Knee osteoarthritis in type 2 diabetes mellitus: does insulin therapy retard osteophyte formation?

Objective: The aim of this study was to investigate whether or not radiographic changes observed in knee osteoarthritis [OA] in type 2 diabetes mellitus [T2DM] patients on insulin therapy differed from those not on insulin

Material and Methods: A cross-sectional study was performed in 311 subjects: 211 T2DM patients and 100 without diabetes [controls] in Mubarak Hospital, Kuwait. Patients were categorized into 3 groups: T2DM patients not on insulin [G1, n = 99], T2DM patients on insulin [G2, n = 112] and a nondiabetic control group [G3, n = 100]. Plain X-ray of both knees was used to assess the changes of knee OA and graded using the Kellegren-Lawrence scale [0-4] and the Osteoarthritis Research Society International Atlas grading scale [0-3]. A total of 622 knee X-rays were evaluated. SPSS version 21.0 was used for data analysis

Results: A highly significant association [p < 0.0001] was observed for joint space narrowing [JSN] as well as for osteophyte formation between the three groups. Comparing G2 and G3, a highly significant association [p < 0.0001] was retained for JSN [201 [89.7%] vs. 199 [99.5%]] and for osteophyte formation [26 [11.7%] vs. 72 [36.0%]]. Comparing G1 and G2, significantly less osteophyte formation was noted in G2 patients compared to G1 patients [26 [11.7%] vs. 39 [19.7%], p = 0.02]. Multivariate logistic regression analysis showed that the G2 group had less chance of osteophyte formation than either the G1 group or G3 control group [OR = 0.294, p = 0.008 and OR = 0.098, p < 0.001, respectively]

Conclusion: Our findings show that T2DM patients with OA knees on insulin therapy have less radiographic osteophytes compared to T2DM patients not on insulin

Prospective evaluation of the effect of short-term oral vitamin D supplementation on peripheral neuropathy in type 2 diabetes mellitus

We aimed to assess the efficacy of short-term oral vitamin D supplementation on peripheral neuropathy in patients with type 2 diabetes. Materials and This prospective, placebo-controlled trial included 112 type 2 diabetic patients with diabetic peripheral neuropathy [DPN] and vitamin D [25[OH]D] deficiency. Patients were sequentially assigned to a treatment group [n = 57] and a placebo group [n = 55]. DPN was assessed using a neuropathy symptom score [NSS], a neuropathy disability score [NDS] and a nerve conduction study [NCS]. Vitamin D status was determined by measuring the serum total 25[OH]D concentration. Patients received either oral vitamin D[3] capsules or starch capsules once weekly for 8 weeks. The primary outcome was changes in NSS and NDS from baseline. The secondary outcome was changes in the NCS result. Serum 25[OH]D concentrations significantly improved after oral vitamin D supplementation in the treatment group when compared to the placebo group [32.8 +/- 23.7 vs. 1.1 +/- 3.6, p < 0.0001]. Similarly, the improvement in NSS values was significantly greater in the treatment group than in the placebo group [-1.49 +/- 1.37 vs. -0.20 +/- 0.59, p < 0.001]. No improvement was observed for NDS and NCS between the 2 groups after treatment. Short-term oral vitamin D[3] supplementation improved vitamin D status and the symptoms of neuropathy in patients with type 2 diabetes