TY - JOUR

T1 - Human Achilles tendon glycation and function in diabetes

AU - Couppé, Christian

AU - Svensson, Rene Brüggebusch

AU - Madsen, Mads Kongsgaard

AU - Kovanen, Vuokko

AU - Grosset, Jean-Francois

AU - Snorgaard, Ole

AU - Bencke, Jesper

AU - Larsen, Jytte Overgaard

AU - Bandholm, Thomas

AU - Christensen, Tomas Møller

AU - Boesen, Anders

AU - Helmark, Ida C

AU - Aagaard, Per

AU - Kjaer, Michael

AU - Magnusson, Stig Peter

N1 - Copyright © 2015, Journal of Applied Physiology.

PY - 2016/1

Y1 - 2016/1

N2 - Diabetic patients have an increased risk of foot ulcers, and glycation of collagen may increase tissue stiffness. We hypothesized that the level of glycemic control (glycation) may affect Achilles tendon stiffness, which can influence gait pattern. We therefore investigated the relationship between collagen glycation, Achilles tendon stiffness parameters and plantar pressure in poorly (n = 22) and well (n = 22) controlled diabetic patients, including healthy age matched (45-70 yrs) controls (n = 11). There were no differences in any of outcome parameters (collagen cross-linking or tendon stiffness) between patients with well-controlled and poorly controlled diabetes. The overall effect of diabetes was explored by collapsing the diabetes groups (DB) compared to the controls. Skin collagen cross-linking lysylpyridinoline (LP), hydroxylysylpyridinoline (HP), (136%, 80%, P < 0.01) and pentosidine concentrations (55%, P < 0.05) were markedly greater in DB. Furthermore, Achilles tendon material stiffness was higher in DB (54%, P < 0.01). Notably, DB also demonstrated higher forefoot/ rearfoot peak plantar pressure (PPP)-ratio (33%, P < 0.01). Overall, Achilles tendon material stiffness and skin connective tissue cross-linking were greater in diabetic patients compared to controls. The higher foot pressure indicates that material stiffness of tendon and other tissue (e.g skin and joint capsule) may influence on foot gait. The difference in foot pressure distribution may contribute to the development of foot ulcers in diabetic patients.

AB - Diabetic patients have an increased risk of foot ulcers, and glycation of collagen may increase tissue stiffness. We hypothesized that the level of glycemic control (glycation) may affect Achilles tendon stiffness, which can influence gait pattern. We therefore investigated the relationship between collagen glycation, Achilles tendon stiffness parameters and plantar pressure in poorly (n = 22) and well (n = 22) controlled diabetic patients, including healthy age matched (45-70 yrs) controls (n = 11). There were no differences in any of outcome parameters (collagen cross-linking or tendon stiffness) between patients with well-controlled and poorly controlled diabetes. The overall effect of diabetes was explored by collapsing the diabetes groups (DB) compared to the controls. Skin collagen cross-linking lysylpyridinoline (LP), hydroxylysylpyridinoline (HP), (136%, 80%, P < 0.01) and pentosidine concentrations (55%, P < 0.05) were markedly greater in DB. Furthermore, Achilles tendon material stiffness was higher in DB (54%, P < 0.01). Notably, DB also demonstrated higher forefoot/ rearfoot peak plantar pressure (PPP)-ratio (33%, P < 0.01). Overall, Achilles tendon material stiffness and skin connective tissue cross-linking were greater in diabetic patients compared to controls. The higher foot pressure indicates that material stiffness of tendon and other tissue (e.g skin and joint capsule) may influence on foot gait. The difference in foot pressure distribution may contribute to the development of foot ulcers in diabetic patients.

U2 - 10.1152/japplphysiol.00547.2015

DO - 10.1152/japplphysiol.00547.2015

M3 - Journal article

C2 - 26542519

VL - 120

SP - 130

EP - 137

JO - Journal of Applied Physiology

JF - Journal of Applied Physiology

SN - 8750-7587

IS - 2

ER -