Plantar fascia thickness in type 1 diabetes mellitus patients: Clinical associations and metabolic correlates

INTRODUCTION: Diabetic peripheral neuropathy (DPN) is a severe complication of diabetes mellitus (DM). Measurement of plantar fascia thickness (PFT) by ultrasound has been proposed as an alternative index of tissue glycation and a marker for diabetes complications such as DPN. RESEARCH DESIGN AND METHODS: A cross-sectional study was conducted in 290 patients with type 1 DM (age 54 [20-87] years and diabetes duration 28 [1-79] years) and 41 healthy volunteers (age 49 [26-73] years). PFT was measured during outpatient clinical evaluation by means of ultrasound. Values were compared with sex, age, anthropometric parameters, advanced glycation end products (AGEs) measured by skin autofluorescence, and parameters derived from clinical evaluation of DPN. RESULTS: Patients with type 1 DM had significantly thicker plantar fascia than controls (2.9 ± 0.6 mm vs. 2.4 ± 0.2 mm; P < 0.001); 199/290 (68.6%) patients with type 1 DM had altered PFT. In this population, male patients and those with worse glycemic control and longer duration of disease had a higher risk of having altered PFT. Higher PFT was significantly associated with reduced vibration sensitivity, higher levels of HbA1c and AGEs, presence of retinopathy and reduced renal function, and a worse diabetic foot risk classification. The use of AHCL integrated systems appeared to be associated with better plantar fascia outcomes. CONCLUSIONS: Our findings indicate that PFT showed a relationship with diabetes microvascular complications, glucometabolic compensation, and with the use of automated insulin delivery systems. PFT might be a useful tool in the assessment of patients with T1DM.