Relationship of difficult laryngoscopy to long-term non-insulin-dependent diabetes and hand abnormality detected using the 'prayer sign'

Editor—About one-third of long-term insulin-dependent(type I) diabetics present with laryngoscopic difficulties.¹This is due, at least in part, to diabetic stiff joint syndromecharacterized by a short stature, joint rigidity, and tightwaxy skin.² The fourth and fifth proximal phalangeal jointsare most commonly involved. Patients with diabetic stiff jointsyndrome have difficulty in approximating their palms and cannotbend their fingers backwards (the prayer sign, Fig. 1).This is due to non enzymatic glycosylation of