Nav: Home

Shoulder 'brightness' on ultrasound may be a sign of diabetes

November 19, 2018

CHICAGO - A shoulder muscle that appears unusually bright on ultrasound may be a warning sign of diabetes, according to a study being presented next week at the annual meeting of the Radiological Society of North America (RSNA).

Ultrasound is commonly used to diagnose sources of pain in the shoulder. More than 10 years ago, musculoskeletal radiologist Steven B. Soliman, D.O., from Henry Ford Hospital in Detroit, began noticing a pattern when images of the deltoid muscle, the largest muscle of the shoulder, appeared bright on ultrasound.

"Every time we would ask one of these patients if they were diabetic, they would say 'yes' or they would tell us they were borderline and not taking any medications," Dr. Soliman said.

The observations prompted Dr. Soliman and colleagues at Henry Ford to conduct a study to see if the brightness, or echogenicity, of the shoulder muscle could be predictive of diabetes. The results revealed that by using the echogenicity of the muscle, radiologists were able to predict type 2 diabetes, the most common type of diabetes, in almost nine out of 10 patients. Brightness on ultrasound also was an accurate predictor of pre-diabetes, a condition of abnormally high blood sugar that generally progresses to diabetes without changes in lifestyle.

The researchers said the findings could allow for earlier interventions.

"If we observe this in patients with pre-diabetes and diabetes, we can get them to exercise, make diet modifications and lose weight," Dr. Soliman said. "If these interventions happen early enough, the patients may be able to avoid going on medications and dealing with all the complications that go with the disease."

For the study, Dr. Soliman and colleagues compiled 137 shoulder ultrasounds from patients with type 2 diabetes, including 13 with pre-diabetes. The researchers also obtained 49 ultrasounds from obese patients without diabetes.

The researchers showed the ultrasounds to two musculoskeletal radiologists who were unaware whether the images came from patients with or without diabetes. The radiologists were asked to classify the patients, based on the brightness of their shoulder muscle, into one of three categories: normal, suspected diabetes and definite diabetes. A third musculoskeletal radiologist acted as an arbitrator in the cases where the other two radiologists disagreed.

The results showed that a consensus diagnosis of "definite diabetes" by the radiologists was a powerful predictor of diabetic status. Using the shoulder ultrasounds, the radiologists correctly predicted diabetes in 70 of 79 patients, or 89 percent.

"We weren't surprised that we had positive results because the shoulder muscle on patients with diabetes looked so bright on ultrasound, but we were surprised at the level of accuracy," Dr. Soliman said.

A hyperechoic, or unusually bright-looking, deltoid muscle was also a strong predictor of pre-diabetes. The musculoskeletal radiologists assigned all 13 pre-diabetic ultrasounds to either the "suspected diabetes" or "definite diabetes" categories.

"A lot of the patients weren't even aware that they were diabetic or pre-diabetic," said Dr. Soliman, who noted that this lack of awareness is a major problem in the U.S.

According to the Centers for Disease Control and Prevention (CDC), nearly one in four Americans with diabetes--about 7.2 million people--are unaware they have the disease and are left undiagnosed.

"Also, the CDC states that pre-diabetes affects an astonishing 84.1 million adults, or nearly 34 percent of the adult U.S. population, and an overwhelming 90 percent of these people are completely unaware of their pre-diabetic status and are at a high risk of developing type 2 diabetes," Dr. Soliman said.

The reasons for the brighter-appearing shoulder muscle on ultrasound among patients with diabetes is not completely understood, according to Dr. Soliman, but the researchers suspect it is due to low levels of glycogen in the muscle, a key source of energy for the body that is stored primarily in the liver and muscles. A study of muscle biopsies in patients with diabetes found that muscle glycogen levels are decreased up to 65 percent. Prior research has also shown that the muscles of athletes appear brighter on ultrasound after exercise, when their glycogen stores are depleted.

"It could be that this appearance in people with diabetes and pre-diabetes is related to the known problems with glycogen synthesis in their muscles because of their insulin abnormalities," Dr. Soliman said.

If they see a bright shoulder muscle on ultrasound, radiologists at Henry Ford now put notes in their reports indicating that this observation has been linked to diabetes.

The researchers plan to continue studying the connection between shoulder muscle echogenicity and diabetes with an eye toward quantifying the phenomenon and seeing if it is reversible.
-end-
Co-authors are Paul Williams, M.D., Kelli A. Rosen, D.O., Jessica K. Kim, B.S., D.O., Paul J. Spicer, M.D., and Marnix T. van Holsbeeck, M.D.

Note: Copies of RSNA 2018 news releases and electronic images will be available online at RSNA.org/press18 beginning Monday, Nov. 26.

RSNA is an association of over 54,000 radiologists, radiation oncologists, medical physicists and related scientists, promoting excellence in patient care and health care delivery through education, research and technologic innovation. The Society is based in Oak Brook, Ill. (RSNA.org)

Editor's note: The data in these releases may differ from those in the published abstract and those actually presented at the meeting, as researchers continue to update their data right up until the meeting. To ensure you are using the most up-to-date information, please contact us.

For patient-friendly information on musculoskeletal ultrasound, visit RadiologyInfo.org.

Radiological Society of North America

Related Diabetes Articles:

Tele-diabetes to manage new-onset diabetes during COVID-19 pandemic
Two new case studies highlight the use of tele-diabetes to manage new-onset type 1 diabetes in an adult and an infant during the COVID-19 pandemic.
Genetic profile may predict type 2 diabetes risk among women with gestational diabetes
Women who go on to develop type 2 diabetes after having gestational, or pregnancy-related, diabetes are more likely to have particular genetic profiles, suggests an analysis by researchers at the National Institutes of Health and other institutions.
Maternal gestational diabetes linked to diabetes in children
Children and youth of mothers who had gestational diabetes during pregnancy are at increased risk of diabetes themselves, according to new research published in CMAJ (Canadian Medical Association Journal).
Two diabetes medications don't slow progression of type 2 diabetes in youth
In youth with impaired glucose tolerance or recent-onset type 2 diabetes, neither initial treatment with long-acting insulin followed by the drug metformin, nor metformin alone preserved the body's ability to make insulin, according to results published online June 25 in Diabetes Care.
People with diabetes visit the dentist less frequently despite link between diabetes, oral health
Adults with diabetes are less likely to visit the dentist than people with prediabetes or without diabetes, finds a new study led by researchers at NYU Rory Meyers College of Nursing and East Carolina University's Brody School of Medicine.
Diabetes, but not diabetes drug, linked to poor pregnancy outcomes
New research indicates that pregnant women with pre-gestational diabetes who take metformin are at a higher risk for adverse pregnancy outcomes -- such as major birth defects and pregnancy loss -- than the general population, but their increased risk is not due to metformin but diabetes.
New oral diabetes drug shows promise in phase 3 trial for patients with type 1 diabetes
A University of Colorado Anschutz Medical Campus study finds sotagliflozin helps control glucose and reduces the need for insulin in patients with type 1 diabetes.
Can continuous glucose monitoring improve diabetes control in patients with type 1 diabetes who inject insulin
Two studies in the Jan. 24/31 issue of JAMA find that use of a sensor implanted under the skin that continuously monitors glucose levels resulted in improved levels in patients with type 1 diabetes who inject insulin multiple times a day, compared to conventional treatment.
Complications of type 2 diabetes affect quality of life, care can lead to diabetes burnout
T2D Lifestyle, a national survey by Health Union of more than 400 individuals experiencing type 2 diabetes (T2D), reveals that patients not only struggle with commonly understood complications, but also numerous lesser known ones that people do not associate with diabetes.
A better way to predict diabetes
An international team of researchers has discovered a simple, accurate new way to predict which women with gestational diabetes will develop type 2 diabetes after delivery.
More Diabetes News and Diabetes Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Dispatch 6: Strange Times
Covid has disrupted the most basic routines of our days and nights. But in the middle of a conversation about how to fight the virus, we find a place impervious to the stalled plans and frenetic demands of the outside world. It's a very different kind of front line, where urgent work means moving slow, and time is marked out in tiny pre-planned steps. Then, on a walk through the woods, we consider how the tempo of our lives affects our minds and discover how the beats of biology shape our bodies. This episode was produced with help from Molly Webster and Tracie Hunte. Support Radiolab today at Radiolab.org/donate.