Tendon pain linked to type 2 diabetes

REUTERS

PublishedJan 30, 2016, 10:52 am IST

UpdatedJan 30, 2016, 10:53 am IST

Having injured tendons may make it difficult to stick with exercise programs, which are essential for management of diabetes.

 Tendinopathy refers to injuries and inflammation of the tendons, the soft tissues that connect muscles to bones, usually due to overuse or repetitive movements.

Exercise is important to managing type 2 diabetes, but the condition may also make a person prone to tendon pain, which can interfere with exercise, researchers say.

Based on an analysis of past studies, researchers found that people with type 2 diabetes are more than three times as likely as those without the disease to have tendon pain, known as tendinopathy. And people with diagnosed tendinopathy have 30 percent higher odds of having diabetes.

The findings may indicate a problem healthcare providers need to be aware of, the study’s senior author said. “People with diabetes are more likely to develop tendinopathy, but the opposite is also true - people with tendinopathy are more likely to have undiagnozed diabetes,” Jamie Gaida told Reuters Health in an email.

“Tendinopathy is a problem for two key reasons,” he said. “First, feeling pain during movements that load the tendon is unpleasant, and second, having a painful tendon stops you being physically active.”

People with diabetes “should absolutely be physically active, as it is one of the most effective treatments for diabetes,” said Gaida, an assistant professor and physiotherapist at the University of Canberra in Australia.

Tendinopathy refers to injuries and inflammation of the tendons, the soft tissues that connect muscles to bones, usually due to overuse or repetitive movements. Having injured tendons may make it difficult to stick with exercise programs, which are essential for management of diabetes.

One past research review has also linked diabetes and increased risk of tendinopathies, the authors of the new study note in the British Journal of Sports Medicine.

To examine the relationship further, Gaida and colleagues reviewed 31 previous studies. Twenty-six of them focused on people with type 2 diabetes while five focused on people with diagnosed tendinopathy.

When they combined and reanalyzed the data in all the studies, Gaita’s team found that people with type 2 diabetes were 3.67 times more likely to develop tendinopathy compared to control participants without diabetes. People with tendinopathy were 1.3 times more likely than controls to have diabetes.

The study team also found that people with diabetes were more likely to have thickened tendons, which is often seen in tendinopathy. And people with both tendinopathy and diabetes typically had been diagnosed diabetic for longer than those with diabetes but no tendon problems.

“The risk of tendinopathy increases with the number of years that you’ve had diabetes,” Gaida said.

Physical activity is one of the most effective treatments for diabetes and tendinopathy can be one of the worst things for diabetes management as it stops physical activity, he said, adding that people who develop tendon pain should seek medical advice early for the speediest recovery.

“Physiotherapists/Physical Therapists are uniquely skilled to help you recover from tendinopathy and return to your chosen activity,” Gaida said.

People with diabetes shouldn’t see this study as a reason to stop exercising, stressed Dr. I. Martin Levy, director of the orthopedic surgery residency program at Montefiore Medical Center in New York.

Levy said that people with diabetes should take a measured approach to any type of exercise or activity. “I think whatever exercise program that you are going to take, use common sense, and start off slowly.”

People sometimes “launch themselves too aggressively into exercise programs and hurt themselves,” he said. “Any exercise that you take on, you should do it in a progressive manner. Start off gently and then increase in a rational way, and constantly observing results of your exercise to determine if in fact you are having any problems from the exercise program that you are on.”

Gaida said the risk of tendinopathy for anyone can be minimized by gradually increasing activity levels and the rate of progression should be slower for someone with diabetes.

Gaida also noted that good control of blood sugar levels can minimize the increased risk of tendinopathy in people with type 2 diabetes.

Youth diabetes is on the rise, study suggests

REUTERS

PublishedMay 6, 2014, 2:38 pm IST

UpdatedJan 10, 2016, 8:38 am IST

Researchers can’t say why exactly rates continue to go up, but it is important to monitor them

 New York: Both type 1 and type 2 diabetes became increasingly common among kids and teens in the U.S. between 2001 and 2009, according to a new study.

Though researchers can’t say why exactly these rates continue to go up, it is important to monitor them, Dr. Dana Dabelea told Reuters Health.

Dabelea worked on the study at the Colorado School of Public Health in Aurora.

“This should draw attention to the seriousness of pediatric diabetes especially for the clinical and public health community,” she said. “At the individual level, every new case of diabetes at a young age means a lifelong burden of difficult, expensive treatment and a high risk of complications.”

Dabelea and her team analyzed data from health plans in California, Colorado, Ohio, South Carolina and Washington state, as well as from American Indian reservations in the Southwest, including more than 3 million patients under age 19.

In 2001, about 14.8 kids in every 10,000 were diagnosed with type 1 diabetes, formerly known as 'juvenile diabetes,' in which the body’s own immune system destroys insulin-producing cells in the pancreas. Insulin is needed to remove sugar from the bloodstream so it can be used for energy.

By 2009, that rate had risen to 19.3 kids in every 10,000, a 21 percent increase, the authors found. Type 1 diabetes was most common among white children.

In type 2 diabetes, which is much more common but not usually diagnosed until adulthood, the body still makes insulin but can’t use it effectively. For the current study, the authors looked at type 2 diabetes among kids ages 10 and up.

Among that group in 2001, 3.4 kids in every 10,000 were diagnosed with type 2 diabetes, which increased to 4.6 per 10,000 in 2009, a 31 percent increase. This type of diabetes was most common among American Indian and black youth.

The results were published online Saturday in the Journal of the American Medical Association, to coincide with a presentation at the annual meeting of the Academic Pediatric Societies, held this year in Vancouver, Canada.

Though the study covered a large number of kids, it only included data from two years. So it’s hard to say there was a steady increase in diabetes among kids throughout the country over the same time period, the authors say.

Still, the increase they saw was larger than expected, according to Dabelea, especially given that other recent studies have found obesity rates in the U.S. have finally started to plateau.

Obesity, along with diet and lifestyle, is closely linked with type 2 diabetes.

“The obesity rates in the U.S. have been relatively stable since 2003-04 with a decline in rates recently, mainly in younger children rather than in older children, so I am not too surprised in the continued rise in type 2 (diabetes) in youth from 2001 to 2009, but I am hopeful that the rate of type 2 in youth will level off over the next five years,” Dr. Georgeanna J. Klingensmith told Reuters Health in an email.

Klingensmith, from the Barbara Davis Center for Childhood Diabetes at the University of Colorado School of Medicine in Aurora, was not part of the new study.

“I do think that we are better at diagnosing type 2 diabetes in youth today than we were 10-15 years ago, so part of the increase in type 2 diabetes may be related to improved detection of diabetes due to screening children at high risk,” she said.

The increase in type 2 diabetes seemed mostly to be driven by increases among minority populations, Dabelea said.

“Since minorities typically have less optimal (blood sugar) control, less access to care and more obesity, these are strong risk factors for type 2 diabetes,” she said.

Type 1 diabetes is not caused by obesity, so it could become more common regardless of U.S. obesity rates, Klingensmith said.

It’s still unclear what exactly causes type 1 diabetes, but it has been steadily increasing in European countries as well, Dabelea said.

“For type 1 we can’t really advise families to do anything differently,” she said.

“For type 2 diabetes on the other hand, since that’s so closely related to obesity it’s likely that implementing programs for kids and families being careful of certain things from very early in life is going to be important.”

To protect against type 2 diabetes, parents should help their children avoid excessive weight gain, eat less fried food and more fresh vegetables and get 30 to 60 minutes of exercise per day, Klingensmith said.