Relationship Between Microvascular Disease And Bone Density In Type 2 Diabetes Mellitus And Its Influencing Factors

Objectives To observe the correlation between type 2 diabetes mellitus?T2DM?microvascular disease and bone mineral density?BMD?.Methods According to WHO criteria for diagnosis and classification of diabetes in 1999,Patients admitted to the endocrinology department of the affiliated hospital of north China university of science and technology from August 2017 to August 2018 with no microvascular disease,simple retinopathy,nephropathy or retinopathy and nephropathy were selected as the research objects,a total of 198 cases.Among them,T2DM was only complicated with DR or DN60 cases?group A?,T2DM was simultaneously complicated with DR and DN50 cases?group B?,and T2DM was not complicated with microvascular lesions in 88 cases?group C?.In each group,the femoral neck,lumbar spine bone density level,bone metabolism related indicators and 16-layer lumbar spine CT values of some patients were measured,The above indicators of each group were compared.Age,course of disease,BMI,hypertension and coronary heart disease were compared among the three groups.Smoking and drinking,HbA1c,blood Ca,blood P,ALP,FGP,FCPE,TC,TG,HDL-L,LDL-L,LP?a?,apo?A?,apo?B?.All data were statistically analyzed using SPSS21.0 statistical software package.The main statistical indicators were tested for normality.The measurement data were expressed as mean standard deviation.The chi-square test was used to compare the mean values of the three groups.The chi-square test was used for counting data,and one-way anova was used for measurement data.Independent risk factors related to microvascular disease were analyzed by unconditioned binary Logistic regression.P<0.05 was considered statistically significant.Results 1.The chi-square test was used to test the counting data of the subjects in the three groups,and the results indicated that there was a statistically significant difference in the number of smokers among the subjects in the three groups.The more types of combined microvascular lesions,the higher the smoking rate,suggesting that smoking may have an effect on microvascular lesions in T2DM patients.There was no significant difference in gender composition,hypertension or coronary heart disease,or drinking between the three groups.These factors showed no significant correlation with T2DM microvascular lesions.2.Three groups laboratory indexes is prompt the object of study,age,duration of diabetes HbA1c,FBG,FCPE,TC,TG,LDL-C difference had statistical significance,suggesting age,duration of diabetes,HbA1c,FBG,FCPE,TC,TG,LDL-C level is associated with T2DM microvascular lesion and progress.Further p2p2comparisons revealed statistically significant differences in FBG,FCPE,TC and TG between the T2DM group with DR or DN alone and the T2DM group without DR or DN,suggesting significant abnormalities in FBG,FCPE,TC,and TG at the early stage of microvascular disease in T2DM patients.By comparison,there was no significant difference in BMI,blood Ca,blood P,ALP,HDL-C,Lp?a?,apoA,apoB between the three groups.PTH,25?OH?₂D₃,OC,?-CTXand PINP of the three groups showed statistically significant differences,indicating abnormal bone metabolism in T2DM patients with microvascular disease.Bone metabolism indexes included in this study:PTH,25?OH?₂D₃,OC,?-CTX,PINP can reflect this phenomenon.Further p2p2comparisons revealed statistically significant differences in?-CTX and OC between the T2DM group with DR or DN alone and the T2DM group without DR or DN,suggesting that?-CTX and OC had begun to be significantly abnormal in the early stage of microangiopathy in T2DM patients.3.Among the 198 subjects,48 patients were required to complete the 16-slice CT plain examination of the lumbar spine due to their illness,and the CT values of the lumbar spine were collected and calculated?see appendix B for details of the method?.The mean difference of CT values between the three groups was statistically significant.Further p2p2comparisons suggested that there was a significant difference in the lumbar spine CT value between T2DM patients with DR and DN and those in the control group,indicating that the microvascular lesions were correlated with the lumbar spine CT value,and the lumbar spine CT value could indeed reflect the level of bone density.4.Comparing the density of femoral neck and lumbar vertebrae among the three groups,the results were statistically significant,and the bone mass in the T2DM combined with microvascular disease group was lower,suggesting that the occurrence of microvascular disease in T2DM was correlated with decreased bone mass.By further p2p2comparisons,it was found that there were statistically significant differences in BMD levels between patients with DR and DN and those in the control group,indicating that significant decreases in BMD levels were likely to occur in patients with at least two types of microvascular lesions.Femoral neck BMD?0.711 was considered as non-exposure,while femoral neck BMD<0.711 was considered as exposure.The chi-square test showed that patients with T2DM combined with DR or DN alone had a 5.4 times higher risk of reduction in femoral neck BMD than those without microvascular lesions.The risk of decreased femoral neck BMD level in T2DM patients with DR and DN was 10 times higher than that in T2DM patients without microvascular lesions,suggesting a very close relationship between the two.Lumbar BMD?0.842 was considered as non-exposure,and lumbar BMD<0.842 was considered as exposure.The chi-square test showed that the risk of decreased BMD level in patients with T2DM combined with DR and DN was nearly 15 times higher than that in patients without T2DM combined with microvascular lesions,indicating a very close relationship between the two.However,when patients with T2DM were only combined with DR or DN,there was no significant relationship between the reduction of lumbar BMD level and those without microvascular lesions in T2DM.5.Put the object of study is not merged in the microvascular lesion group is 0,merge the DR alone or DN group down to 1,with DR and DN group down to 2 at the same time,as the dependent variable,with smoking,age,duration of diabetes,HbA1c,FCPE,FBG,TC,TG,LD-C,PTH,1,25?OH?₂D₃,OC,PINP,?-CTX,femoral neck BMD,lumbar BMD as independent variables,multivariate Logistic regression analysis,the index of all mutual correction.The results showed that the level of HbA1c and lumbar BMD was an independent risk factor for the type of microvascular diseases associated with T2DM,and the risk multiples were 12 times and 9 times respectively,indicating that the increase of HbA1c and the decrease of lumbar BMD were closely related to the microvascular diseases of T2DM.ConclusionsThere is a risk correlation between microvascular disease and BMD in type2 diabetes mellitus.HbA1c is an independent risk factor for microvascular disease in type2 diabetes mellitus.Figure 0;Table 8;Reference 74...