Diabetes mellitus types 1 and 2: an overview

Evaluation of bone density measurement in type 2 diabetic postmenopausal women with hypertension and hyperlipidemia

Objectives

The aim of the study was to compare bone mineral density (BMD) in healthy postmenopausal women to BMD in type 2 diabetic hypertensive postmenopausal women with hyperlipidemia.

Methods

Fifty type 2 diabetic and hypertensive postmenopausal women with hyperlipidemia and 51 age and body mass index (BMI) matched healthy postmenopausal women were included. Lumbar spine and femoral neck BMD were noted in both groups. BMD was measured using dual energy X-ray absorptiometry (DXA). Serum alkaline phosphatase (ALP), calcium and phosphorous were also measured. Pearson correlation coefficients were used to establish the relationship between various clinical characteristics.

Results

There were no significant differences between two groups in respect to lumbar and vertebral BMD values, age, BMI, gravidity, parity. Serum cholesterol and fasting glucose levels were significantly different between each groups (P = 0.0001, P = 0.002).

Conclusion

We found that, accompanying chronic diseases such as diabetes, hypertension and hyperlipidemia don't affect the BMD measurements at postmenopausal period. So these postmenopausal women don't have excess risk regarding osteoporosis.

Cardiovascular dementia - a different perspective

The number of dementia patients has been growing in recent years and dementia represents a significant threat to aging people all over the world. Recent research has shown that the number of people affected by Alzheimer's disease (AD) and dementia is growing at an epidemic pace. The rapidly increasing financial and personal costs will affect the world's economies, health care systems, and many families. Researchers are now exploring a possible connection among AD, vascular dementia (VD), diabetes mellitus (type 2, T2DM) and cardiovascular diseases (CD). This correlation may be due to a strong association of cardiovascular risk factors with AD and VD, suggesting that these diseases share some biologic pathways. Since heart failure is associated with an increased risk of AD and VD, keeping the heart healthy may prove to keep the brain healthy as well. The risk for dementia is especially high when diabetes mellitus is comorbid with severe systolic hypertension or heart disease. In addition, the degree of coronary artery disease (CAD) is independently associated with cardinal neuropathological lesions of AD. Thus, the contribution of T2DM and CD to AD and VD implies that cardiovascular therapies may prove useful in preventing AD and dementia.

Regulation and function of selenoproteins in human disease

Selenoproteins are proteins containing selenium in the form of the 21st amino acid, selenocysteine. Members of this protein family have many diverse functions, but their synthesis is dependent on a common set of cofactors and on dietary selenium. Although the functions of many selenoproteins are unknown, several disorders involving changes in selenoprotein structure, activity or expression have been reported. Selenium deficiency and mutations or polymorphisms in selenoprotein genes and synthesis cofactors are implicated in a variety of diseases, including muscle and cardiovascular disorders, immune dysfunction, cancer, neurological disorders and endocrine function. Members of this unusual family of proteins have roles in a variety of cell processes and diseases.

Diabetes and osteoporosis

Care of patients with diabetes should include assessment of bone health. The extension of the average life expectancy of people with diabetes, which has accompanied improvements in medical care, has also increased the significance of osteoporosis. In addition to the usual causes of osteoporosis associated with aging, bone health is also compromised by diabetes. Studies on bone involvement in patients with diabetes mellitus have generated conflicting results, largely because of the pathogenetic complexity of the condition. It is now clear that patients with type 1 diabetes have lower bone mineral density (BMD) and a higher risk of fractures. Evidence is emerging that patients with type 2 diabetes who have complications are also at increased risk of certain types of osteoporotic fractures, despite having a higher BMD when compared to patients with type 1 diabetes. Although many factors, including number and type of falls, visual impairment, neuropathy, and reduced muscle strength, influence the probability of fractures, the most significant factor seems to be the strength of the bone itself. Thus, sarcopenia, a reduction in muscle mass and muscle strength, is considered one of the main determinants of bone fragility. The aim of this review is to examine the occurrence of osteoporosis in type 1 and type 2 diabetes.

Correlation between bone mineral density and plasma lipids in Taiwan

Many studies showed that depression is correlated with osteoporosis, while others showed that low cholesterol level is also related to depression. However, these relationships still remain controversial. Since the bone mineral density (BMD) is related to depression and depression is related to hypocholesterolemia, there might exist a correlation between BMD and plasma cholesterol levels. To prove this, we enrolled 5000 individuals, 2170 males, and 2830 females, who had health check-ups at a private clinic between 1998 and 1999. They were divided into three groups. Group 1 was composed of male subjects; Group 2, female subjects; and Group 3, females aged over 50 to exclude pre-menopausal females. Each subject had a routine physical examination, fasting blood drawing, BMD measured by dual energy x-ray absorptiometry (DEXA) over the wrist, and was given a questionnaire to answer. Between Groups 1 and 2, the females were significantly younger, had higher body mass index (BMI), total cholesterol (TC), high density lipoprotein cholesterol (HDLC), low density lipoprotein cholesterol (LDLC), and platelet, but lower BMD, fasting plasma glucose (FPG), triglycerides (TG), hemoglobin (Hgb), and white blood cell (WBC) count. As for Groups 1 and 3, all the aforementioned findings still remained the same except that the systolic blood pressure (SBP) was higher and diastolic blood pressure (DBP) was lower in Group 3. Our results showed that BMD is negatively related to age in males. In females, it is negatively correlated with age, FPG, PPG, SBP, DBP, TC, LDLC, TG, and Hgb, but positively related to BMI and platelet. However, for females in Group 3, BMD is only negatively related to age, FPG, SBP, and TG but positively related to BMI. Stepwise multiple regression analysis showed that the BMD is negatively related to age but positively related to BMI in both males and females. In Group 3, BMD is negatively related to age and FPG but positively related BMI. In conclusion, no correlation exists between BMD and cholesterol. This implies that the depression is not significantly related to cholesterol and/or BMD. This might be due to various confounding factors, which could affect their relationships. The negative correlation between BMD and FPG is only observed in females older than 50 years. Further studies are needed to clarify these relationships.

Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women

OBJECTIVE

To examine whether postmenopausal women with diabetes experienced a higher incidence of hip fracture than women without diabetes.

RESEARCH DESIGN AND METHODS

A prospective cohort of 32,089 postmenopausal women residing in Iowa were surveyed by mail in 1986 and followed for 11 years. Diabetes status and other potential risk factors were assessed by questionnaires at baseline; incidence of hip fracture was ascertained by follow-up questionnaires.

RESULTS

A total of 490 hip fractures were reported over 306,900 person-years of follow-up. After adjustment for age, smoking status, estrogen use, BMI, and waist-to-hip ratio, women with type 1 diabetes (n = 47) were 12.25 times (95% CI 5.05-29.73) more likely to report an incident hip fracture than women without diabetes. Women with type 2 diabetes had a 1.70-fold higher risk (1.21-2.38) of incident hip fracture than women without diabetes. Longer duration of type 2 diabetes was associated with higher incidence, as was use of insulin or oral diabetes medications in women with type 2 diabetes. Furthermore, women who were initially free of diabetes but in whom diabetes developed had a relative risk of hip fracture of 1.60 (1.14-2.25) compared with women who never had diabetes.

CONCLUSIONS

Postmenopausal women who have diabetes or in whom diabetes develops are at higher risk for hip fracture than nondiabetic postmenopausal women. Strategies to prevent osteoporosis and/or falling may be especially warranted in women with diabetes.