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Scientific Articles   |    
Effects of Glycemic Control on Prevalence of Diabetic Frozen Shoulder
Edward H. Yian, MD1; Richard Contreras, MS2; Jeffrey F. Sodl, MD1
1 Southern California Permanente Medical Group, 411 North Lakeview Avenue, Anaheim, CA 92807.
2 Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles, Pasadena, CA 91101
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Investigation performed at Kaiser Permanente Orange County, Anaheim Medical Center, Anaheim, California



Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. None of the authors, or their institution(s), have had any financial relationship, in the thirty-six months prior to submission of this work, with any entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. Also, no author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2012 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2012 May 16;94(10):919-923. doi: 10.2106/JBJS.J.01930
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Abstract

Background: 

There is controversy regarding the influence of glycemic control in diabetic patients with frozen shoulder. To determine the relationship between glycemic control and the prevalence of frozen shoulder in diabetic patients, we hypothesized that increased glycosylated hemoglobin A1c (HbA1c) levels would correlate with an increased prevalence of frozen shoulder.

Methods: 

A retrospective analysis with statistical review of 201,513 diabetic patients enrolled in a regional health maintenance organization in 2007 was performed. Analysis included determining the relationship between the prevalence of frozen shoulder and the following factors: HbA1c level, type of diabetes treatment, duration of diabetes treatment, and presence of end-stage diabetic manifestations.

Results: 

There were 1150 diabetic patients with a diagnosis of frozen shoulder. There was no significant relationship between HbA1c level and the prevalence of frozen shoulder. Insulin-dependent patients who used or did not use oral hypoglycemics were 1.93 times more likely than non-insulin-dependent diabetic patients to have frozen shoulder, and that rate increased to 1.96 times more likely when the results were adjusted for HbA1c level. Patients who were taking oral hypoglycemic drugs were 1.5 times more likely to develop frozen shoulder than those who did not use insulin or take oral hypoglycemic drugs. Duration of diabetes was also associated with the development of frozen shoulder, after controlling for insulin use (odds ratio: 1.85 for duration of more than ten years of use compared with less than five years of use). The prevalence of end-stage diabetic manifestations was increased in patients with frozen shoulder as compared with those without frozen shoulder (p < 0.0001).

Conclusion: 

There was no association found between HbA1c level and the prevalence of frozen shoulder in this diabetic population.

Level of Evidence: 

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

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    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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