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Limited Joint Mobility in Childhood Diabetes Mellitus Indicates Increased Risk for Microvascular Disease

Abstract:

We detected limited mobility of small and large joints in 92 (30 per cent) of 309 patients with diabetes who were one to 28 years old. Among patients who had had diabetes for more than 4.5 years (the shortest duration at which microvascular complications were noted), 82 of 169 had joint limitation. Forty-one of these 82 also had microvascular complications, but only 10 of the 87 patients without joint limitation had complications. Life-table analysis indicated an 83 per cent risk for microvascular complications after 16 years of diabetes if joint limitation was present, but only a 25 per cent risk if joint limitation was absent. Consequently, limited joint mobility identifies a population exceptionally at risk for the early development of microvascular complications, and intervention to forestall or prevent these complications can now be focused. (N Engl J Med. 1981; 305:191–4.). IN 1974, we described three adolescents with long-standing diabetes who had restricted mobility of small and large joints, thick, tight, waxy skin, growth impairment, and maturational delay.<sup>1</sup> We subsequently identified four similarly affected young patients and 61 others with milder expression of joint limitation among 229 campers with diabetes, as compared with only two affected subjects among 210 controls matched for age and sex.<sup>2</sup> In that study, the most severely affected subjects had had retinal and renal microvascular disease before the age of 18 years. The purpose of this report is to substantiate the relation between limited joint mobility and. . . © 1981, Massachusetts Medical Society. All rights reserved.