DIABETES IN PALEOPATHOLOGY: NEW METHODS AND APPLICATIONS

Abstract

Diabetes mellitus has become a common disease. It causes a complicated physiological cascade of changes to the body, including the skeleton. Diabetes is characterized by hyperglycemia because of insulin deficiency or insulin resistance. Type 2 diabetes is the most common type of diabetes. Although symptoms of diabetes have been documented throughout history, the effects of diabetes on bone are indirect and not well understood. At least thirteen musculoskeletal disorders (MSDs) have been associated with diabetes in modern medical literature. Most of these disorders result from changes to bone quality, primarily through the accumulation of byproducts from hyperglycemia. The MSDs included in this research are hyperostosis frontalis interna, periodontal disease, frozen shoulder, hand-related disorders, carpal tunnel syndrome, diffuse idiopathic skeletal hyperostosis, peripheral neuroarthropathy, gout, lower-extremity amputation, degenerative joint disease, osteoporosis, osteomyelitis, and fractures. This research developed new methods for determining the effects of diabetes on the severity of the MSDs and to identify which MSDs can be used to predict diabetes in human skeletal material from three modern anatomical collections. This research also applied the new methods to four Midwestern archaeological precontact American Indian skeletal collections to detect a change in the prevalence of diabetes-associated MSDs as the consumption of carbohydrates increased with the adoption of maize into the diet. The results from the modern skeletal material suggest there is a suite of MSDs that are consistently more severe in those with diabetes than in those without diabetes. This suite of MSDs provides a predictive model for the potential diagnosis of diabetes in the past. The predictive model was then used to identify three precontact American Indian individuals as potential case studies of the earliest and only case studies to date of diabetes in precontact American Indians. Overall, this research expands on what is known about how diabetes affects skeletal material and what diabetes may look like in the archaeological record. The more MSDs present, the stronger the likelihood diabetes may be diagnosed. However, a definitive diagnosis of diabetes may never be known without supporting medical documentation.