학술논문
Poor Glycemic Control Is Associated With Impaired Bone Accrual in the Year Following a Diagnosis of Type 1 Diabetes
CLINICAL RESEARCH ARTICLE
CLINICAL RESEARCH ARTICLE
Document Type
Clinical report
Author
Source
Journal of Clinical Endocrinology & Metabolism. October 2019, Vol. 104 Issue 10, p4511, 10 p.
Subject
Language
English
ISSN
0021-972X
Abstract
Despite technological advances in insulin delivery and glucose monitoring, type 1 diabetes (T1D) remains an incurable disease. Systemic complications of T1D have been recognized for decades and include retinopathy, neuropathy, [...]
Context: Type 1 diabetes (T1D) is associated with an increased fracture risk across the life course. The effects on bone accrual early in the disease are unknown. Objective: To characterize changes in bone density and structure over the year following diagnosis of T1D and to identify contributors to impaired bone accrual. Design: Prospective cohort study. Setting: Academic children's hospital. Participants: Thirty-six children, ages 7 to 17 years, enrolled at diagnosis of T1D. Outcomes: Whole body and regional dual-energy X-ray absorptiometry and tibia peripheral quantitative computed tomography obtained at baseline and 12 months. The primary outcome was bone accrual assessed by bone mineral content (BMC) and areal bone mineral density (aBMD) velocity z score. Results: Participants had low total body less head (TBLH) BMC (z =-0.46 6 0.76), femoral neck aBMD (z =-0.57 6 0.99), and tibia cortical volumetric BMD (z =-0.44 6 1.11) at diagnosis, compared with reference data, P < 0.05. TBLH BMC velocity in the year following diagnosis was lower in participants with poor (hemoglobin A1c [greater than or equal to]7.5%) vs good (hemoglobin A1c Conclusions: Our results suggest that the adverse effects of T1D on BMD develop early in the disease. Bone accrual following diagnosis was impaired in participants with poor glycemic control and appeared to be mediated by diminished bone formation on the periosteal surface. (J Clin Endocrinol Metab 104: 4511-4520, 2019)
Context: Type 1 diabetes (T1D) is associated with an increased fracture risk across the life course. The effects on bone accrual early in the disease are unknown. Objective: To characterize changes in bone density and structure over the year following diagnosis of T1D and to identify contributors to impaired bone accrual. Design: Prospective cohort study. Setting: Academic children's hospital. Participants: Thirty-six children, ages 7 to 17 years, enrolled at diagnosis of T1D. Outcomes: Whole body and regional dual-energy X-ray absorptiometry and tibia peripheral quantitative computed tomography obtained at baseline and 12 months. The primary outcome was bone accrual assessed by bone mineral content (BMC) and areal bone mineral density (aBMD) velocity z score. Results: Participants had low total body less head (TBLH) BMC (z =-0.46 6 0.76), femoral neck aBMD (z =-0.57 6 0.99), and tibia cortical volumetric BMD (z =-0.44 6 1.11) at diagnosis, compared with reference data, P < 0.05. TBLH BMC velocity in the year following diagnosis was lower in participants with poor (hemoglobin A1c [greater than or equal to]7.5%) vs good (hemoglobin A1c Conclusions: Our results suggest that the adverse effects of T1D on BMD develop early in the disease. Bone accrual following diagnosis was impaired in participants with poor glycemic control and appeared to be mediated by diminished bone formation on the periosteal surface. (J Clin Endocrinol Metab 104: 4511-4520, 2019)