Shoulder ultrasound effectively detects insulin resistance, even before abnormal labs

A quick and easy ultrasound of certain muscles could help detect insulin resistance before it progresses into diabetes. 

Researchers at Michigan Medicine recently assessed the efficacy of measures of muscle echo intensity of the deltoid and vastus lateralis for identifying insulin resistance. The team found the method to be “100% accurate” in detecting insulin sensitivity, even in the absence of standard blood biomarkers.  

The idea for the study came after providers who treat musculoskeletal conditions at Michigan Medicine noticed a pattern in many of their patients’ records. 

“We perform a large number of shoulder ultrasounds and noticed that many patients' muscles appear unusually bright,” lead author Steve Soliman, DO, director of musculoskeletal ultrasound and the MSK radiology fellowship at the University of Michigan, said in a news release. “We found it interesting that most of these patients have type 2 diabetes. Seeing this pattern, we often thought, 'This patient must have diabetes.' More importantly, many were unaware of their condition until we verified with their electronic records and confirmed with their bloodwork that they indeed had type 2 diabetes or prediabetes.” 

To test their theory, Soliman and colleagues analyzed 25 individuals with varying health histories. They completed ultrasound assessments of the shoulder on 20 patients with obesity but no diagnosis of diabetes or prediabetes and five healthy controls.  

Two readers, who were blinded to the patients’ demographics and health histories, were instructed to analyze the images and take detailed measurements of muscle echo intensity for each patient. Patients’ measurements were compared alongside their peripheral insulin sensitivity, while dual-energy x-ray absorptiometry was performed to evaluate body composition and calculate sarcopenia indices. 

On US, the obese cohort displayed significantly higher measures of muscle echo intensity in the vastus lateralis and deltoid. These heightened figures had a strong correlation with insulin resistance and impaired insulin sensitivity. The team also observed a negative relationship between muscle echo intensity and muscle mass, body mass and obesity, suggesting that the measurement effectively differentiates insulin resistance from other confounding factors. 

The brightness on imaging of these areas may be indicative of excessive fat accumulation and possibly fibrosis, which would negatively affect muscle health and function.  

Interestingly, the ultrasound findings were present well before any of the patients’ bloodwork showed abnormal HbA1C levels, indicating that high muscle echo intensity could be used as a biomarker that precedes diabetes and prediabetes. 

Although the study was limited by its small sample size, experts are hopeful their findings could pave the way for more widespread use of ultrasound during routine doctor visits, as this could effectively detect signs of insulin resistance before it progresses into diabetes. 

“Clinicians increasingly use these point-of-care and handheld ultrasound devices, sometimes called ‘the stethoscope of the future,’ for rapid diagnosis of various conditions,” Soliman said. “This information could be automatically analyzed by these noninvasive devices. A medical assistant or clinician with little to no training could easily use this device on a patient’s upper arm or thigh, as routinely as checking weight or blood pressure, and potentially flag patients as 'high risk' or 'low risk' for further testing.” 

Learn more about the findings here. 

Hannah murhphy headshot

In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.

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