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‘Diabetic hand’ may be marker for subclinical atherosclerosis
Adults with type 2 diabetes and limited joint mobility of the hand were more likely to have subclinical atherosclerosis, as measured by increased carotid plaque formation, when compared with adults with diabetes who do not have limited hand motion, study data from Japan show.
“‘Diabetic hand’ is a complication of the upper extremity that manifests as conditions such as limited joint mobility, Dupuytren’s contracture and trigger finger,” Yusuke Mineoka, MD, PhD, of the department of internal medicine at Otsu Municipal Hospital in Japan, and colleagues wrote. “Diabetic hand tends to be ignored in clinical situation[s], despite several reports about positive [associations] between [limited joint mobility] of the hand and microvascular complications.”
Mineoka and colleagues analyzed data from 341 patients with type 2 diabetes but without cardiovascular who visited the outpatient clinic of Otsu Municipal Hospital between April 2012 and December 2014 (142 women). Patients underwent carotid ultrasound and provided blood samples to measure HbA1c, total cholesterol, triglycerides, creatinine and uric acid; limited joint mobility of the hand was diagnosed using a “prayer sign” or table test. Researchers used linear regression analyses to assess the relationship between limited joint mobility of the hand and markers of subclinical atherosclerosis.
Within the cohort, 72 patients had limited joint mobility; these patients tended to be older (mean age, 73 years vs. 61 years), have a longer duration of diabetes (mean, 17.8 years vs. 14.1 years) and worse renal function (estimated glomerular filtration rate, 59.9 mL/min/1.73 m² vs. 68.1 mL/min/1.73 m²) than patients without limited joint mobility.
Compared with patients who did not have limited joint mobility of the hand, those with the condition had a greater carotid intima-media thickness (mean, 1.45 mm vs. 1.14 mm; P = .013) and a higher carotid plaque score (mean, 8 mm vs. 5.4 mm; P < .001). However, in multiple linear regression analyses, limited joint mobility of the hand was only positively correlated with carotid plaque score (beta = 0.423; P = .043); an association with mean maximum intima-media thickness did not rise to statistical significance, according to researchers (beta = 0.129; P = .077).
“Previous report[s] indicated that [intima-media thickness] was influenced by genetic determinants, but plaque is determined by [coronary heart disease] risk factors, such as age, hypertension, dyslipidemia and diabetes mellitus,” the researchers wrote. “Progression of plaque score is more affected with the duration of diabetes. ... Taken together, our study suggested that [limited joint mobility] of the hand reflects carotid plaque formation rather than thickening of intima-media layer.
“Diagnosis of diabetic hand is simple and noninvasive, and thus is a useful method for assessment of subclinical atherosclerosis in patients with type 2 diabetes,” the researchers wrote. “In a clinical situation, it is important to measure carotid [intima-media thickness] or plaque directly by noninvasive echography as an established surrogate marker for concomitant diseases or predictors.” – by Regina Schaffer
Disclosures: The authors report no relevant financial disclosures.