Francia Piergiorgio, Sorelli Michele, Piccini Barbara, Iannone Giulia, Capirchio Laura, Toni Sonia, Gulisano Massimo, Bocchi Leonardo
1 Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy.
2 Department of Information Engineering, University of Florence, Florence, Italy.
J Diabetes Sci Technol. 2019 Jul;13(4):728-733. doi: 10.1177/1932296818802840. Epub 2018 Sep 26.
It is widely known that diabetes can induce stiffness and adversely affect joint mobility even in young patients with type 1 diabetes mellitus (T1D). The aim of this study was to identify a mathematical model of diabetes mellitus long-term effects on young T1D patients.
Ankle joint mobility (AJM) was evaluated using an inclinometer in 48 patients and 146 healthy, sex- BMI-, and age-matched controls. Assuming time invariance and linear superposition of the effects of hyperglycemia, the influence of T1D on AJM was formalized as an impulse response putting into relationship past supernormal HbA1c concentrations with the ankle total range of motion. The proposed model was identified by means of a nonlinear evolutionary optimization algorithm.
AJM was significantly reduced in young T1D patients ( < .001). AJM in both plantar and dorsiflexion was significantly lower in subjects with diabetes than in controls ( < .001). The identified impulse response indicates that impaired metabolic control requires 3 months to bring out its maximum effect on the reduction of AJM, while the following long-lasting decay phase with the expected AJM recovery times, normally depends on the slow turnover of collagen. HbA1c concentration levels above 7.2% are sufficient to produce a reduction of ankle ROM.
In young patients with T1D the lack of glycemic control over time affects AJM. HbA1c levels can serve as a relevant prognostic factor for assessing the progression of LJM in subjects with diabetes.
众所周知，糖尿病会导致关节僵硬，甚至对1型糖尿病（T1D）的年轻患者的关节活动度产生不利影响。本研究的目的是确定糖尿病对年轻T1D患者长期影响的数学模型。
使用倾角仪对48例患者和146名年龄、性别、体重指数相匹配的健康对照者的踝关节活动度（AJM）进行评估。假设高血糖影响具有时间不变性和线性叠加性，将T1D对AJM的影响形式化为一种脉冲响应，将过去超常的糖化血红蛋白（HbA1c）浓度与踝关节总活动范围建立联系。通过非线性进化优化算法确定所提出的模型。
年轻T1D患者的AJM显著降低（P<0.001）。糖尿病患者的跖屈和背屈AJM均显著低于对照组（P<0.001）。所确定的脉冲响应表明，代谢控制受损需要3个月才能对AJM降低产生最大影响，而随后具有预期AJM恢复时间的长期衰减阶段，通常取决于胶原蛋白的缓慢更新。HbA1c浓度水平高于7.2%足以导致踝关节活动范围减小。
在年轻的T1D患者中，长期血糖控制不佳会影响AJM。HbA1c水平可作为评估糖尿病患者下肢关节活动度（LJM）进展的相关预后因素。
