THE HIGH INCIDENCE OF DIABETIC MYONECROSIS IN FAR NORTH QUEENSLAND, THE DIFFERENTIAL DIAGNOSIS WE MIGHT BE MISSING IN PATIENTS WITH CHRONIC KIDNEY DISEASE.

R JOHNSTON1J KOPPEN1, G WITHEY2, P BOURKE3, A RAPISARDA4, S DHEDA4,5
1Cairns Hospital And Hinterland Health Service, Cairns, Australia, 2Department of Medical Imaging, Cairns Hospital and Hinterland Health Service, Cairns, Australia, 3Department of Medicine, Cairns Hospital and Hinterland Health Service, Cairns, Australia, 4Department of Renal Medicine, Cairns Hospital and Hinterland Health Service, Cairns, Australia, 5Division of Tropical Health and Medicine; James Cook University, Townsville, Queensland, Townsville, Australia

Aim: To assess the epidemiology of diabetic myonecrosis (DMN) in far north Queensland (FNQ).
Background: DMN is a painful disabling complication of diabetes with limited Australian data. FNQ has a disproportionate representation of diabetes and CKD. Delayed or misdiagnosis can prolong hospital stay and morbidity. We sought to quantify the epidemiology of the disease in FNQ.
Methods: The search strategy incorporated all discharge diagnoses of patients with diabetes and a musculoskeletal diagnosis-related-group(DRG), between 2008 and 2017. Files were individually assessed to confirm a diagnosis of DMN. The final cohort was limited to inpatients. The demographics, presenting features, investigations and radiology were collated. New episodes were defined as occurring greater than 6 months after a previous episode with intercurrent clinical quiescence. The final group included 11 patients with 21 distinct episodes.
Results: DMN was more common in females (63%) with mean age 44 years(26-62). There was a high prevalence of CKD (9/11, including 5/11 receiving dialysis). Diabetes tended to be type 2 (91%), poorly controlled (mean HbA1C 10.2%) with significant microvascular complications (72% neuropathy, 63% retinopathy). There were 20/21 episodes involving the lower limbs and 14/21 specifically involving the thigh. Profound localised tenderness (100%) and swelling (85%) were common with raised CRP (88mg/L ±70) and high normal CK (320U/L ± 278). 63% had subsequent episodes of DMN. Mean time to MRI was 7 days (0–20) when performed 12/21. 30% were misdiagnosed at first presentation.
Conclusions: DMN is a poorly recognised and often misdiagnosed condition with significant disparities in its clinical management. It affects poorly controlled T2DM with microvascular complications and CKD. There is predominant lower limb involvement. Diagnosis is often delayed and representation is high.


Biography:
Resident medical officer,
Research interests: include tropical and rural medicine, medical innovation and modelling with a focus on reducing cost burden of diagnosis and treatment to facilitate greater scope of practice in rural/ remote settings.
Past research; nicotine’s potential as a performance enhancing drug in athletes.
Personal: Formal international athlete in the sport of athletics

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