| Objective:Type 2 diabetes mellitus(T2DM)and osteoporosis(OP)have complex pathophysiological interactions.They are both affected by aging and frequently coexist.The goal of this study is to investigate the impact of short-term blood glucose fluctuations on bone mineral density in patients with type 2 diabetes mellitus(T2DM),as well as to further investigate the influencing factors of osteoporosis in T2 DM patients,and to score patients with T2 DM with the FRAX score,in order to provide a clinical basis for identifying high-risk individuals with T2 DM and preventing and treating fractures as early as possible.Methods:From March 2021 to October 2022,209 T2 DM patients,aged 40～80,were hospitalised in Department of Endocrinology at Jilin University’s Second Hospital and all wore Medtronic Continuous Glucose Monitoring System(CGMs)in our hospital to monitor their blood sugar.Collect basic information,such as gender,age,BMI,blood pressure.The following parameters were measured: FPG,Hb A1 c,fasting C-peptide(FC-P),TG,TC,HDL-C,LDL-C,ALT,AST,serum albumin(ALB),uric acid(UA),urea nitrogen(BUN),serum creatinine(Scr),homocysteine(HCY),and25(OH)D.Blood glucose fluctuation indexes(mean amplitude of glycemic excursions(MAGE),mean blood glucose(MBG),standard deviation of mean blood glucose(SDBG),coefficient of variation(CV),time in rage(TIR)and T/Z value were recorded,and fracture risk was calculated using the FRAX evaluation tool,that is,within ten years.According to MAGE,patients were divided into two groups: stable blood glucose group(MAGE < 3.9 mmol/L)and fluctuating blood glucose group(MAGE ≥ 3.9mmol/L).The two groups’ clinical data and BMD were compared.Simultaneously,the correlation between blood glucose fluctuation and BMD was investigated in order to investigate the relationship between MOF and HF and various indexes.According to the level of BMD,the patients were divided into three groups,and the differences among the groups were compared to explore the influencing factors of osteoporosis in patients with T2 DM.Results:1.The BMD of the 1st to 4th lumbar vertebrae and the BMD of the femoral neck in the blood glucose fluctuation group were significantly lower than those in the blood glucose stability group(P<0.05).2.The BMI and the waist circumference of the osteoporosis group was lower than that of the normal bone mass group(P<0.05).The proportion of age and female increased gradually(P<0.05),while the proportion of 25(OH)D decreased gradually(P<0.05).MAGE,SDBG,and CV blood glucose fluctuation indices showed an upward trend,while TIR showed a downward trend(P<0.05).UA was significantly higher in the osteoporosis group than in the non-osteoporosis group(P<0.05).MOF and HF in the following decade was significantly higher in the osteoporotic group than in the normal bone mass group(P< 0.05).3.Correlation analysis showed that female,age,MAGE,SDBG,CV were negatively correlated with femoral neck BMD(r=-0.314,-0.408,-0.284,-0.238,-0.292,P<0.001),BMI,waist circumference,UA,25(OH)D,TIR was negative ly correlated with femoral neck BMD(r=0.397、0.292、0.188、0.303、0.275,P<0.05)。4.Correlation analysis of fracture risk of FRAX showed that age and female were positively correlated with MOF(r=0.423,0.279,P<0.05),while UA,BMD of femoral neck and hip were negatively correlated with MOF(r=-0.214,-0.283,-0.271,P < 0.05).Age and course of disease were positively correlated with HF(r=0.539,0.171,P<0.05),UA,BMD of femoral neck and hip were negatively correlated with HF(r=-0.184,-0.327,-0.255,P<0.05).5.Multivariate Logistic regression analysis showed that age,UA,25(OH)D and MAGE were independent influencing factors of osteoporosis in T2 DM patients(OR =1.111,95% CI: 1.036-1.192;OR=0.980,95%CI: 0.967-0.991;OR=0.864,95%CI:0.768-0.973;OR=1.241,95%CI: 1.058-1.456;P<0.05).For every 1-point increase in MAGE,the risk of osteoporosis increases by 24.1%.6.ROC curve revealed that the AUC of age,UA,25(OH)D,and MAGE combined in predicting osteoporosis in T2 DM was 0.879,with a 95% confidence interval of 0.811-0.930,P<0.001,a sensitivity of 84.2%,a specificity of 81.1%,and a cutoff value of 65.3.Conclusions:1.Variation in short-term blood glucose levels in T2 DM will have an effect on bone mineral density,which will manifest as abnormal blood glucose fluctuation,resulting in a decrease in bone mineral density.2.Age and MAGE are risk factors for osteoporosis in T2 DM patients,whereas25(OH)D and uric acid are protective factors.3.Age,female status,uric acid,and femoral neck and hip BMD are all linked to MOF and HF in T2 DM patients.Within ten years,a high uric acid level can reduce the risk of fracture in T2 DM patients.4.When no conditions exist to improve bone mineral density measurement,the combined predictors of age,UA,25(OH)D,and MAGE can be used as initial indicators for the diagnosis of osteoporosis in T2 DM patients,guiding the next clinical examination and treatment. |
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