Prospective validation of mean metacarpophalangeal joint extension as a measure of diabetes-related fibrotic hand manifestations.
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2025-01
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Introduction
Hand conditions in diabetes, namely, limited joint mobility (LJM), flexor tenosynovitis (FT), carpal tunnel syndrome (CTS), and Dupuytren disease (DD), share a common pathophysiological process involving pro-fibrotic inflammation in flexor structures. A unified, quantitative measure of disease severity across these conditions is lacking, limiting correlational research. We evaluated mean metacarpophalangeal (MCP) joint extension as a potential measure of severity.Methods
We assessed 2,405 adults, including individuals with type 1 diabetes (n=291), type 2 diabetes (n=877), prediabetes (n=326), and non-diabetic controls (n=911). MCP extension was calculated as the average maximum passive extension of the second to fifth fingers, measured with a protractor. Validity was determined by correlating MCP extension with physician-rated severity (convergent) and hand grip strength and the Duruöz Hand Index (DHI, both divergent). Inter-rater reliability was tested in 128 individuals, and sensitivity to change was evaluated in 143 participants assessed at two time points.Results
Mean MCP extension was significantly lower in individuals with all hand conditions (42.4° LJM, 42.8°FT, 39.9° DD, 51.7 °CTS) than in those without (58.6°, all p<0.05). MCP extension correlated with physician-rated severity (-0.5, p<0.01) and weakly with DHI (R2 = 0.03) and grip strength (R2 = 0.07). Inter-rater reliability was strong (ICC 0.72), and MCP extension demonstrated sensitivity to change, worsening over 8 months (SRM -0.61).Conclusion
Mean MCP extension is a valid, reliable, and responsive measure for assessing fibro-inflammatory hand conditions in diabetes.Clinical trial registration
https://ctri.nic.in/Clinicaltrials/login.php, identifier CTRI/2020/12/030057.Type
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Phatak, Sanat, Sarita Jadhav, Rucha Wagh, Parth Ladha, Rishi Nalkande, Rutvij Tope, Harsh Balbudhe, Rohan Shah, et al. (2025). Prospective validation of mean metacarpophalangeal joint extension as a measure of diabetes-related fibrotic hand manifestations. Frontiers in clinical diabetes and healthcare, 6. p. 1650796. 10.3389/fcdhc.2025.1650796 Retrieved from https://hdl.handle.net/10161/34926.
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Jennifer Leigh Ingram
Dr. Ingram's research interests focus on the study of airway remodeling in human asthma. Proliferation, migration, and invasion of airway fibroblasts are key features of airway remodeling that contribute to diminished lung function over time. Dr. Ingram uses molecular biology approaches to define the effects of interleukin-13 (IL-13), a cytokine abundantly produced in the asthmatic airway, in the human airway fibroblast. She has identified important regulatory functions of several proteins prevalent in asthma that control fibroblast growth and pro-fibrotic growth factor production in response to IL-13. By understanding these pathways and their role in human asthma and the chronic effects of airway remodeling, novel treatment strategies may be developed.
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