A case-control study of osteopathic palpatory findings in type 2 diabetes mellitus
John C Licciardone, Kimberly G Fulda, Scott T Stoll, Russell G Gamber, A Clifton Cage, John C Licciardone, Kimberly G Fulda, Scott T Stoll, Russell G Gamber, A Clifton Cage
Abstract
Background: Although type 2 diabetes mellitus is often managed by osteopathic physicians, osteopathic palpatory findings in this disease have not been adequately studied.
Methods: A case-control study was used to measure the association between type 2 diabetes mellitus and a series of 30 osteopathic palpatory findings. The latter included skin changes, trophic changes, tissue changes, tenderness, and immobility at spinal segmental levels T5-T7, T8-T10, and T11-L2 bilaterally. Logistic regression models that adjusted for age, sex, and comorbid conditions were used to compute odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between type 2 diabetes mellitus and each of these findings.
Results and discussion: A total of 92 subjects were included in the study. After controlling for age, sex, hypertension, and clinical depression, the only significant finding was an association between type 2 diabetes mellitus and tissue changes at T11-L2 on the right side (OR, 5.54; 95% CI, 1.76-17.47; P = .003). Subgroup analyses of subjects with type 2 diabetes mellitus and hypertension demonstrated significant associations with tissue changes at T11-L2 bilaterally (OR, 27.38; 95% CI, 1.75-428; P = .02 for the left side and OR, 24.00; 95% CI, 1.51-382; P = .02 for the right side). Among subjects with type 2 diabetes mellitus and hypertension, there was also a strong diabetes mellitus duration effect for tissue changes at T11-L2 bilaterally (OR, 12.00; 95% CI, 1.02-141; P = .05 for short duration vs. OR, 32.00; 95% CI, 2.29-448; P = .01 for long duration on the left side; and OR, 17.33; 95% CI, 1.39-217; P = .03 for short duration vs. OR, 32.00; 95% CI, 2.29-448; P = .01 for long duration on the right side).
Conclusion: The only consistent finding in this study was an association between type 2 diabetes mellitus and tissue changes at T11-L2 on the right side. Potential explanations for this finding include reflex viscerosomatic changes directly related to the progression of type 2 diabetes mellitus, a spurious association attributable to confounding visceral diseases, or a chance observation unrelated to type 2 diabetes mellitus. Larger prospective studies are needed to better study osteopathic palpatory findings in type 2 diabetes mellitus.
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References
- Centers for Disease Control and Prevention . National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2003. Revised edition. Atlanta, GA: US Department of Health and Human Services; 2004.
- Segal KR. Type 2 diabetes and disease management: exploring the connections. Dis Manag. 2004;7:S11–22. doi: 10.1089/1093507042317125.
- American Diabetes Association Economic costs of diabetes in the US in 2002. Diabetes Care. 2003;26:917–932.
- Beal MC. Viscerosomatic reflexes: a review. J Am Osteopath Assoc. 1985;85:786–801.
- Bandeen SG. Diabetes: report covering twenty-five years research on stimulation of pancreas, blood chemical changes. Osteopath Prof. 1949;17:11–15. 38, 40, 42, 44, 46–47.
- American Osteopathic Association . 2000/01 Yearbook and Directory of Osteopathic Physicians. 91. Chicago, IL; 2000.
- Kuchera WA, Kuchera ML. Osteopathic Principles in Practice. 2nd edition, revised. Kirksville, MO:Kirksville College of Osteopathic Medicine; 1992.
- Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.
- Ritz E, Stefanski A. Diabetic nephropathy in type II diabetes. Am J Kidney Dis. 1996;27:167–194.
- Mazzucco G, Bertani T, Fortunato M, Bernardi M, Leutner M, Boldorini R, Monga G. Different patterns of renal damage in type 2 diabetes mellitus: a multicentric study on 393 biopsies. Am J Kidney Dis. 2002;39:713–720.
- Siraj ES, Myles J, Nurko S, Mehta AE, Reddy SSK. Development of diabetes mellitus several years after manifestation of diabetic nephropathy: case report and review of literature. Endocr Pract. 2003;9:301–306.
- Kuchera ML, McPartland JM. Myofascial trigger points as somatic dysfunction. In: Ward RC, editor. Foundations for Osteopathic Medicine. 2. Philadelphia, PA: Lippincott Williams & Wilkins; 2003. pp. 1034–1050.
- Kappler RE. A comparison of structural examination findings obtained by experienced physician examiners and student examiners on hospital patients. J Am Osteopath Assoc. 1980;79:468–471.
- Beal MC, Patriquin DA. Interexaminer agreement on palpatory diagnosis and patient self-assessment of disability: a pilot study. J Am Osteopath Assoc. 1995;95:97–106.
- Orwin RG. Evaluating coding decisions. In: Cooper H, Hedges LV, editor. The Handbook of Research Synthesis. New York, NY: Russell Sage Foundation; 1994. pp. 139–162.
- Sackett DL, Haynes RB, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine. Boston, MA: Little, Brown and Co; 1985.
Source: PubMed