clin Biomech (Bristol, Avon). 2005;20(5):540–6.CrossRef
37.
Gaida JE, Alfredson L, Kiss ZS, Wilson AM, Alfredson H, Cook JL. Dyslipidemia in Achilles tendinopathy is characteristic of insulin resistance. Med Sci Sports Exerc. 2009;41(6):1194–7.CrossRefPubMed
38.
39.
Beeharry D, Coupe B, Benbow EW, Morgan J, Kwok S, Charlton-Menys V, et al. Familial hypercholesterolaemia commonly presents with Achilles tenosynovitis. Ann Rheum Dis. 2006;65(3):312–5.CrossRefPubMed
40.
Gaida JE, Ashe MC, Bass SL, Cook JL. Is adiposity an under-recognized risk factor for tendinopathy? A systematic review. Arthritis Rheum. 2009;61(6):840–9.CrossRefPubMed
41.
Nichols GA, Glauber HS, Brown JB. Type 2 diabetes: incremental medical care costs during the 8 years preceding diagnosis. Diabetes Care. 2000;23(11):1654–9.CrossRefPubMed
42.
Gulliford MC, Latinovic R, Charlton J, Hughes RA. Increased incidence of carpal tunnel syndrome up to 10 years before diagnosis of diabetes. Diabetes Care. 2006;29(8):1929–30.CrossRefPubMed
43.
Saunders SA, Wallymahmed M, MacFarlane IA. Glycaemic control in a type 1 diabetes clinic for younger adults. QJM. 2004;97(9):575–80.CrossRefPubMed
44.
Svensson M, Eriksson JW, Dahlquist G. Early glycemic control, age at onset, and development of microvascular complications in childhood-onset type 1 diabetes: a population-based study in northern Sweden. Diabetes Care. 2004;27(4):955–62.CrossRefPubMed
45.
Burner T, Gohr C, Mitton-Fitzgerald E, Rosenthal AK. Hyperglycemia reduces proteoglycan levels in tendons. Connect Tissue Res. 2012;53(6):535–41.CrossRefPubMed
46.
Tsai WC, Liang FC, Cheng JW, Lin LP, Chang SC, Chen HH, et al. High glucose concentration up-regulates the expression of matrix metalloproteinase-9 and −13 in tendon cells. BMC Musculoskelet Disord. 2013;14:255.CrossRefPubMedPubMedCentral
Metadata
Title
Does type 1 diabetes mellitus affect Achilles tendon response to a 10 km run? A case control study
Authors
Andrea M. Y. Wong
Sean I. Docking
Jill L. Cook
James E. Gaida
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Musculoskeletal Disorders / Issue 1/2015
Electronic ISSN: 1471-2474
DOI
https://doi.org/10.1186/s12891-015-0803-z

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