| Objective:To select type 2 diabetes mellitus(T2DM)patients in middle-aged and elderly as our research objects,detecting the levels of fasting plasma glucose(FPG),fasting insulin(FINS),fasting C peptide(FCP),glycosylated hemoglobin(HbA1c),osteocalcin(OCN),type 1 procollagen N-terminal propeptide(P1NP)and ?-C-terminal telopeptide of type 1 collagen(?-CTX),computing insulin resistance index(HOMA-IR)and beta cell function(HOMA-?).To investigate the effect of bone turnover markers on glucose metabolism in middle and old patients with type 2 diabetes mellitus(T2DM).To analyze the correlation between bone turnover markers(BTMs)and the indexes of glucose metabolism and investigate the impact of bone turnover markers(BTMs)on glucose metabolism in middle-aged and elderly patients with T2 DM.Methods:85 diabetic patients who were confirmed by standardization of DM were collected in our hospital department of endocrinology during August 2016 to August 2017,including 44 males over 50 years and 41 postmenopausal females.The average age of males was 62.7 ±7.6 years,the course of disease was 9.6 ±7.6 years.The average age of females was 65.3 ±7.9 years,the course of disease was 9.5 ±7.9 years.All patients match the diagnostic criteria of WHO of diabetes on1999.The judgment standard of bone mass was according to the diagnosis criteria of WHO osteoporosis on 1994.All cases were measured height,weight,body mass index.The serum level of FPG were measured using glucose oxidase method.The serum level of FINS and FCP were measured using Chemiluminescence method.The serum level of HbA1 c were measured using highpressure liquid chromatography(HPLC).The serum level of OCN,P1 NP and ?-CTX were measured using electrochemiluminescence(ECL).The homeostasis model was used to evaluate the insulin resistance index(HOMA-IR)and islet beta-cell function(HOMA-?),HOMA-IR= FPG×FINS/22.5,HOMA-?(%)=FINS×20/(FPG-3.5).Bone mass of the patients were detected using duel-energy X-ray absorptiometry,select femoral neck and lumbar vertebrae L1-L4 to measure.Group:(1)According to the level of HbA1 c,it was divided into three groups: HbA1c?7.2,HbA1 c 7.2-9.0% and HbA1c?9.0%.(2)According to the amount of bone mass,it was divided into three groups:normal bone mass group,osteopenia group and osteoporosis group.The changes were comepared BTMs and glucose metabolism indexes in different groups.The correlations between BTMs and the above indicators of glucose metabolism were analyzed.Results:1.Comparison between general date:In three groups of different HbA1 c levels,there was no significant difference in age,course of disease or BMI.In three groups of different bone mass,there was no significant difference in age,course of disease or BMI.2.With HbA1 c increasing,OCN,P1 NP and ?-CTX levels gradually decreased in middle-aged and elderly patients with T2 DM.Compared with those of HbA1 c ? 7.2%group,the levels of OCN,P1 NP and ?-CTX were lower in patients with HbA1c?9.0%were lower(P < 0.01,P < 0.05,P < 0.05).Compared with those of HbA1 c 7.2-9.0%group,the level of OCN was significantly lower in HbA1c?9.0 group(P < 0.01).3.In middle-aged and elderly patients with T2 DM,the levels of OCN and P1 NP were negatively related with FPG,HbA1 c and HOMA-IR(r=-0.270,r=-0.334,r=-0.274;r=-0.284,r=-0.241,r=-0.361;P<0.05),respectively.The level of ?-CTX was negatively related with FPG and HbA1c(r=-0.218,r=-0.265;P<0.05),but the level of ?-CTX had not correlation with HOMA-IR(r=-0.187;P>0.05).4.According to the amount of bone mass,it was divided into three groups:normalbone mass group,osteopenia group and osteoporosis group.Compared with normal bone mass patients,FPG and HOMA-IR decreased in osteopenia patients(P<0.05),FPG decreased in osteoporosis patients(P<0.05).However,compared with normal bone mass patients,the levels of P1 NP and ?-CTX increased in osteopenia patients(P<0.05),the levels of OCN and P1 NP increased in osteoporosis patients(P<0.05).Furthermore,our study found that the levels of OCN,P1 NP and ?-CTX were the highest in osteopenia patients,while the levels of FPG and HOMA-IR were the lowest.Conclusion:1.The BTMs is correlated with the levels of blood glucose and insulin resistance index in middle-aged and elderly patients with T2 DM,which affecting the blood glucose regulation,the mechanism need deep exploration.2.Our study found that the levels of OCN,P1 NP and ?-CTX were the highest in osteopenia patients,while the levels of FPG and HOMA-IR were the lowest.It is inferred that the increase of BTMs may be a compensatory regulation mode,which can promote the release of insulin and increase the sensitivity of insulin through increasing the levels of BTMs,thus reducing blood glucose.Further research and validation are needed. |
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