Type 2 Diabetes Patients Have Accelerated Cartilage Matrix Degeneration Compared to Diabetes Free Controls: Data from the Osteoarthritis Initiative
Arnaldo Libman
Type 2 Diabetes Patients Have Accelerated Cartilage Matrix Degeneration Compared to Diabetes Free Controls: Data from the Osteoarthritis Initiative
Figures
Figure 1
Patient selection from the OAI. Flow-chart illustrating patient selection from the OAI cohort.
Figure 2
Longitudinal change of T2 color map of a diabetic patient over 24-months. T2 color maps of the same diabetic patient at baseline (A) and after 24-months (B), both showing the region of the lateral femoral condyle and the lateral tibial plateau. At baseline (A), the tibial plateau shows predominantly lower T2 values (blue and green), whereas, especially the weight-bearing portion of the lateral condyle already shows areas of higher T2 values (yellow and red). After 24-months (B) the cartilage of the femoral condyle shows overall increased T2 values, including the posterior aspect of the femoral condyle. The tibial plateau also shows several areas of higher T2 values, with particular emphasis at the anterior and posterior aspect of the tibial plateau, consistent with an accelerated rate of cartilage matrix degradation.
Figure 3
Cross-sectional cartilage mean T2 values in diabetics and non-diabetics at baseline and 24-months. Cross-sectional mean cartilage T2 values in diabetics and non-diabetics at baseline and 24-months. Data are given as adjusted means (ms), corrected for race, age, sex, baseline BMI and baseline KL score. Error bars indicate standard errors. P-values in bold refer to significance of differences between diabetics vs non-diabetics at baseline and 24-months, respectively: global knee (p=0.669, baseline; p=0.009, 24-months), patella (p=0.003, baseline; p=0.012, 24-months), lateral tibia (p=0.314, baseline; p=0.006, 24-months). Global = global T2 values/mean of all compartments, PAT = patella, LT = lateral tibia.
Figure 4
Cross-sectional GLCM texture analysis in diabetics and non-diabetics at baseline and 24-months. Texture parameters (contrast, variance, and entropy) in diabetics and non-diabetics at baseline and 24-months. Data are given as adjusted means, corrected for age, sex, baseline BMI and baseline KL score. Error bars indicate standard errors. P-values in bold refer to significance of differences between diabetics vs non-diabetics at baseline and 24-months, respectively: Global knee contrast (p=0.021, baseline; p<0.001, 24-months), patella contrast (p=0.010, baseline; p=0.001, 24-months), lateral tibia contrast (p<0.001, baseline; p=0.004, 24-months). Global knee variance (p=0.029, baseline; p=0.007, 24-months), patella variance (p=0.009, baseline; p=0.009, 24-months), lateral tibia variance (p<0.001, baseline; p=0.041, 24-months). Global knee entropy (p=0.001, baseline; p=0.058, 24-months), patella entropy (p=0.009, baseline; p=0.002, 24-months), lateral tibia entropy (p=0.144, baseline; p=0.121, 24-months). Global = global T2 values/mean of all compartments, PAT = patella, LT, lateral tibia.
Summary
Purpose
Osteoarthritis (OA) and diabetes mellitus (DM) share common risk factors with a potential underlying relationship between both diseases. The purpose of this study was to investigate the longitudinal effects of DM on cartilage deterioration over 24-months with MR-based T2 relaxation time measurements.
Methods
From the Osteoarthritis Initiative cohort 196 diabetics were matched in small sets for age, sex, BMI and Kellgren-Lawrence score with 196 non-diabetic controls. Knee cartilage semi-automatic segmentation was performed on 2D multi-slice multi-echo spin-echo sequences. Texture of cartilage T2 maps was obtained via grey level co-occurrence matrix analysis. Linear regression analysis was used to compare cross-sectional and changes in T2 and texture parameters between the groups.
Results
Both study groups were similar in age (63.3 vs 63.0 years, p=0.70), BMI (30.9 vs 31.2 kg/m2, p=0.52), sex (female 53.6% vs 54.1%, p=0.92) and KL score distribution (p=0.97). In diabetics, except for the patella, all compartments showed a significantly higher increase in mean T2 values when compared to non-diabetic controls. Global T2 values increased almost twice as much; 1.77ms vs 0.98ms (0.79ms [CI: 0.39,1.19]) (p < 0.001). Additionally, global T2 values showed a significantly higher increase in the bone layer (p=0.006), and in a separate analysis of the texture parameters, diabetics also showed consistently higher texture values (p<0.05), indicating a more disordered cartilage composition.
Conclusion
Cartilage T2 values in diabetics show a faster increase with a consistently more heterogeneous cartilage texture composition. DM seems to be a risk factor for developing early OA with an accelerated degeneration of the articular cartilage in the knee.