LONG-TERM GLYCEMIC CONTROL INFLUENCES THE ONSET OF LIMITED JOINT MOBILITY IN TYPE-1 DIABETES

Background: Limited joint mobility (LJM) in childhood insulin-dependen t (type 1) diabetes is associated with a substantially increased risk of microvascular complications. Cross-sectional studies have not demon strated a relationship between LJM and metabolic control. This study w as designed to determine whether glycemic control, as measured by glyc ohemoglobin (hgbA(1C)) levels from the onset of diabetes, is associate d with the occurrence of LJM. Method: Probands (n = 18) had hgbA(1C) v alues and recorded observation of joint function from soon after onset of their diabetes. Controls (n = 40) were matched to probands for gen der and age at diagnosis and had follow-up beyond the age at which the proband was found to have LJM. Results: The odds ratio for occurrence of LJM for the mean hgbA(1C) from diabetes onset was 1.46, 95% confid ence limits 1.07 to 2.00, Thus, for every unit increase in average hgb A(1C) there was approximately a 46% increase in the risk of LJM. When hgbA(1C) was dichotomized, the OR for hgbA(1C) of more than 8% was 2.5 5, and the OR was 4.54 if the hgbA(1C) was greater than 12%. Age at di agnosis and duration of diabetes were not independent prognostic facto rs for LJM. Conclusion: Glycemic control from onset of diabetes is str ongly associated with occurrence of LJM.