Associations between Geriatric Nutrition Risk Index,bone mineral density and body composition in type 2 diabetes patients

BACKGROUND Type 2 diabetes mellitus(T2DM),a fast-growing issue in public health,is one of the most common chronic metabolic disorders in older individuals.Osteoporosis and sarcopenia are highly prevalent in T2DM patients and may result in fractures and disabilities.In people with T2DM,the association between nutrition,sarcopenia,and osteoporosis has rarely been explored.AIM To evaluate the connections among nutrition,bone mineral density(BMD)and body composition in patients with T2DM.METHODS We enrolled 689 patients with T2DM for this cross-sectional study.All patients underwent dual energy X-ray absorptiometry(DXA)examination and were categorized according to baseline Geriatric Nutritional Risk Index(GNRI)values calculated from serum albumin levels and body weight.The GNRI was used to evaluate nutritional status,and DXA was used to investigate BMD and body composition.Multivariate forward linear regression analysis was used to identify the factors associated with BMD and skeletal muscle mass index.RESULTS Of the total patients,394 were men and 295 were women.Compared with patients in tertile 1,those in tertile 3 who had a high GNRI tended to be younger and had lower HbA1c,higher BMD at all bone sites,and higher appendicular skeletal muscle index(ASMI).These important trends persisted even when the patients were divided into younger and older subgroups.The GNRI was positively related to ASMI(men:r=0.644,P<0.001;women:r=0.649,P<0.001),total body fat(men:r=0.453,P<0.001;women:r=0.557,P<0.001),BMD at all bone sites,lumbar spine(L1-L4)BMD(men:r=0.110,P=0.029;women:r=0.256,P<0.001),FN-BMD(men:r=0.293,P<0.001;women:r=0.273,P<0.001),and hip BMD(men:r=0.358,P<0.001;women:r=0.377,P<0.001).After adjustment for other clinical parameters,the GNRI was still significantly associated with BMD at the lumbar spine and femoral neck.Additionally,a low lean mass index and higherβ-collagen special sequence were associated with low BMD at all bone sites.Age was negatively correlated with ASMI,whereas weight was positively correlated with ASMI.CONCLUSION Poor nutrition,as indicated by a low GNRI,was associated with low levels of ASMI and BMD at all bone sites in T2DM patients.Using the GNRI to evaluate nutritional status and using DXA to investigate body composition in patients with T2DM is of value in assessing bone health and physical performance.

Effects of different doses of metformin on bone mineral density and bone metabolism in elderly male patients with type 2 diabetes mellitus

BACKGROUND Diabetes is a chronic disease,which may cause various complications.Patients with diabetes are at high risk of bone and joint disorders,such as osteoporosis and bone fractures.In addition,it became widely accepted that diabetes has an important impact on bone metabolism.Metformin is a commonly used and effective first-line treatment for type 2 diabetes.Some glucose-lowering agents have been found to have an effect on bone metabolism.The present study explored if different doses of metformin have an effect on bone mineral density(BMD)and bone metabolism in type 2 diabetes.AIM To investigate the effects of different doses of metformin on BMD and bone metabolism in elderly male patients with type 2 diabetes mellitus.METHODS A total of 120 elderly male outpatients with type 2 diabetes mellitus who were admitted to our hospital were included in the study from July 2018 to June 2019.They were randomly assigned to an experimental group and a control group with 60 patients in each group.Patients in the experimental group were given high dose metformin four times a day 0.5 g each time for 12 wk.Patients in the control group were given low dose metformin orally twice a day 0.5 g each time for 12 wk.The changes in bone mineral density and bone metabolism before and after treatment and the efficacy rate of the treatment were compared between the two groups.RESULTS There was no significant difference in the efficacy rate between the two groups(P>0.05).Before the treatment,there was no significant difference in BMD and bone metabolism between the two groups(P>0.05).However,after the treatment,BMD and bone metabolism were improved in the two groups.Moreover,BMD and 25-hydroxyvitamin D were significantly higher in the experimental group than in the control group,and N-terminal/midregion andβ-isomerized Cterminal telopeptides were significantly lower in the experimental group than in the control group(all P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).CONCLUSION Both high and low dose metformin can effectively control the blood glucose levels in elderly male patients with type 2 diabetes mellitus.However,the benefits of high dose metformin in improving BMD and bone metabolism level was more obvious in patients with type 2 diabetes mellitus.

Factors associated with trabecular bone score in postmenopausal women with type 2 diabetes and normal bone mineral density

BACKGROUND Osteoporosis and type 2 diabetes(T2D)have been recognized as a widespread comorbidity leading to excess mortality and an enormous healthcare burden.In T2D,bone mineral density(BMD)may underestimate the risk of low-energy fractures as bone quality is reduced.It was hypothesized that a decrease in the trabecular bone score(TBS),a parameter assessing bone microarchitecture,may be an early marker of impaired bone health in women with T2D.AIM To identify clinical and body composition parameters that affect TBS in postmenopausal women with T2D and normal BMD.METHODS A non-interventional cross-sectional comparative study was conducted.Potentially eligible subjects were screened at tertiary referral center.Postmenopausal women with T2D,aged 50-75 years,with no established risk factors for secondary osteoporosis,were included.BMD,TBS and body composition parameters were assessed by dual-energy X-ray absorptiometry.In women with normal BMD,a wide range of anthropometric,general and diabetes-related clinical and laboratory parameters were evaluated as risk factors for TBS decrease using univariate and multivariate regression analysis and analysis of receiver operating characteristic(ROC)curves.RESULTS Three hundred twelve women were initially screened,176 of them met the inclusion criteria and underwent dual X-ray absorptiometry.Those with reduced BMD were subsequently excluded;96 women with normal BMD were included in final analysis.Among them,43 women(44.8%)showed decreased TBS values(≤1.31).Women with TBS≤1.31 were taller and had a lower body mass index(BMI)when compared to those with normal TBS(Р=0.008 and P=0.007 respectively).No significant differences in HbA1c,renal function,calcium,phosphorus,alkaline phosphatase,PTH and 25(ОН)D levels were found.In a model of multivariate linear regression analysis,TBS was positively associated with gynoid fat mass,whereas the height and androgen fat mass were associated negatively(all P<0.001).In a multiple logistic regression,TBS≤1.31 was associated with lower gynoid fat mass(adjusted odd ratio[OR],0.9,95%confidence interval[CI],0.85-0.94,P<0.001),higher android fat mass(adjusted OR,1.13,95%CI,1.03-1.24,P=0.008)and height(adjusted OR,1.13,95%CI,1.05-1.20,P<0.001).In ROC-curve analysis,height≥162.5 cm(P=0.04),body mass index≤33.85 kg/m2(P=0.002),gynoid fat mass≤5.41 kg(P=0.03)and android/gynoid fat mass ratio≥1.145(P<0.001)were identified as the risk factors for TBS reduction.CONCLUSION In postmenopausal women with T2D and normal BMD,greater height and central adiposity are associated with impaired bone microarchitecture.

Oral bisphosphonates improve the bone mineral density in men with diabetes with or without thiazolidinediones

Objective: Osteoporosis and type 2 diabetes mellitus (DM) two of the most common chronic conditions and represent major public health burdens. Epidemiological and observational studies indicate that thiazolidinedione (TZD) therapy with rosiglitazone and pioglitazone is associated with an increased risk of fractures and decreased bone mineral density (BMD). To our knowledge, no data are available to evaluate bisphosphonate therapy in thiazolidinedione-treated patients. The aim of this study was to investigate the benefit of bisphosphonates to improve changes in BMD in subjects with DM associated with TZDs. Methods: In a cross-sectional observational study using a retrospective review of electronic medical records, the changes in BMD in subjects with type 2 DM. The study subjects were divided into four groups. First group with DM receiving both TZDs and BPs;second group neither;third group receiving only TZDs and the fourth only BPs. The comparison of annual percent changes in BMD between the groups were carried out. Results: Decreased BMD noted in subjects with DM on TZDs. Bisphosphonates improved BMD in subjects with DM on TZDs. BMD improved in subjects with DM in those not receiving TZDs also. Conclusion: We conclude that concomitant treatment with bisphosphonates improves BMD in subjects with diabetes and on TZDs.

Critical review of bone health,fracture risk and management of bone fragility in diabetes mellitus

The risk of fracture is increased in both type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM).However,in contrast to the former,patients with T2DM usually possess higher bone mineral density.Thus,there is a considerable difference in the pathophysiological basis of poor bone health between the two types of diabetes.Impaired bone strength due to poor bone microarchitecture and low bone turnover along with increased risk of fall are among the major factors behind elevated fracture risk.Moreover,some antidiabetic medications further enhance the fragility of the bone.On the other hand,antiosteoporosis medications can affect the glucose homeostasis in these patients.It is also difficult to predict the fracture risk in these patients because conventional tools such as bone mineral density and Fracture Risk Assessment Tool score assessment can underestimate the risk.Evidence-based recommendations for risk evaluation and management of poor bone health in diabetes are sparse in the literature.With the advancement in imaging technology,newer modalities are available to evaluate the bone quality and risk assessment in patients with diabetes.The purpose of this review is to explore the patho-physiology behind poor bone health in diabetic patients.Approach to the fracture risk evaluation in both T1DM and T2DM as well as the pragmatic use and efficacy of the available treatment options have been discussed in depth.

Decreased bone mineral density in young male veterans on Pioglitazone

Background and objective: Epidemiological and observational studies indicate that thiazolidinedione (TZD) therapy with rosiglitazone and pioglitazone is associated with an increased risk of fractures. The effect of TZDs on bone mineral density (BMD) in men with type 2 diabetes is still in debate. The objective of the study was to investigate changes in BMD and bone turnover markers (BTM) associated with Pioglitazone use in men. Design and Methods: This prospective cross sectional comparative study evaluated the changes in BMD and BTM in male veterans aged less than 55 years, with diabetes with or without use of pioglitazone. In a 6 month follow up study, main outcome measures included BMD at AP spine, femur and wrist;and BTM (osteocalcin and CTx) at a referral center, with no interventions. Results: Pioglitazone use was associated with significant decrease in BMD (annualized %change of >3%) at femoral neck, total hip and 1/3rd radius;increase in CTx by 29% and decrease in osteocalin by 20% at 6months. Conclusions: Even in young men pioglitazone use was associated with bone loss. The changes in BTM suggest effect of pioglitazone on both osteoblast and osteoclast activity.

Role of Sclerostin in the Bone Loss of Postmenopausal Chinese Women with Type 2 Diabetes

Objective To evaluate the role of sclerostin in bone loss of postmenopausal Chinese women with type 2 diabetes me｜litus. Methods The postmenopausal patients suffering from type 2 diabetes mellitus and age, body mass index, and duration of menopause matched healthy controls were enrolled into this cross-sectional study according to criteria of inclusion and exclusion.

Type 2 diabetes and bone fragility in children and adults

Type 2 diabetes(T2D)is a global epidemic disease.The prevalence of T2D in adolescents and young adults is increasing alarmingly.The mechanisms leading to T2D in young people are similar to those in older patients.However,the severity of onset,reduced insulin sensitivity and defective insulin secretion can be different in subjects who develop the disease at a younger age.T2D is associated with different complications,including bone fragility with consequent susceptibility to fractures.The purpose of this systematic review was to describe T2D bone fragility together with all the possible involved pathways.Numerous studies have reported that patients with T2D show preserved,or even increased,bone mineral density compared with controls.This apparent paradox can be explained by the altered bone quality with increased cortical bone porosity and compromised mechanical properties.Furthermore,reduced bone turnover has been described in T2D with reduced markers of bone formation and resorption.These findings prompted different researchers to highlight the mechanisms leading to bone fragility,and numerous critical altered pathways have been identified and studied.In detail,we focused our attention on the role of microvascular disease,advanced glycation end products,the senescence pathway,the Wnt/β-catenin pathway,the osteoprotegerin/receptor-activator of nuclear factor kappa B ligand,osteonectin and fibroblast growth factor 23.The understanding of type 2 myeloid bone fragility is an important issue as it could suggest possible interventions for the prevention of poor bone quality in T2D and/or how to target these pathways when bone disease is clearly evident.

Profile of Bone Mass and Its Determining Factors in Type 2 Diabetes: Case-Control Study

Background: Type 2 diabetes mellitus, beyond its well-known cardiovascular and neurological complications, is now increasingly recognized as having deleterious effects on bone tissue. It’s thus presented as an independent risk factor for bone fragility with a considerable fracture risk relating to many more or less intricate parameters. The general objective of our study is to assess bone mass during type 2 diabetes in Senegalese women. Methodology: We had carried out a cross-sectional and descriptive study. Socio-demographic characteristics were collected on the basis of a questionnaire. Then each of the subjects had undergone a complete clinical examination followed by a blood sample for a biological assessment of certain cardiovascular risk factors. Bone mass was measured using a bio-impedancemeter. Results: We recruited 88 women with type 2 diabetes and 83 healthy control women. The mean age of diabetic subjects was 52.7 years ± 6.8 (with extremes of 39 and 74 years). In control, the mean age was 51.0 ± 8.5 years (with extremes of 35 and 72 years). Among the diabetic subjects, 22 subjects or 25% practiced a regular walk against 27 (32.5%) in the control. Forty-three among the diabetic subjects (48.8%) were known hypertensive and followed. According to the body mass index, 71 patients (80.7%) were overweight compared to 59 (71.1%) controls. According to the waist size, 80 (90.9%) diabetic subjects had an elevated waist size compared to 69 control women (83.1%). Among diabetic subjects, 41 patients (46.5%) were hyperglycemic imbalance according to fasting blood glucose and 59 patients (67%) according to glycated hemoglobin level. Thirty-seven diabetics (42%), had both high fasting blood glucose and elevated glycated hemoglobin. The mean duration of diabetes was 8.68 ± 7.18 years. We found significantly higher bone mass in type 2 diabetic subjects (p = 0.03). Among diabetics, 27.3% had low bone mass compared to 36.1% of control. It’s noted that the subjects of the “low bone mass” group among the control subjects also have a significant drop in other anthropometric parameters (weight, body mass index, waist size, muscle mass). It should also be noted that the fat mass is significantly higher in diabetic subjects with normal or even high bone mass. In control subjects, bone mass was positively correlated with weight (r = 0.36;p = 0.001), muscle mass (r = 0.93;p < 0.0001) and fasting blood glucose (r = 0.26;p = 0.02);and negatively correlate with age (r = 0.22;p = 0.04). On the other hand, in type 2 diabetic subjects, bone mass is positively correlated with age (r = 0.22;p = 0.04), muscle mass (r = 0.89;p < 0.0001) and the diabetes duration (r = 0.44;p = 0.001). Conclusion: Bone mass is higher in type 2 diabetics compared to healthy controls. Chronic hyperglycemia and the diabetes duration are believed to be responsible for the increase in bone mass. In addition, an increase in muscle mass would lead to an increase in bone mass.

Vitamin Dreceptor gene polymorphism and bone mineral density in patients with type 2 diabetes mellitus

Objective To explore the relationship between vitamin D receptor(VDR)gene polymorphisms and bone mineral density(BMD)in patients with type 2 diabetes mellitus(DM)and to better understand the pathogenesis of osteoporosis.Methods Ninety seven patients with type 2 DM were recruited for this study.BMD was measured by single photon absorptiometry at the lower one third of the nondominant radius and ulna.Polymorphisms of the VDR gene were analyzed by DNA amplification with polymerase chain reaction(PCR)and endonuclease digestion with Bsm Ⅰ.Results The respective frequencies of VDR genotypes were BB 18.6%,Bb 27.8% and bb 53.6%.The Z scores of the three groups were - 1.57 ± - 0.60,- 1.45 ± - 0.67 and - 1.41 ± - 0.81,respectively.Although the BMD of the Bb genotype DM patients was higher than that of BB genotype DM patients and lower than that of bb genotype DM patients,there were no significant differences.Conclusion These findings suggest a small influence of VDR gene polymorphism on the BMD of patients with type 2 DM.Further study on the value of VDR genotypes in the pathogenesis of osteoporosis in diabetes mellitus is still needed.

健脾益气活血汤治疗2型糖尿病合并骨质疏松的疗效

目的探讨健脾益气活血汤治疗2型糖尿病(type 2 diabetes mellitus,T2DM)合并骨质疏松的疗效。方法选取100例河北省沧州中西医结合医院收治的T2DM合并骨质疏松患者,分为对照组(50例)和研究组(50例),分组方法为随机数字表法,选例时间设置在2022年1月—2022年10月。对照组接受常规西医方案治疗,研究组在对照组的基础上接受健脾益气活血汤治疗,两组患者连续治疗6个月。比较两组治疗后临床疗效,治疗前后骨代谢指标、腰椎、双髋部骨密度、疼痛程度、中医症状积分以及血糖指标。结果治疗后,研究组总有效率高于对照组;治疗后与治疗前比较,两组血清总Ⅰ型胶原氨基端延长肽(peptide of type I collagen,PINP)、β胶原降解产物(β-collagen degradation product,β-CTX)、I型胶原C末端肽(C-terminal peptide of type I collagen,CTX-1)、空腹血糖(fasting blood glucose,FBG)、餐后2 h血糖(2 h postprandial blood glucose,2 h PG)、糖化血红蛋白(glycosylated hemoglobin,HbA1c)水平、视觉模拟评分法(visual analogue scale,VAS)评分及各项中医症状积分降低,两组间治疗后相比,研究组更低;治疗后与治疗前比较,两组血清碱性磷酸酶(alkaline phosphatase,ALP)、护骨素(osteoprotegerin,OPG)及腰椎、双髋部骨密度水平升高,两组间治疗后相比,研究组水平更高,数据存在较显著的差异(P<0.05)。结论健脾益气活血汤治疗T2DM合并骨质疏松患者有助于缓解其临床症状,优化骨代谢指标,增加腰椎、双髋部骨密度,减轻疼痛,改善血糖指标,疗效显著。

Asprosin在2型糖尿病合并骨质疏松患者中的变化及其与TLR4/JNK/IL-1β通路的关系

目的探讨血清白脂素(Asprosin)水平在2型糖尿病合并骨质疏松(type 2 diabetic osteoporosis,T2DOP)患者中的变化情况,及其与Toll样受体4/c-Jun氨基末端蛋白激酶/白细胞介素1β(TLR4/JNK/IL-1β)炎症信号通路的关系。方法选取2020年1月至2023年1月在黄冈市中心医院就诊的123例2型糖尿病(type 2 diabetes mellitus,T2DM)患者,根据骨密度(bone mineral density,BMD)计算出的T值分为3组。采用酶联免疫吸附试验(ELISA)检测3组患者血清Asprosin、骨钙素(OC)、骨源性碱性磷酸酶(BALP)、Ⅰ型原胶原N-端前肽(P1NP)、TLR4、p-JNK/JNK和IL-1β的表达水平;利用Pearson相关系数分析Asprosin与TLR4、p-JNK/JNK、IL-1β及BMD、OC、BALP的相关性;利用多因素Logistic回归分析Asprosin对T2DOP的风险性;并采用受试者工作特征(ROC)曲线判断Asprosin对T2DOP的诊断价值。结果3组患者血清Asprosin水平差异明显(P<0.05)。血清Asprosin水平与TLR4、p-JNK/JNK、IL-1β呈正相关(P<0.05),与BMD、OC、BALP呈显著负相关(P<0.001)。多因素Logistic回归分析显示,血清Asprosin水平升高是诱发T2DOP的危险因素(P<0.05)。ROC曲线分析显示,血清Asprosin截断值230.5 ng/mL对预测T2DOP具有良好的灵敏度(80.43%)和特异性(85.00%),曲线下面积(AUC)为0.844(95%CI:0.818~0.959,P<0.001)。结论血清Asprosin水平在T2DOP患者中显著升高,且与BMD、OC和BALP呈负相关,是T2DOP的危险因素,对预测T2DOP具有良好的诊断价值,并可能通过激活TLR4/JNK/IL-1β信号通路,促进T2DOP的发生发展。

青海地区2型糖尿病患者血清胱抑素C及尿酸水平与骨密度的相关性分析

目的探究青海地区2型糖尿病(T_(2)DM)患者血清胱抑素C及尿酸水平与骨密度的相关性。方法选取2023年1—12月在青海省人民医院内分泌科就诊的T_(2)DM患者141例。根据骨质疏松症的诊断标准将患者分为骨量正常组(56例)、骨量减少组(53例)和骨质疏松组(32例),收集患者的一般资料,测定血清胱抑素C、尿酸等生化指标及骨密度数据,分析相关指标与骨密度的相关性。结果3组性别分布、年龄及25-羟维生素D、胱抑素C、总胆固醇、高密度脂蛋白胆固醇水平比较差异均有统计学意义(均P<0.05)。将单因素分析差异有统计学意义的变量作为自变量纳入多因素有序Logistic回归分析模型,分析结果显示,年龄、胱抑素C是T_(2)DM患者骨量减少及骨质疏松的危险因素,而男性、25-羟维生素D是其保护因素(比值比=0.434、0.922、1.100、3.555,均P<0.05)。结论高水平血清胱抑素C、女性、高龄、低水平25-羟维生素D可能是青海地区T_(2)DM患者骨量减少及骨质疏松症的危险因素,血尿酸水平与T_(2)DM患者骨密度变化无显著相关性。

老年男性2型糖尿病患者血糖波动与骨代谢指标及骨密度的相关性研究

目的探讨老年男性2型糖尿病患者(T2DM)血糖波动相关指标与骨代谢指标及骨密度的相关性。方法选取2020年9月至2023年3月在安徽医科大学第一附属医院内分泌科就诊的老年男性T2DM患者252例,根据患者骨密度结果分为正常组、骨量减少组以及骨质疏松组。所有受试者均进行临床信息的采集,同时行体格检查、实验室检查,所有受试者均进行连续72h动态血糖监测(CGM),并收集血糖波动相关指标。采用t检验或方差检验对3组患者间的一般临床资料、实验室结果进行比较;采用Pearson相关分析、多元回归分析探讨血糖波动相关指标与骨代谢指标及骨密度的相关性。结果随着骨量减少的严重程度的增加,患者的年龄、病史时间显著增加,BMI显著降低,使用GLP-1受体激动剂的患者比例在骨质疏松症组显著减少。同时骨形成指标OC、PINP以及骨吸收指标CTX、TRAP均有明显减少。血糖波动指标TIR、SDBG、CV、MAGE、MODD随着患者骨量减少的严重程度的增加而显著增加。另外,通过Pearson相关分析、多元回归分析后发现,OC与CV、MAGE、MODD呈显著独立负相关,CTX与TIR、CV、MAGE呈显著独立负相关,TRAP与MAGE呈显著独立负相关。股骨颈T值与全髋T值与MAGE呈显著独立负相关。结论本研究发现老年男性T2DM患者血糖波动和骨转换标志物、骨密度之间存在独立的负相关关系。故积极控制老年男型T2DM患者的血糖波动可能有利于骨代谢以及骨密度的改善。

绝经后2型糖尿病患者BMI、腰围与骨密度的相关性及其骨密度的影响因素

目的:探讨绝经后2型糖尿病(T2DM)患者BMI、腰围与骨密度的相关性及其骨密度的影响因素。方法:选取我院内分泌科2022年11月至2024年2月收治的130例绝经后T2DM患者为研究对象,根据BMI分级标准将患者分为肥胖组、超重组、正常组;根据腰围大小分为腹型肥胖组及腰围正常组。比较不同BMI及腰围组间临床资料及骨密度差异,研究BMI、腰围与骨密度的相关性,分析骨密度的影响因素。结果:BMI与腰围、体重及各部位骨密度均呈正相关(P<0.05)。腰围与年龄、体重及各部位骨密度均呈正相关(P<0.05)。多元线性回归分析显示,仅体重是各部位骨密度的影响因素(P<0.05)。结论:绝经后T2DM患者BMI及腰围与骨密度呈正相关,其骨密度受体重的影响,体重低者,骨密度也低,故T2DM患者在绝经后需避免体重过轻。

男性2型糖尿病患者目标范围内时间与25羟基维生素D、骨密度的相关性研究

目的探讨2型糖尿病(T2DM)葡萄糖在目标范围内时间(TIR)与25羟基维生素D、骨密度的相关性,进而评价TIR对于2型糖尿病患者防治骨质疏松的重要意义。方法选取194例男性T2DM患者,其糖化血红蛋白水平在7%~8%,同时给予二甲双胍0.5 g,2次/d,每次1粒口服,通过监测2日7段指尖血糖,进而计算TIR,以TIR值分组为高TIR组及低TIR组,分别比较两组的血糖波动指标、25羟基维生素D[25-(OH)D]、骨密度(BMD)的差异,并将TIR与其他数据做相关性分析及多元线性回归分析。结果2组间年龄、FPG、PPG、BMI、年龄、血脂均未见明显差异,血糖波动指标中SDBG及MDBG在2组中有统计学意义,高TIR组的25-(OH)D、BMD明显高于低TIR组。使用Pearson相关性研究方法证实,TIR与HbA1c、SDBG、MDBG、TG成负相关性,与25-(OH)D、BMD、HDL之间呈现正相关性,与其他指标无相关性。以TIR为因变量,以上述有相关性的数据为自变量,计算多元线性回归方程TIR=3.17-0.28×SDBG+0.53×25-(OH)D+0.69×BMD,证实SDBG、25-(OH)D、BMD与TIR有线性回归关系。结论SDBG上升使TIR下降,25-(OH)D、BMD上升使TIR升高,其中BMD对TIR的影响最大。目标范围内时间越高,患者的25-(OH)D、BMD则越高,临床可推广应用TIR作为糖尿病患者防治骨质疏松的一个重要指标。

利拉鲁肽联合胰岛素对2型糖尿病合并骨质疏松患者的疗效

目的探究利拉鲁肽联合胰岛素对2型糖尿病(type 2 diabetic mellitus,T2DM)合并骨质疏松(osteporsis,OP)患者血清爱帕琳肽(Apelin)水平、骨密度及骨代谢水平的影响。方法选取收治的80例T2DM合并OP患者,随机分为试验组和对照组,各40例。对照组给予胰岛素治疗,试验组在此基础上联合利拉鲁肽治疗,观察2组治疗后的疗效,治疗前后糖代谢、血清Apelin和脂联素(adiponectin,ADPN)水平、各部位骨密度(bone mineral density,BMD)、骨代谢指标[骨特异性碱性磷酸酶(bone-specific alkaline phosphatases,BAP)、骨钙素(bone gla protein,BGP)和Ⅰ型胶原N端肽(typeⅠcollagen N-terminal peptide,NTX)]和不良反应发生情况。结果试验组的总有效率明显高于对照组(P<0.05);治疗后,试验组的空腹、餐后2 h血糖和糖化血红蛋白(hemoglobin A1c,HbA1c)水平明显低于对照组(P<0.05),血清Apelin和ADPN水平显著高于对照组(P<0.05),腰椎L2~L4和股骨颈的BMD明显高于对照组(P<0.05),BAP和BGP水平高于对照组,NTX水平低于对照组(P<0.05);治疗期间2组不良反应发生率比较差异无统计学意义。结论采用利拉鲁肽和胰岛素联合治疗T2DM合并OP患者的疗效良好,能改善患者糖代谢水平,提高血清Apelin和ADPN水平,增加各部位BMD,改善骨代谢,且未增加不良反应发生率。

达格列净与阿卡波糖对2型糖尿病伴骨量减少患者骨代谢和骨密度的影响比较

目的比较达格列净与阿卡波糖对2型糖尿病伴骨量减少患者骨代谢和骨密度的影响。方法选取2017年2月—2021年6月就诊于福建医科大学附属泉州第一医院内分泌科的2型糖尿病伴骨量减少患者150例,根据随机数字表法分为阿卡波糖组和达格列净组,各75例。其中阿卡波糖组脱落或失访7例,达格列净组9例,最终阿卡波糖组纳入68例,达格列净组纳入66例。阿卡波糖组给予阿卡波糖片,达格列净组给予达格列净片,2组均治疗并随访1年。比较2组治疗前及治疗1年后体质量、BMI、腰围、臀围、收缩压、舒张压、血糖、血钙、血磷、估算肾小球滤过率(eGFR)、骨代谢指标、骨密度、不良反应。结果治疗1年后,达格列净组腰围低于治疗前,且达格列净组腰围、舒张压低于阿卡波糖组(P<0.05或P<0.01);2组空腹血糖、餐后2 h血糖、糖化血红蛋白低于治疗前(P<0.01);达格列净组eGFR、血清骨碱性磷酸酶水平高于治疗前及阿卡波糖组(P<0.05或P<0.01);2组腰椎、股骨颈、髋关节骨密度比较,差异无统计学意义(P>0.05)。达格列净组不良反应总发生率高于阿卡波糖组(12.12%vs.1.47%,χ^(2)=4.483,P=0.034)。结论达格列净与阿卡波糖治疗2型糖尿病伴骨量减少均可有效降低血糖,但达格列净可改善患者骨代谢,对骨密度的影响较小,但不良反应较多。

胸部CT椎体HU值在2型糖尿病骨质疏松症机会性筛查中的价值

背景:有研究表明基于腰椎CT的HU(hounsfield units)值可以筛查骨质疏松症,而目前因肺部感染就诊的患者增加,肺部感染合并2型糖尿病的患者也随之增加,增加了胸部CT的使用率。目的:探讨胸部CT检查中L_1椎体HU值在2型糖尿病骨质疏松症筛查中的作用。方法:回顾性分析2020年6月至2022年6月成都医学院第一附属医院收治的244例2型糖尿病患者的临床资料。利用双能X射线骨密度仪获得骨密度T值,按WHO的骨质疏松症诊断标准,将研究对象分为非骨质疏松组(n=120)及骨质疏松组(n=124),比较两组患者一般情况、骨密度T值及胸部CT检查中L_(1)椎体的HU值,分析HU值与各部位T值的关系并评估2型糖尿病骨质疏松症的准确性。结果与结论:(1)两组患者性别、年龄、体质量指数、糖化血红蛋白、平均血糖、钙、磷、2型糖尿病患病时间、高血压病史、高脂血症病史之间对比差异无显著性意义(P>0.05);(2)HU值与最低T值呈正相关(r=0.619,P<0.01),与髋部T值呈正相关(r=0.584,P<0.01),与股骨颈T值呈正相关(r=0.641,P<0.01);当HU值取98时,其预测2型糖尿病骨质疏松症具有良好的准确性,敏感性为70.8%;(3)提示基于胸部CT检查的L_1椎体HU值对2型糖尿病患者的骨质疏松症筛查具有良好的价值,可作为2型糖尿病骨质疏松症一种机会性、无成本的补充筛查方法。

血清性激素及甲状腺激素水平与绝经期女性2型糖尿病患者骨密度、骨质疏松或骨量减少的相关性研究

目的 研究绝经后女性2型糖尿病(T2DM)患者血清性激素、甲状腺相关激素与骨密度和骨质疏松或骨量减少风险间的相关性。方法 回顾性将2019年3月至2022年3月安徽省安庆市第一人民医院收治的100例绝经后女性T2DM患者纳入本次研究。采用双能X线骨密度仪测定腰椎(L_(1-4))、股骨颈和全髋部的骨密度T值,将3个部位骨密度最小T值>-1.0的患者设为正常骨密度组(n=22),T值≤-1.0为骨量减少,T值≤-2.5为骨质疏松,纳入骨质疏松或骨量减少组(n=78)。检测并比较两组患者性激素[血清雌二醇、黄体生成素(LH)、卵泡刺激素(FSH)、孕酮、总睾酮、催乳素]、甲状腺相关激素[促甲状腺素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)、总三碘甲状腺原氨酸(TT3)和总甲状腺素(TT4)]、骨密度T值(L_(1-4)、股骨颈、全髋关节)及3个部位的最小骨密度T值、骨折风险评估工具(FRAX)的主要部位骨折的概率(MOF)评分及FRAX髋部骨折的概率(HF)评分。采用多变量线性回归和Logistic回归分析绝经后女性T2DM患者的雌二醇、TSH与L_(1-4)、股骨颈、全髋关节骨密度T值及3个部位最小T值、FRAX MOF和FRAX HF评分的相关性。结果 骨质疏松/骨量减少组的血清雌二醇、TSH分别为(18.45±6.09) pmol/L和(2.09±0.44) mU/L,均显著低于正常骨密度组[(23.95±6.85) pmol/L和(2.77±0.514) mU/L],差异均有统计学意义(P<0.05);两组其他性激素和甲状腺相关激素差异均无统计学意义(P>0.05)。骨质疏松或骨量减少组的腰椎L2-4、股骨颈、全髋关节骨密度T值及3个部位的最小骨密度T值分别为-3.25±0.75、-2.85±0.70、-2.48±0.61、-2.14±0.62,均显著低于正常骨密度组(-0.06±0.62、-0.12±0.51、0.15±0.51、-0.49±0.26),FRAX MOF评分及FRAX HF评分分别为(4.47±2.10)、(1.50±1.23)分,均显著高于正常骨密度组[(2.28±0.51)、(0.20±0.15)分],差异均有统计学意义(P<0.05)。多变量线性回归和Logistic回归分析显示,血清雌二醇、TSH与腰椎L_(1-4)和3个部位的骨密度T值呈正相关(P<0.05),与FRAX MOF和FRAX HF评分呈负相关(P<0.05)。结论 绝经后女性T2DM患者骨质疏松/骨量减少的患病率较高,其血清雌二醇、TSH较正常骨密度患者显著降低,雌二醇、TSH与骨密度T值、FRAX评分及骨质疏松或骨量减少的风险显著相关。