Medical Biochemistry and Molecular Biology, Khartoum, Sudan.
Department of Biochemistry, College of Medicine and Medical Sciences (CMMS), Arabian Gulf University (AGU), Manama, Kingdom of Bahrain.
Acta Diabetol. 2022 Jul;59(7):871-883. doi: 10.1007/s00592-022-01860-9. Epub 2022 Mar 15.
Tendino-myopathy, an unexplored niche, is a non-vascular unstated T2DM complication, which is largely disregarded in clinical practice, thus, we aim to explore it in this review. Literature search using published data from different online resources. Epidemiologically, reported prevalence varies around 10-90%, which is marked variable and unreliable. Clinically, diabetic tendino-myopathy is typified by restriction of movement, pain/tenderness, cramps and decreased functions. Moreover, myopathy is characterized by muscle atrophy, weakness and ischemia, and tendinopathy by deformities and reduced functions/precision. In tendonapthy, the three most affected regions are: the hand (cheiroarthropathy, Dupuytren's contracture, flexor tenosynovitis and carpel tunnel syndrome), shoulder (adhesive capsulitis, rotator cuff tendinopathy and tenosynovitis) and foot (Achilles tendinopathy with the risk of tear/rupture), in addition to diffuse idiopathic skeletal hyperostosis. Pathologically, it is characterized by decreased muscle fiber mass and increased fibrosis, with marked extracellular matrix remodeling and deposition of collagens. The tendon changes include decreased collagen fibril diameter, changed morphology, increased packing and disorganization, with overall thickening, and calcification. Diagnosis is basically clinical and radiological, while diagnostic biomarkers are awaited. Management is done by diabetes control, special nutrition and physiotherapy, while analgesics, steroids and surgery are used in tendinopathy. Several antisarcopenic drugs are in the pipeline. This review aims to bridge clinical practice with research and update routine diabetic checkup by inclusion of tendino-myopathies in the list with an emphasis on management.
肌腱肌病是一个尚未被充分研究的领域，它是非血管性的、未被明确的 2 型糖尿病并发症，在临床实践中往往被忽视。因此，我们旨在通过这篇综述对其进行探讨。使用不同在线资源发表的已有数据进行文献检索。从流行病学角度来看，报告的患病率约为 10%至 90%，差异很大且不可靠。从临床角度来看，糖尿病性肌腱肌病的特征是运动受限、疼痛/压痛、痉挛和功能下降。此外，肌病表现为肌肉萎缩、无力和缺血，而肌腱病则表现为畸形和功能/精度下降。在肌腱病变中，受影响最严重的三个部位是：手（手畸形、掌腱膜挛缩、屈肌腱鞘炎和腕管综合征）、肩（粘连性囊炎、肩袖肌腱病和肌腱炎）和脚（跟腱病，有撕裂/断裂的风险），此外还有弥漫性特发性骨肥厚。从病理角度来看，其特征是肌肉纤维质量减少和纤维化增加，细胞外基质重塑和胶原蛋白沉积明显。肌腱的变化包括胶原纤维直径减小、形态改变、排列增加和组织紊乱，导致整体增厚和钙化。诊断主要基于临床和影像学，而诊断生物标志物仍在等待中。治疗方法是通过控制糖尿病、特殊营养和物理治疗，而在肌腱病中则使用镇痛药、类固醇和手术。目前有几种抗肌少症药物正在研发中。本综述旨在将临床实践与研究联系起来，并通过将肌腱肌病纳入常规糖尿病检查列表中，重点关注其管理，从而更新常规糖尿病检查。
