Study On The Relationship Between Microangiopathy And Serum 25 Hydroxyvitamin D And Bone Mineral Density In Type 2 Diabetes Mellitus

Objective:To analyze the microangiopathy(DMAP)and serum 25-hydroxyl vitamin D(25(OH)D)and bone mineral density(BMD)in patients with type2 diabetes mellitus(T2DM).Methods:A collection of 528 patients with type 2 diabetes who were hospitalized in the Endocrinology Department of Chengde Central Hospital from October2019 to September 2020,including 275 males and 253 females,aged 22-83years.Collect basic clinical data of all study subjects,including age,gender,height,weight,body mass index(BMI),course of diabetes,family history of diabetes,insulin application,history of smoking,history of drinking,history of hypertension,female Menstrual history,hyperlipidemia,fatty liver,random blood glucose on admission,etc;fasting cubital venous blood was drawn at 05:00 the morning of the next day of admission for testing fasting plasma glucose(FPG),fasting c-peptide,(FC-P),glycosylated hemoglobin(Hb A1c),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C)and low density lipoprotein cholesterol(LDL-C),25-hydroxy vitamin D(25(OH)D),parathormone(PTH),calcium(Ca),Blood phosphorus(P),blood magnesium(Mg),blood creatinine(CR),cystatin C(Cys-C)and other biochemical indicators.And take urine to measure urine albumin/creatinine(A/C),urine microalbumin excretion rate and other indicators,and use dual energy X-ray absorptiometry(DXA)to measure the patient’s lumbar spine(L1-4)and the bone mineral density of the bilateral femoral necks.Fundus photography was performed to measure the visceral adipose(VAT)and subcutaneous adipose tissue(SAT).The modified HOMA model was used to evaluate insulin resistanc e and isletβCell function,HOMA-IR=1.5+FPG×FC-P/2800,HOMA-β=0.27×FC-P/(FPG-3.5).Assess all patients with diabetic nephropathy(DN),diabetic retinopathy(DR)and other combined different microvascular conditions.(1)Divide patients into simple type 2 diabetes mellitus group(group A),type 2 diabetes mellitus combined with retinopathy group(group B),type 2 diabetes mellitus combined with diabetic nephropathy group(group C),and type 2 diabetes according to their combined different microvascular diseases Simultaneously combined with diabetic retinopathy and diabetic nephropathy group(group D)4 groups,compare the differences in general data,BMD and 25(OH)D among the groups;(2)According to the results of bone density,the patients were divided into normal bone mass groups(U1 group),osteopenia group(U2 group),osteoporosis group(U3 group)3 groups,compare the differences in general data,microvascular disease occurrence,25(OH)D and other indicators among the groups;(3)Using SPSS 26.0 statistical software,the data were processed statistically by one-way analysis of variance,X~2test,Kruskal-Wallis test,and ordinal Logistic regression analysis.The difference was statistically significant with P<0.05.Results:1.T2DM patients with different microangiopathy group age,diabetes course,insulin application,combined fatty liver,25(OH)D,BMI,Hb A1c,FCP,CR,TG,Cys-C,blood P,VAT and SAT levels,The difference was statistically significant(P<0.05);smoking,drinking,hyperlipidemia,random blood glucose on admission,FPG,TC,HDL-C,LDL-C,PTH,blood Ca,Mg,HOMA-IR,HOMA-There was no statistically significant difference inβlevels(all P>0.05).1.1 From A to D,the FCP level gradually decreased.In addition,compared with group A,age,diabetes course,TG,HOMA-IR,smoking,insulin use,fatty liver,and osteoporosis were higher in groups B,C,and D,while blood P,VAT,and bone mass decreased.The ratio is low.Compared with group A,the average bone mineral density of group B,C,and D is lower than group A,among which group B is the leading group,and group D is the second.1.2 There was a statistically significant difference in 25(OH)D lev-els between groups A,B,C and D[14.57(10.27～18.71)ng/m L]vs[15.34(11.31～18.45)ng/m L]vs[12.19(9.56)～15.04)ng/m L]vs[11.18(6.72～17.28)ng/m L](P<0.05),the concentration of 25(OH)D in group B was the hig-hest,and the concentration of 25(OH)D in group D was the lowest.The prevalence of osteopenia between groups A,B,C,and D(135 ca ses,48.60%)vs(50 cases,40.70%)vs(26 cases,45.60%)vs(30 case s,42.90%),group A The prevalence of osteopenia is the highest;the prevalence of osteoporosis between groups(45 cases,16.20%)vs(21 c-ases,17.10%)vs(12 cases,21.10%)vs(16 cases,22.90%),D The p revalence of osteoporosis was the highest in the group;2.Analyze the results of the risk factors of T2DM patients with microvascular disease,and single-factor screening of sixteen suspicious influencing factors leading to changes in the severity of the disease,including gender,age,course of diabetes,combined fatty liver,insulin use,BMI,Hb A1c,FCP,CR,TG,Cys-C,25(OH)D,blood P,VAT,SAT,HOMA-IR;multi-factor ordered logistic regression analysis results show that SAT,BMI,TG,Cys-C,blood P The combined fatty liver is a risk factor for diabetic microvascular disease;FCP,25(OH)D,and insulin are protective factors for the severity of diabetic microvascular disease.3.According to the analysis of the results of bone mineral density grouping of T2DM patients,gender,age,diabetes course,smoking,drinking,insulin application,BMI,FPG,FCP,CR,TG,HDL-C,Cys-C between U1,U2,and U3 groups,VAT,and SAT levels are statistically significant(P<0.05);family history of diabetes,fatty liver,hyperlipidemia,random blood glucose,Hb A1c,TC,LDL-C,25(OH)D,There was no significant difference in the number of cases of PTH,Ca,Mg,P,HOMA-β,and microangiopathy(all P>0.05).3.1 From the U1 group to the U3 group,the proportion of male patients,smoking,and drinking gradually decreased,while BMI,FPG,FCP,TG,VAT,and SAT gradually decreased,age,random blood glucose,insulin application ratio,CR,HDL-C,LDL-C,Cys-C,blood Mg,blood P are gradually increased.3.2 There was no statistically significant difference in 25(OH)D le-vels between U1,U2 and U3 groups[13.68(9.83～18.48)ng/m L]vs[14.33(10.07～17.73)ng/m L]vs[13.37(8.95～18.46))ng/m L](P>0.05),the U3 gr-oup has the lowest 25(OH)D concentration,and the osteoporosis grou-p is more likely to have a low 25(OH)D level;there is no statistically significant difference in the number of cases with microvascular disea-se among the groups(95 Cases,38.2%)vs(106 cases,42.6%)vs(48cases,19.3%)(P>0.05),there were more cases of bone reduction com bined with microvascular disease.4.Analyze the results of risk factors for bone loss or osteoporosis in patients with T2DM,and single-factor screening of sixteen suspicious influencing factors leading to changes in the severity of the disease,including gender,age,course of diabetes,smoking,drinking,fatty liver,Whether to use insulin,BMI,FCP,CR,FPG,TG,HDL-C,Cys-C,VAT,SAT;the results of multivariate ordered logistic regression analysis show that VAT,Cys-C,and smoking are the causes of bone loss in T2DM patients Or a risk factor for osteoporosis,and BMI is a protective factor for osteopenia or osteoporosis in patients with T2DM;Conclusion:In patients with T2DM,low 25(OH)D levels may promote the occurrence of diabetic microangiopathy.As the degree of diabetic microvascular disease worsens,the risk of suffering from osteoporosis is higher.Patients with T2DM are more likely to have 25(OH)D low when suffering from osteoporosis.