| Objective:To investigate the correlation between serum osteocalcin and glucose metabolism in patients with type 2 diabetes mellitus,and to observe the clinical efficacy of Strengthing bone Pill in the treatment of patients with osteoporosis in type 2 diabetes mellitus,as well as the influence of Strengthing bone Pill on bone metabolism and glucose metabolism,and to explore whether Strengthing bone Pill can affect glucose metabolism through the change of osteocalcin level,so as to study the mechanism of kidney-tonifying therapy for this disease.Methods:(1)According to inclusion and exclusion criteria,160 patients with type 2 diabetes mellitus were selected.The basic information of gender,age,height and weight were recorded,Serum osteocalcin,glycometabolism and biochemical indicators were measured,and Body mass index,insulin secretion index and insulin resistance index were calculated.The patients were grouped according to sex and osteocalcin level,comparing the levels of osteocalcin,glycometabolism and insulin resistance and analyzing other relevant indicators.(2)Choosing patients with osteoporosis in type 2 diabetes mellitus that meets the inclusion and exclusion criteria,and dividing them into experimental group and control group according to random number grouping method.Both experimental group and control group are treated with basic therapy and hypoglycemic therapy(except for thiazolidinedione and sodium-glucose synergistic transporter 2 inhibitor).The control group is given alfacalciferol capsule 0.25 ug,1 times per day.On the basis of treatment in the control group,the experimental group+Strengthing bone Pill 5g,1 times in the morning and 1 times in the evening every day respectively,the course of treatment was observed for 6 months.The improvement of symptoms,changes of bone metabolism indexes(osteocalcin,parathyroid hormone,25-hydroxyvitamin D,blood calcium,blood phosphorus,alkaline phosphatase),glucose metabolism indexes(fasting blood sugar,2-hour postprandial blood sugar,fasting insulin,fasting C-peptide,glycosylated hemoglobin,insulin secretion index,insulin resistance index)and bone mineral density were observed before and after treatment.Results:(1)Correlation analysis:①There were no significant differences in course of disease,BMI,waist circumference,FBG,PBG,FINS,FCP,2hCP,HbA1c,25-hydroxyvitamin D,ALP,HOMA-β and HOMA-IR between men and women(P>0.05);age,OC,2hINS in women group were higher than those in men group,while Ca was less than that in men group(P<0.05).②There was no significant difference in age,course of disease,BMI,FINS,HOMA-IR between high OC group and low OC group(P>0.05);FBG,PBG and HbAlc in the low OC group were higher than those in the high OC group,and FCP and HOMA-β were lower than those in the high OC group,and there is a difference in them(P<0.05).③By correlation analysis,OC was negatively correlated with FBG,PBG and HbAlc(P<0.01),positively correlated with FCP and HOMA-β(P<0.01),but had no significant correlation with BMI,FINS,HOMA-IR(P>0.05).(2)Clinical effect observation:① Symptom improvement:The efficacy of the two groups was compared after treatment,there were 32 cases in the experimental group,of which 6 cases were markedly effective,22 cases were effective,4 cases were ineffective,and the total effective rate was 87.50%.There were 34 cases in the control group,including 3 cases were markedly effective,18 cases were effective,13 cases were ineffective,and the total effective rate was 61.76%.There was statistical difference between the two groups(P<0.05),and the effect of the experimental group was better than that of the treatment group.After treatment,the total scores of symptoms in both groups were improved compared with those before treatment(P<0.01);the scores in the experimental group were improved more significantly than those in the experimental group(P<0.05).②Bone metabolic indicators:OC and 25-hydroxyvitamin D increased after treatment in both groups(P<0.01).PTH was lower than before(P<0.01 in the experimental group,P<0.05 in the control group),blood Ca was higher than before(P<0.01),blood P was lower than before treatment,but there was no statistical significance(P>0.05),ALP was slightly higher in the experimental group and slightly lower in the control group,but there was no statistical significance(P>0.05);Compared with the two groups,the improvement of OC,PTH and 25-hydroxyvitamin D was more advantageous in the experimental group after treatment(P<0.05),and there was no significant difference in blood Ca,blood P and ALP(P>0.05).③Glucose metabolic indexes:FBG,PBG,HbAlc of the two groups were significantly improved after treatment(P<0.01),FCP had no significant difference(P>0.05),FINS of the two groups was lower than that before treatment(P<0.05),HOMA-IR was lower than that before treatment,HOMA-β was higher than that before treatment(P<0.01);Compared with the control group,FBG,PBG,HbAlc,FINS,FCP,homa-beta and homa-IR of the two groups were not significantly different in the experimental group after treatment(P>0.05).④Bone mineral density:BMD of lumbar spine and hip joints was increased after treatment in both groups,but the difference was small and had no statistical significance(P>0.05);Compared with the control group,the BMD of the lumbar and hip joints was slightly improved,but not statistically significant in the experimental group after treatment(P>0.05).⑤Safety evaluation:During the treatment period,no serious adverse reactions occurred in both groups,and no significant abnormalities were observed in safety indicators.Conclusion:(1)Serum osteocalcin may play a positive role in improving blood glucose and islet function.(2)Stengthing bone Pill can effectively improve clinical symptoms in the treatment of patients with osteoporosis in type 2 diabetes mellitus;it can increase OC and vitamin D content,reduce PTH level,increase bone turnover rate,promote bone formation,reduce bone destruction and maintain calcium and phosphorus metabolism balance in bone metabolism indicators.(3)In the treatment of patients with osteoporosis in type 2 diabetes mellitus,Jiangu Pill has no beneficial or adverse effects on glycometabolism compared with the experimental group.Whether it can affect the level of glycometabolism through the change of OC level has not been concluded. |
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