1. Arthur Vinnitsky
Hunter College
Prevalence of Hand Disorders in Type 2 Diabetes Mellitus
Purpose:
This poster will analyze recent research on diabetes and related drug therapy and address
potential orientation and mobility implications.
Maladies include:
• Limited Joint Mobility
• Dupuytren’s Disease
• Trigger Finger
• Carpal Tunnel Syndrome
• Frozen Shoulder Syndrome
• Diabetic Peripheral Neuropathy
Given diabetes’ prevalence and its many physical side effects, it’s imperative for O&M
specialist to understand the implications of both diabetes’ and leading medications’
impacts
Medications are often used to treat diabetes. Two prominent ones are:
Thiazolidinediones
Inhaled Insulin
Medications often have adverse side effects including:
• Kidney Complications
• Upset Stomach
• Lethargy
• Dizziness
• Weight Gain
• Anemia Risk
• Swelling of lower extremities
67% of patients having one or more hand disorders:
Limited Joint Mobility: 40.5%
Dupuytren’s Disease: 19%
Trigger Finger: 16.5%
Carpal Tunnel Syndrom: 14%
Common Musculoskeletal Disorders in Diabetes Mellitus Patients
Type 1 Diabetes Mellitus Type 2 Diabetes Mellitus
Advances in the epidemiology, pathogenesis and
management of diabetic peripheral neuropathy.
•Diabetic peripheral neuropathy (DPN) is the most common
neuropathic
syndrome seen in persons with diabetes affecting up to 50% of
patients
with diabetes.
•DPN starts in the toes and gradually moves proximally. Once it is
well
established in the lower limbs, it affects the upper limbs, with
sensory
loss following the typical ‘glove and stocking’ pattern of distribution.
•Diabetic peripheral neuropathy (DPN) is associated with
considerable
morbidity, mortality and characterized by pain, paresthesia and
sensory loss.
•Painful symptoms such as burning, tingling , shooting or lancing are
present in around a third of patients with DPN and around 20% of all
diabetic patients. Symptoms are not a reliable indicator of the
severity of the nerve damage: patients with severe pain symptoms
have little sensory deficit, whereas others with no painful symptoms
have completely numb feet.
A Review of Inhaled Insulin.
•Barriers to patient use of subcutaneous insulin include anticipated pain, anxiety,
inconvenience, fear of hypoglycemia, and concern about weight gain. Patients may be
reluctant to start insulin when prescribed or to delay starting treatment.
•Pulmonary delivery of insulin has been shown to have a 4-to-40 fold increase in
bioavailability compared with nasal, rectal, buccal, and conjunctival formulations.
•Cough is the most common pulmonary symptom associated with inhaled insulin but it
becomes diminished in frequency and severity over time.
Consumers’ Perspectives on Effective
Orientation and Mobility Services for
Diabetic Adults Who Are Visually
Impaired
Effective O&M Teaching Strategies mentioned
by participants:
• “She let you make your mistakes. She’d go
back and reteach; was always real patient . . .
she never rushed you. She made you do it over
and over again. She took you out in the
environment you were going to be in.”
• “Exposure to most things you would run into
when you were out—like escalators.”
• “Talking to me and finding out where I needed
to go and what I wanted to do.”
Advice for O&M Specialists:
• Have class after consumers have
eaten
• Have consumers carry their
glucometers and candy during O&M
lessons
• Know your students well enough to
recognize when they are having an
insulin reaction
• Recognize that learning a new area
and walking during lessons can lead to
low
blood sugar
• Know when to challenge students
• Provide a relaxed atmosphere during
lessons.
Conclusion:
 Ample and thorough research into diabetes and related drug therapies and its
impacts on physical functioning.
 Lacking research specifically dealing with the impact on orientation and mobility.
 Given the impact diabetes has on physical functioning and thus, orientation and
mobility, more research in this area is of crucial importance.
Effectiveness and side effects of
thiazolidinediones
for type 2 diabetes:
Amongst 203 patients using Pioglitazone and Rosiglitazone
findings included:
•Statistically significant increases in total cholesterol and
triglyceride levels were associated with rosiglitazone, but not
pioglitazone.
•Increased frequency of hypoglycemia was noted in 18
patients in the pioglitazone group (17%) and 11 in the
rosiglitazone group (11%).
•After six months of treatment, weight gain was observed in
over 100 patients. Ranged from -5 to 19 kg with a mean of 2.3
kg.
•Peripheral edema was noted in 33% of the pioglitazone group
and 21% of the rosiglitazone group.
Implications for O&M Specialists:
• Learners may experience inability to hold or manipulate objects - impacting the
ability to perform cane techniques.
• Further aggravation from the touch technique on the wrist in those with carpal
tunnel syndrome.
• Inability to detect feedback from the cane due to peripheral neuropathy.
• A deviation in gait and balance may be observed.
• Schedule lessons appropriately, by asking an adult learner or scheduling after meals.
• Monitoring and maintenance of blood sugar levels in students during lessons.
• Be aware of and recognize hypoglycemic symptoms in learners - and have a source
of sugar handy.
• Explore the use of guide dogs as they may be more appropriate to those with
peripheral neuropathy.
• Use an interdisciplinary approach.
52.50%
44.02%
15.70% 14.60% 13.52%
12.26% 11.32% 11.32%
5.03%
Osteoathritis -
Upper Body
Frozen
Shoulder
Tendinitis Carpel Tunnel
Syndrome
Fibromyalgia Synovitis Rheumatoid
Arthritis
Osteoathritis -
Lower Body
Dupuytren's
Contracture
63.15%
52.63%
14.03% 14.03%
12.28%
5.26%
1.57% 1.57% 1.57%
Frozen
Shoulder
Osteoarthritis -
Upper Body
Carpel Tunnel
Syndrome
Sinovitis Fibromyalgia Rheumatoid
Arthritis
Tendinitis Dupuytren's
Contracture
Osteoarthritis -
Lower Body