1
|
Calmarza P, Pérez-Ajami RI, Prieto-López C, Gallego-Royo A, García-Carro C, Lou-Francés GM. Glycemic control and study of lipid and bone metabolism in type 1 diabetic children. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2024; 44:171-181. [PMID: 39079139 PMCID: PMC11361410 DOI: 10.7705/biomedica.7132] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 05/15/2024] [Indexed: 08/04/2024]
Abstract
Introduction. Type 1 diabetes mellitus is considered one of the most common chronic diseases of childhood. It is a high-risk factor for developing early cardiovascular disease and it also affects bone health. Objective. To describe demographic characteristics and biochemical parameters of a population of children with type 1 diabetes, evaluated in the pediatric diabetes unit of a tertiary Spanish hospital. Materials and methods. In this retrospective study, we determined metabolic, lipid, and bone parameters in 124 children with type 1 diabetes who were monitored in the pediatric diabetes unit of the Hospital Universitario Miguel Servet in Zaragoza (Spain) from May 2020 to July 2021. Results. Children with type 1 diabetes have worse metabolic control of the disease at puberty, but their lipid control is considered acceptable. We found an inverse correlation between bone formation markers and disease duration, as well as with metabolic control. Conclusion. Bone formation markers are inversely correlated with the percentage of glycated hemoglobin and diabetes evolution time. Patients’ lipid and bone profiles are more favorable when metabolic control of the disease is achieved.
Collapse
Affiliation(s)
- Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, EspañaHospital Universitario Miguel ServetHospital Universitario Miguel ServetZaragozaSpain
- Instituto de Investigación Sanitaria Aragón (IIS Aragón), Universidad de Zaragoza, Zaragoza, EspañaUniversidad de ZaragozaUniversidad de ZaragozaZaragozaSpain
- Centro de Investigación en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid, EspañaInstituto de Salud Carlos IIIInstituto de Salud Carlos IIIMadridSpain
| | - Rasha Isabel Pérez-Ajami
- Servicio de Pediatría, Hospital Universitario Miguel Servet, Zaragoza, EspañaHospital Universitario Miguel ServetHospital Universitario Miguel ServetZaragozaSpain
| | - Carlos Prieto-López
- Servicio de Bioquímica Clínica, Hospital de Alcañiz, Alcañiz, EspañaHospital de AlcañizHospital de AlcañizAlcañizSpain
| | - Alba Gallego-Royo
- Servicio de Medicina Preventiva, Hospital Universitario Miguel Servet, Zaragoza, EspañaHospital Universitario Miguel ServetHospital Universitario Miguel ServetZaragozaSpain
| | - Celia García-Carro
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, EspañaHospital Universitario Miguel ServetHospital Universitario Miguel ServetZaragozaSpain
| | - Graciela María Lou-Francés
- Centro de Salud de Barbastro, Barbastro, EspañaCentro de Salud de BarbastroCentro de Salud de BarbastroBarbastroSpain
| |
Collapse
|
2
|
Hovsepian S, Chegini R, Alinia T, Ghaheh HS, Nouri R, Hashemipour M. Final height in children and adolescents with type 1 diabetes mellitus: A systematic review and meta-analysis. Hormones (Athens) 2024; 23:35-48. [PMID: 37914868 DOI: 10.1007/s42000-023-00500-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 10/19/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Considering the high prevalence of type 1 diabetes mellitus (T1DM) together with the importance of improved physical growth and the significance of promoting healthcare quality among T1DM children, this meta-analysis aims to determine mean final height in this population group. METHODS We systematically searched PubMed, EMBASE, Web of Science, Scopus, and Cochrane databases for all studies published until May 2023 and reviewed references of published articles. Meta-analytic procedures were used to estimate the effect size (mean final height Z-score) among T1DM children in a random effects model. Significance values, weighted effect sizes, 95% CIs, and tests of homogeneity of variance were calculated. The included studies consisted of data from 3274 patients. RESULTS The mean final height Z-score for T1DM children was -0.201 (n = 25 studies, 95% CI: -0.389, -0.013; I2 = 97%), -0.262 in males (n = 20 studies, 95% CI: -0.539, 0.015, I2 = 97.1%), and -0.218 in females (n = 18 studies, 95% CI: -0.436, 0, I2 = 94.2%). The non-significant negative association between age at diagnosis, HbA1c levels, and final height Z-score is suggested by the findings of the univariate meta-regression. CONCLUSION Our findings indicated that children with T1DM have impaired linear growth and that monitoring of growth in these patient populations is an important issue in the management of T1DM. Due to a scarcity of studies providing data on the relationship between uncontrolled diabetes (increased HbA1c) and early diagnosis and final height, further investigation is warranted to determine whether there is indeed a correlation. Consequently, any conclusion regarding the association between uncontrolled diabetes (elevated HbA1c), early diagnosis of T1DM, and the increased risk of impaired linear growth or final height remains uncertain.
Collapse
Affiliation(s)
- Silva Hovsepian
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Rojin Chegini
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Tahereh Alinia
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | | | - Rasool Nouri
- Department of Medical Library and Information Sciences, School of Management and Medical Information Sciences, Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahin Hashemipour
- Metabolic Liver Disease Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
3
|
Fröhlich-Reiterer E, Elbarbary NS, Simmons K, Buckingham B, Humayun KN, Johannsen J, Holl RW, Betz S, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Other complications and associated conditions in children and adolescents with type 1 diabetes. Pediatr Diabetes 2022; 23:1451-1467. [PMID: 36537532 DOI: 10.1111/pedi.13445] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | | | - Kimber Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Denver, Colorado, USA
| | - Bruce Buckingham
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University Medical Center, Stanford, California, USA
| | - Khadija N Humayun
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Jesper Johannsen
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Steno Diabetes Center Copenhagen, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Shana Betz
- Parent/Advocate for people with diabetes, Markham, Canada
| | - Farid H Mahmud
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Santiprabhob J, Charoentawornpanich P, Khemaprasit K, Manpayak T, Kiattisakthavee P, Pipatsathian A, Wannasilp N, Tangjittipokin W. Effect of gender, diabetes duration, inflammatory cytokines, and vitamin D level on bone mineral density among Thai children and adolescents with type 1 diabetes. Bone 2021; 153:116112. [PMID: 34252600 DOI: 10.1016/j.bone.2021.116112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 06/27/2021] [Accepted: 07/07/2021] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) is considered a risk factor for osteoporosis in adults; however, studies in bone mineral density (BMD) in children with T1DM reported conflicting results. The aim of this study was to compare BMD between T1DM youth and healthy controls, and to identify factors that affect BMD in T1DM youth. METHODS One hundred T1DM youths and 100 healthy controls (both groups aged 5-20 years) were recruited. BMD of total body, lumbar (L2-4), femoral neck, and total hip were assessed using dual energy X-ray absorptiometry. Blood investigations, including hemoglobin A1c (HbA1c), 25-hydroxyvitamin D, and inflammatory cytokines, were performed. RESULTS Forty-four boys and 56 girls with T1DM were enrolled [mean age 14.5 ± 2.7 years, median (IQR) duration of T1DM 5.80 (2.97-9.07) years, and mean HbA1c entire duration 9.2 ± 1.4%]. T1DM girls had a lower height Z-score than control girls (p < 0.05), and 25-hydroxyvitamin D level was higher in T1DM youth than in controls (p < 0.001). After adjusting for pubertal status, height Z-score, and 25-hydroxyvitamin D, T1DM youth had a significantly lower lumbar BMD Z-score and femoral neck BMD than controls (p = 0.027 and p = 0.025, respectively). We also found that T1DM boys had a significantly lower lumbar BMD Z-score (p = 0.028), femoral neck BMD (p = 0.004), and total hip BMD (p = 0.016) than control boys. In contrast, these significant differences were not found in T1DM girls. Factors affecting BMD were different between T1DM boys and girls, and among different BMD sites. IL-13 was positively correlated with BMD in the total cohort and among girls. In boys - IL-2 and 25-hydroxyvitamin D were positively associated with BMD, and duration of diabetes was found to negatively affect BMD. CONCLUSION Deleterious effect of T1DM on BMD is gender specific. The longer the duration of T1DM, the greater the deficit in BMD found among boys with T1DM.
Collapse
Affiliation(s)
- Jeerunda Santiprabhob
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; Siriraj Diabetes Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Parichat Charoentawornpanich
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Khwanhatai Khemaprasit
- Siriraj Diabetes Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Teerarat Manpayak
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Pornpimol Kiattisakthavee
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Amornrat Pipatsathian
- Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Nilrat Wannasilp
- Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Watip Tangjittipokin
- Department of Immunology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| |
Collapse
|
5
|
Weber DR. Bone accrual in children and adolescents with type 1 diabetes: current knowledge and future directions. Curr Opin Endocrinol Diabetes Obes 2021; 28:340-347. [PMID: 33965967 DOI: 10.1097/med.0000000000000638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Skeletal fragility is now recognized as a significant complication of type 1 diabetes (T1D). Many patients with T1D develop the disease in childhood and prior to the attainment of peak bone mass and strength. This manuscript will review recent studies investigating the effects of T1D on skeletal development. RECENT FINDINGS Mild-to-moderate deficits in bone density, structure, and mineral accrual were reported early in the course of T1D in some but not all studies. Childhood-onset disease was associated with a more severe skeletal phenotype in some adult studies. Lower than expected bone mass for muscle size was been described. Hemoglobin A1c was negatively associated with bone density and structure in several studies, though the mechanism was not clear. SUMMARY The use of advanced imaging techniques has shown that the adverse effects of T1D on the developing skeleton extend beyond bone density to include abnormalities in bone size, shape, microarchitecture, and strength. Despite these gains, a uniform understanding of the pathophysiology underlying skeletal fragility in this disorder remains elusive. Longitudinal studies, especially in association with interventions to reduce hyperglycemia or improve muscle strength, are needed to inform bone healthcare in T1D.
Collapse
Affiliation(s)
- David R Weber
- Division of Pediatric Endocrinology and Diabetes, The Children's Hospital of Philadelphia and The Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
Abstract
PURPOSE OF REVIEW Patients with diabetes mellitus (DM) are at increased risk of developing osteopathogenesis and skeletal fragility. The role of the gut microbiota in both DM and osteopathy is not fully explored and may be involved in the pathology of both diseases. RECENT FINDINGS Gut microbiota alterations have been observed in DM and osteopathogenic disorders as compared with healthy controls, such as significantly lower abundance of Prevotella and higher abundance of Lactobacillus, with a diminished bacterial diversity. Other overlapping gastro-intestinal features include the loss of intestinal barrier function with translocation of bacterial metabolites to the blood stream, induction of immunological deficits and changes in hormonal and endocrinal signalling, which may lead to the development of diabetic osteopathy. Signalling pathways involved in both DM and osteopathy are affected by gut bacteria and their metabolites. Future studies should focus on gut microbiota involvement in both diseases.
Collapse
Affiliation(s)
- Julie Kristine Knudsen
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark.
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, Aalborg, Denmark.
| | - Peter Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Mølleparkvej 4, Aalborg, Denmark
| | - Suzette Sørensen
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark
- Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, Aalborg, Denmark
- Steno Diabetes Center North Jutland, Mølleparkvej 4, Aalborg, Denmark
| |
Collapse
|
7
|
Jiang H, Robinson DL, Nankervis A, Garland SM, Callegari ET, Price S, Lee PVS, Wark JD. Bone Measures by Dual-Energy X-Ray Absorptiometry and Peripheral Quantitative Computed Tomography in Young Women With Type 1 Diabetes Mellitus. J Clin Densitom 2021; 24:259-267. [PMID: 32586681 DOI: 10.1016/j.jocd.2020.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 12/16/2022]
Abstract
Understanding bone fragility in young adult females with type 1 diabetes mellitus (T1DM) is of great clinical importance since the high fracture risk in this population remains unexplained. This study aimed to investigate bone health in young adult T1DM females by comparing relevant variables determined by dual-energy X-ray absorptiometry (DXA), peripheral quantitative computed tomography (pQCT) at the tibia and pQCT-based finite element analysis (pQCT-FEA) between T1DM subjects (n = 21) and age-, height- and weight-matched controls (n = 63). Tibial trabecular density (lower by 7.1%; 228.8 ± 33.6 vs 246.4 ± 31.8 mg/cm3, p = 0.02) and cortical thickness (lower by 7.3%; 3.8 ± 0.5 vs 4.1 ± 0.5 cm, p = 0.03) by pQCT were significantly lower in T1DM subjects than in controls. Tibial shear stiffness by pQCT-FEA was also lower in T1DM subjects than in controls at both the 4% site (by 17.1%; 337.4 ± 75.5 vs 407.1 ± 75.4 kN/mm, p < 0.01) and 66% site (by 7.9%; 1113.0 ± 158.6 vs 1208.8 ± 161.8 kN/mm, p = 0.03). These differences remained statistically significant after adjustment for confounding factors. No difference between groups was observed in DXA-determined variables (all p ≥ 0.08), although there was a trend towards lower aBMD at the lumbar spine in T1DM subjects than in controls after adjustment for confounders (p = 0.053). These novel findings elicited using pQCT and pQCT-FEA suggest a clinically significant impact of T1DM on bone strength in young adult females with T1DM. Peripheral QCT and pQCT-FEA may provide more information than DXA alone on bone fragility in this population. Further longitudinal studies with a larger sample size are warranted to understand the evolution and causes of bone fragility in young T1DM females.
Collapse
Affiliation(s)
- Hongyuan Jiang
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Dale L Robinson
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - Alison Nankervis
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Diabetes Service, Royal Women's Hospital, Melbourne, Australia; Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
| | - Suzanne M Garland
- Centre for Women's Infectious Diseases Research, Royal Women's Hospital, Melbourne, Australia; Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Australia; Infection & Immunity, Murdoch Children's Research Institute, Melbourne, Australia
| | - Emma T Callegari
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
| | - Sarah Price
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia
| | - Peter V S Lee
- Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
| | - John D Wark
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia; Bone and Mineral Medicine, Royal Melbourne Hospital, Melbourne, Australia; Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, Australia.
| |
Collapse
|
8
|
Abstract
Many children with chronic disease are now surviving into adulthood. As a result, there is a growing interest in optimizing bone health early in the disease course with the dual goals of improving quality of life during childhood and reducing life-long fracture risk. Risk factors for impaired bone health in these children include immobility, nutritional deficiency, exposure to bone toxic therapies, hormonal deficiencies affecting growth and pubertal development, and chronic inflammation. This review focuses on the chronic diseases of childhood most commonly associated with impaired bone health. Recent research findings and clinical practice recommendations, when available, for specific disorders are summarized.
Collapse
Affiliation(s)
- David R Weber
- Department of Pediatrics - Endocrinology, Golisano Children's Hospital, University of Rochester, Rochester, NY, USA.
| |
Collapse
|
9
|
Nilsson F, Madsen JOB, Jensen AK, Olsen BS, Johannesen J. High prevalence of disordered eating behavior in Danish children and adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:1043-1049. [PMID: 32418266 DOI: 10.1111/pedi.13043] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 04/16/2020] [Accepted: 05/04/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE A higher prevalence of disordered eating behavior (DEB) has been demonstrated in children and adolescents with type 1 diabetes (T1D) compared to healthy aged-matched peers. DEB is associated with higher HbA1c levels and increased risk of developing complications to T1D. The aim of this study was to determine the prevalence of DEB in a Danish cohort of children and adolescents with T1D aged 11 to 19 years and to characterize them regarding metabolic control and relevant clinical data. RESEARCH DESIGN AND METHODS In a cross-sectional study, we determined the prevalence of DEB using the revised Diabetes Eating Problem Survey (DEPS-R) questionnaire. HbA1c and relevant clinical data were obtained at the time they filled in the questionnaire. RESULTS Hundred and ninety-two children and adolescents (46% girls) aged 11 to 19 years with T1D were included from the pediatric diabetes outpatient clinic. A total of 40 participants (21%) had DEB. The prevalence was higher among girls compared with boys (34.1% vs 8.9%) and those who had DEB were older (16.7 vs 15.0 years, P < .001), had longer duration of T1D (7.5 vs 4.9 years, P < .001), higher BMI Z-scores (1.2 vs 0.3, P < .001), higher HbA1c (72.8 (8.8%) vs 62.0 (7.8%) mmol/mol, P < .001), higher total cholesterol (4.6 mmol/L vs 4.2 mmol/L, P = .0048), and LDL (2.7 vs 2.3, P = .001) compared with those with no signs of DEB. CONCLUSION As in other countries, the prevalence of DEB is high in Danish adolescents with T1D. Early detection of DEB is essential to prevent short- and long-term complications to T1D.
Collapse
Affiliation(s)
- Franciska Nilsson
- Department of Children Adolescents, Copenhagen University Hospital, Herlev, Denmark
| | | | - Andreas Kryger Jensen
- Section of Biostatistics, Institute of Public Health , University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - Birthe Susanne Olsen
- Department of Children Adolescents, Copenhagen University Hospital, Herlev, Denmark
| | - Jesper Johannesen
- Department of Children Adolescents, Copenhagen University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
10
|
Madsen JOB, Herskin CW, Zerahn B, Jørgensen NR, Olsen BS, Pociot F, Johannesen J. Decreased markers of bone turnover in children and adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:505-514. [PMID: 31970841 DOI: 10.1111/pedi.12987] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/09/2019] [Accepted: 01/13/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND AND AIM Adults with type 1 diabetes (T1D) have increased risk of bone fractures and decreased bone mineral density (BMD). Alterations in bone turnover have been suggested as the link between T1D and the impaired bone health. Furthermore, bone turnover has been suggested to have beneficial effects on glucose metabolism. This study aimed at describing bone turnover markers (BTM), and the relationship with glycemic control, in children and adolescents with T1D. METHODS A total of 173 (47% girls) children and adolescents aged 7.7 to 17.5 years with T1D for more than 1 year were included. Participants were evaluated by BMD together with measurements of selected BTM; two formation markers: osteocalcin (OCN) and procollagen type-1 amino-terminal propeptide (P1NP) and one resorption marker, C-terminal cross-linked telopeptide of type-1 collagen (CTX). BTM were converted into Z-scores utilizing new national references. RESULTS Mean OCN Z-score (-0.68 ± 1.31), P1NP Z-score (-0.33 ± 1.03) and CTX Z-score (-0.43 ± 1.10) were all significantly lower than the reference population (P < .001). No associations were seen between BTM and T1D duration. BMD Z-score was comparable to the reference population and associated with none of individual BTMs. CTX Z-score was negatively associated with HbA1c (P = .007) independent of both exogenous and residual endogenous insulin. CONCLUSIONS Markers of bone formation and resorption were decreased in children and adolescents with T1D. CTX Z-score associated negatively with HbA1c adjusted for insulin treatment and endogenous insulin production indicating a potential association between CTX and insulin sensitivity. The long-term consequences of decreased BTM on BMD need further attention.
Collapse
Affiliation(s)
| | | | - Bo Zerahn
- Department of Nuclear Medicine, Herlev Hospital, University of Copenhagen, Herlev, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark.,OPEN, Odense Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Birthe Susanne Olsen
- Department of Paediatrics and Adolescent Medicine, Herlev Hospital, Herlev, Denmark
| | - Flemming Pociot
- Department of Paediatrics and Adolescent Medicine, Herlev Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Jesper Johannesen
- Department of Paediatrics and Adolescent Medicine, Herlev Hospital, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
11
|
Madsen JOB, Herskin CW, Zerahn B, Jensen AK, Jørgensen NR, Olsen BS, Svensson J, Pociot F, Johannesen J. Bone turnover markers during the remission phase in children and adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:366-376. [PMID: 31840392 DOI: 10.1111/pedi.12963] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/08/2019] [Accepted: 12/04/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND AIM In rodents, osteocalcin (OCN) stimulates insulin production and insulin sensitivity, both important factors during partial remission in humans with type 1 diabetes (T1D). However, decreased OCN has been reported in both adult and pediatric T1D. This study aims at investigating bone turnover and partial remission in children and adolescents with recent onset T1D. SUBJECTS AND METHODS Ninety-nine individuals (33% girls) were recruited within 3 months of T1D onset and examined three times, 6 months apart. Outcome variables were bone formation markers OCN and procollagen type 1 amino-terminal propeptide (P1NP) and the bone resorption marker C-terminal crosslinked telopeptide of type 1 collagen (CTX). Dependent variables included IDAA1c (surrogate marker of partial remission), total body bone mineral density (BMD) and stimulated C-peptide as representative of endogenous insulin production. RESULTS OCN- and P1NP Z-scores were significantly decreased throughout the study, whereas CTX Z-scores were increased. None of the bone turnover markers changed significantly between visits. Total body BMD Z-score did not change during the study but was significantly higher than the reference population at visit 2 (P = .035). There were no differences in the bone turnover markers for those in partial remission as defined by either C-peptide or IDAA1c at any visit. The individual change in CTX Z-score was negatively associated with the increase of IDAA1c (P = .030) independent of C-peptide decline (P = .034). CONCLUSION Bone turnover markers indicate increased bone resorption and decreased bone formation during the first year of T1D. The negative association between bone resorption and IDAA1c might represent compensatory mechanisms affecting insulin sensitivity.
Collapse
Affiliation(s)
- Jens O B Madsen
- Department of Children Adolescents, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Camilla W Herskin
- Department of Children Adolescents, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Bo Zerahn
- Department of Nuclear Medicine, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Andreas K Jensen
- Section of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - Niklas R Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Glostrup, Denmark.,OPEN, Open Patient Data Explorative Network, Odense University Hospital/Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Birthe S Olsen
- Department of Children Adolescents, Copenhagen University Hospital Herlev, Herlev, Denmark
| | - Jannet Svensson
- Department of Children Adolescents, Copenhagen University Hospital Herlev, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Pociot
- Department of Children Adolescents, Copenhagen University Hospital Herlev, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Jesper Johannesen
- Department of Children Adolescents, Copenhagen University Hospital Herlev, Herlev, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|