A Preliminary Study On The Correlation Between Insulin Resistance & TCM Syndromes And Bone Mass In T2DM Male Patients

Objective: The objective of this study was to survey the correlation between insulin resistance & TCM syndromes and bone mass(bone mineral content,area bone mineral density and Corrected bone mineral content)in T2 DM male patients,and to try to provide a new reference Direction for the etiology of diabetes mellitus combined with osteoporosis,and to provide an objective basis for clinical practice.Method: Following the method of cross-sectional study,this study selected 260 cases of male inpatients with T2 DM,who match the inclusion and do not meet exclusion standard,from the endocrinology department of Teaching hospital of Chengdu university of traditional Chinese medicine in the time from March 2016 to September 2016,and through history-taking collected relevant clinical datas and Four Diagnostic Methods datas.Divided these cases into group by HOMA-IR,Corrected the left femoral neck bone mineral content by weight(cfn BMC)and TCMs successively and then explored the correlation between insulin resistance & TCM syndromes and bone mass.SPSS21.0 software was used to analyze the data.Results:1.Group analysis carried out by HOMA-IR quartile grouping:1.1 There were significant statistical differences in body weight,BMI,SBP,FINS,1hINS,2h INS,3hINS,0hCP,2hCP and AUCins,and increased with the HOMA-IR;1.2 FPG,2hPBG,3hPBG,AUCglu and HbA1 c were statistically different,but there were no obvious regularity between groups;1.3 TG increased gradually with the HOMA-IR(P<0.01),while HDL-c decreased with the HOMA-IR(P<0.01);but serum calcium,phosphorus,alkaline phosphatase,albumin,correction of calcium,Cr,eGFR,CYS-C,TC and LDL-c had no significant difference(P>0.05).The serum total testosterone level decreased with the HOMA-IR in the 166 patients,whose total testosterone were measured;1.4 There was no significant correlation between HOMA-IR and BMC in FN and L1-L4(P>0.05);1.5 There was an obvious correlation between HOMA-IR and the aBMD of FN in group ?50y(r=0.226,P=0.021);but no obvious correlation in others(P>0.05);1.6 There were negative correlations between HOMA-IR and c BMC of L2 in group >50y(r=-0.189),and cBMC of L3 and L4 in all the two age groups(r=-0.251,-0.228,-0.202,-0.165)(P<0.05);2.Group analysis carried out by cfn BMC quartile grouping:2.1 Height,body weight and BMI decreased successively with the increase of cfnBMC(P<0.01);2.2 The BMC and aBMD of FN increased with the increase of cfnBMC(P<0.01);2.3 SBP,FINS,1h INS,2h INS,3h INS,0hCP,2hCP and AUCins showed a decreasing trend with the increase of cfnBMC;2.4 cfnBMC was negatively correlated with the following 12 factors,including height,body weight,BMI,course,SBP,FINS,1h INS,2h INS,3h INS,2hCP,AUCins,and TZDs medication history(P<0.05),but it was positively correlated with BMC and aBMD of FN(r=0.873,0.605;P<0.01);3.Group analysis carried out by TCMs grouping:3.1 In group >50y,aBMD in the normal range accounted for 71.8%,osteopenia accounted for 26.3%,osteoporosis accounted for 1.9%;In group ?50y,97.1% was in the age of normal bone density range,2.9% belonged to "the low bone density with age";3.2 TCMs: 36 cases of Yin deficiency and excessive heat syndrome;44 cases of dampness,heat and spleen deficiency syndrome;97 cases of Qi-Yin deficiency syndrome;40 cases of syndrome of Yin-yang deficiency and blood stasis and water retention;and 43 cases of blood stasis syndrome;3.3 The patients of syndrome of Yin-yang deficiency and blood stasis and water retention are older and have long course,whlie the Yin deficiency and excessive heat syndrome is opposite;The body weight and BMI of dampness,heat and spleen deficiency syndrome were the largest;and in group >50y,syndrome of Yin-yang deficiency and blood stasis and water retention had the highest proportion of osteoporosis;3.4 FN can reflect a certain degree of difference between the syndromes in the matter of BMC,aBMD and c BMC;3.5 Only the cBMC of FN were statistically different in the five types of TCMs,which was sorted by descending order: Yin deficiency and excessive heat syndrome > Qi-Yin deficiency syndrome > dampness,heat and spleen deficiency syndrome = blood stasis syndrome >syndrome of Yin-yang deficiency and blood stasis and water retention.And there was statistical difference between the syndrome of Yin-yang deficiency and blood stasis and water retention and Yin deficiency and excessive heat syndrome,and Qi-Yin deficiency syndrome;3.6 The difference between c BMC and aBMD,BMC was the biggest in dampness,heat and spleen deficiency syndrome.Conclusion:1.HOMA-IR has no significant correlation between BMC of femoral neck,BMC and aBMD of lumbar bone,but has significant positive correlation with the aBMD of femoral neck;It has significant negative correlation with lumbar bone strength(c BMC),but no significant correlation with femoral neck bone strength;2.The serum insulin content may play a more significant role in the level of IR and change of bone mass;the bone strength of the FN was significantly negatively correlated with the serum insulin levels of fasting,1h,2h,3h and 2hCP;3.It was not enough to evaluate fracture risk only by the BMD,particularly for patients with T2 DM,cBMC could be a better indicator;4.The application of predicting the bone mass of T2 DM male patients by TCMs was more valuable for FN,while the clinical value in the lumbar spine needs further evaluated.