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

Two-hundred and sixty-nine shoulders in 223 patients with a diagnosis of primary frozen shoulder were studied. The main outcome measure was the Oxford shoulder score. The mean follow-up from symptom onset was 4.4 years (range, 2-20 years). The mean age at symptom onset was 53.4 years; with women affected more commonly than men (1.6:1.0). Twenty percent of patients reported bilateral symptoms, but there were no recurrent cases. In the long term, 59% of patients had normal or near normal shoulders and 41% reported some ongoing symptoms. The majority of these persistent symptoms were mild (94%), with pain being the most common complaint. Only 6% had severe symptoms with pain and functional loss. Those with the most severe symptoms at condition onset had the worst long-term prognosis, P < .001.

We collected population-based normative data for the DASH (disabilities of the arm, shoulder and hand ) and QuickDASH questionnaires in order to determine the co-morbidity to be expected in a group of patients. We also studied the correlation between the two scores. A total of 2000 DASH forms and 800 QuickDASH forms were mailed to 1400 men and 1400 women. They were selected randomly in groups of 200 men and women in each age decade from 20-29 to over 80 years old. A total of 50% of the DASH forms and 56% of the QuickDASH forms were returned (p < 0.005). The mean DASH scores for women rose with age from 5 among those aged 20-29, to 22 among those aged 70-79 and 36 for those over 80. The corresponding mean values for men were 5, 13 and 22. The mean DASH and QuickDASH scores extracted from the DASH forms were very similar in each age decade. Spearman's correlation coefficient for the two forms was 0.965 for all 992 forms and 0.930 for the 174 forms with scores of 30 or more. There were, however, wide confidence limits for the agreement between scores in individual patients. The high average scores in the general population, particularly among the elderly, should be borne in mind when evaluating scores among patients. The QuickDASH should be preferred to the full DASH as it gives the same information, but is shorter and completed more often.

Glucose irreversibly modifies long-lived macromolecules by forming AGEs as a function of glucose concentration and time. AGEs cause qualitative and quantitative changes in extracellular matrix components such as type IV collagen, laminin, and vitronectin. These AGE-induced changes can affect cell adhesion, growth, and matrix accumulation. AGE-modified proteins also alter cell function by interacting with specific receptors on macrophages and endothelial cells, inducing changes that promote matrix overproduction, focal thrombosis, and vasoconstriction. DNA and nuclear proteins also may be targets for AGE damage. The persistence of accumulated AGEs during periods of normal glucose homeostasis may explain the phenomenon of hyperglycemic memory. Pharmacological inhibition of in vivo AGE formation by aminoguanidine prevents or ameliorates diabetic retinopathy, nephropathy, and neuropathy in animal models. These data suggest that aminoguanidine and other AGE inhibitors have a potential therapeutic role in the treatment of diabetic patients.