Skeletal health in adolescents with poorly controlled type 1 diabetes: results from a randomized controlled trial.

IF 4.1 2区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Mari-Anne Pulkkinen, Tero Varimo, Sanna Toiviainen-Salo, Taina H Härkönen, Saila Laakso, Anna-Kaisa Tuomaala, Matti Hero
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Abstract

Introduction: Poorly controlled type 1 diabetes (T1D) has been associated with impaired bone health, but the mechanisms remain unclear. We aimed to investigate whether changes in glycemic control and glucose variability are associated with skeletal health and to evaluate the roles of insulin-like growth factor I (IGF-I) and advanced glycation end-products (AGEs) in bone mineral accrual.

Research design and methods: This longitudinal study included adolescents with poorly controlled T1D (HbA1c >9%/75 mmol/mol), who underwent dual-energy X-ray absorptiometry (DXA) at baseline and after 12 months. Glycemic control was assessed using glycohemoglobin (HbA1c), continuous glucose monitoring (CGM) parameters, and glycemic load. Serum IGF-I and AGEs, specifically methyl-glyoxal-hydro-imidazolone (MG-HI), were measured. Correlation analyses and linear regression models were used to evaluate the associations between glycemic markers, IGF-I, AGEs and bone parameters.

Results: Altogether, 37 adolescents (48.6 % female) with T1D, with mean HbA1c 9.9% (85 mmol/mol), were followed up from mean age of 14.3 for 12 months. DXA-derived bone mineral density (BMD) z-scores at lumbar spine, proximal femur, and total body less head were approximately 0.5 SDS lower than reference values (p=0.005-0.04). The only significant change in BMD z-scores during the 12-month follow-up was an increase in proximal femur in girls. In the whole group, an increase in IGF-1 was associated with BMD accrual, while changes in HbA1c, time in range, or MG-HI were not. No vertebral fractures were detected.

Conclusions: Despite lower BMD in adolescents with poorly controlled T1D, neither changes in glycemic control nor MG-HI levels correlated significantly with bone health measures, while increase of IGF-1 was associated with BMD accrual. Future studies should explore alternative AGEs and use advanced bone imaging techniques to better understand skeletal fragility in T1D.

Abstract Image

控制不良的1型糖尿病青少年的骨骼健康:一项随机对照试验的结果
导读:控制不良的1型糖尿病(T1D)与骨骼健康受损有关,但其机制尚不清楚。我们的目的是研究血糖控制和葡萄糖变异性的变化是否与骨骼健康相关,并评估胰岛素样生长因子I (IGF-I)和晚期糖基化终产物(AGEs)在骨矿物质积累中的作用。研究设计和方法:这项纵向研究纳入了T1D控制不良的青少年(HbA1c bbb9% /75 mmol/mol),他们在基线和12个月后接受了双能x线吸收测定(DXA)。采用糖蛋白(HbA1c)、连续血糖监测(CGM)参数和血糖负荷评估血糖控制情况。测定血清igf - 1和AGEs,特别是甲基乙二醛-氢咪唑酮(MG-HI)。采用相关分析和线性回归模型评估血糖指标、IGF-I、AGEs与骨骼参数之间的关系。结果:37例青少年T1D患者(女性48.6%),平均HbA1c为9.9% (85 mmol/mol),平均年龄为14.3岁,随访12个月。dxa衍生的腰椎、股骨近端和全身少头部的骨密度(BMD) z-评分比参考值低约0.5 SDS (p=0.005-0.04)。在12个月的随访中,BMD z-评分的唯一显著变化是女孩股骨近端增加。在整个组中,IGF-1的增加与BMD的增加有关,而HbA1c、范围时间或MG-HI的变化则无关。未发现椎体骨折。结论:尽管T1D控制不佳的青少年骨密度较低,但血糖控制和MG-HI水平的变化与骨骼健康指标均无显著相关性,而IGF-1的升高与骨密度增加有关。未来的研究应该探索替代AGEs,并使用先进的骨成像技术来更好地了解T1D患者的骨骼脆弱性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BMJ Open Diabetes Research & Care
BMJ Open Diabetes Research & Care Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
9.30
自引率
2.40%
发文量
123
审稿时长
18 weeks
期刊介绍: BMJ Open Diabetes Research & Care is an open access journal committed to publishing high-quality, basic and clinical research articles regarding type 1 and type 2 diabetes, and associated complications. Only original content will be accepted, and submissions are subject to rigorous peer review to ensure the publication of high-quality — and evidence-based — original research articles.
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