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Plantar Fascia Thickness, a Measure of Tissue Glycation, Predicts the Development of Complications in Adolescents with Type 1 Diabetes

¹Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, NSW Australia
²Discipline of Paediatrics and Child Health, University of Sydney
³School of Women's and Children's Health, University of New South Wales
⁴University of Western Sydney, Sydney
⁵Department of Radiology, Children's Hospital at Westmead

mariac{at}chw.edu.au

m.craig{at}unsw.edu.au

ABSTRACT

Objective: Direct measurement of collagen glycation requires skin biopsy, which is invasive. We hypothesized that measurement of plantar fascia thickness (PFT) by ultrasound is an alternative index of tissue glycation and a marker of microvascular disease.

Research Design And Methods: This was a prospective longitudinal study of microvascular complications in 344 adolescents with type 1 diabetes, whose. PFT was assessed by ultrasound (ACUSON 128 grey scale imager, Mountain View, CA) at baseline. Retinopathy was assessed by 7 field fundal photography, albumin excretion rate (AER) measured from 3 consecutive timed overnight urine specimens, autonomic neuropathy by pupillometry and cardiovascular tests and peripheral neuropathy by vibration and thermal thresholds. Longitudinal analysis was performed using generalized estimating equations with baseline PFT, duration and A1C as explanatory variables.

Results: At first assessment, median [interquartile range] age was 15.1 years [13.5–17.2] and diabetes duration 8.5 years [6.0–11.5]. Median follow up was 3.2 years [2.1–4.5] with a median of 4 complications assessments per patient (range 2-13). In multivariate analysis, baseline PFT (abnormal in 132, 38%) predicted subsequent development of retinopathy: Odds Ratio (95% CI) 2.4 (1.1–5.0), elevated AER (2.24, 1.05–5.11), peripheral neuropathy (2.3, 1.2-4.41) and autonomic neuropathy (4.94, 2.46-9.91). LJM was present in only 4%.

Conclusions: PFT is a significant predictor of the subsequent development of complications in type 1 diabetes, suggesting that glycation and oxidation of collagen in soft tissues may be independent risk factors for microvascular complications.

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