Arthur VinnitskyHunter College

Analysis of Recent Research on Diabetes and Related Drug Therapy and Potential Orientation and Mobility Implications

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:

ThiazolidinedionesInhaled 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.

Osteoathritis - Upper Body

Frozen Shoulder

Tendinitis Carpel Tunnel Syndrome

Fibromyalgia Synovitis Rheumatoid Arthritis

Osteoathritis - Lower Body

Dupuytren's Contracture

52.50%

44.02%

15.70% 14.60% 13.52% 12.26% 11.32% 11.32%

5.03%

Frozen Shoulder

Osteoarthritis - Upper Body

Carpel Tunnel Syndrome

Sinovitis Fibromyalgia Rheumatoid Arthritis

Tendinitis Dupuytren's Contracture

Osteoarthritis - Lower Body

63.15%

52.63%

14.03% 14.03% 12.28%

5.26%1.57% 1.57% 1.57%