| BackgroundWith the improving of the modern people living conditions,shows obvious upward trend in the prevalence of Diabetes,Diabetes(Diabetes mellitus)is a kind of to elevated blood sugar metabolic disease cause damage to the multiple systems.Osteoporosis(OP)is the most common skeletal disorder.It is a systemic bone disease characterized by low bone mass,loss of bone microstructure,increased bone fragility,and susceptibility to fractures.Type 2 diabetes mellitus(T2DM)can also cause osteoporosis,prone to fracture,has the high fractures and morbidity.CONUT(controlling nutritional status)that control the nutritional status.CONUT score is obtained by scoring the range of serum albumin,total lymphocyte count in peripheral blood and serum cholesterol concentration in liver function test,and then summarizing the above three scores.Currently,CONUT score is mainly used for early evaluation of nutritional status of patients.In recent years,a number of studies have shown that CONUT score is a new prognostic indicator of malignant tumor,which has been proved to be related to the prognosis of patients with gastric cancer,colorectal cancer,lung cancer and liver cancer.However,there are few studies on the relationship between the occurrence of osteoporosis in elderly type 2 diabetes patients with CONUT score.With the continuous improvement of living conditions of modern people,the incidence of diabetes has also shown an obvious upward trend.Some studies have shown that the incidence of fracture in patients with type 2 diabetes has increased significantly.In recent years,the incidence of OP fracture has increased year by year,thus increasing the mortality and disability rate of elderly patients.Therefore,it is of great clinical significance to predict the risk factors of OP fracture in the elderly,treat OP actively and prevent fracture in the early stage.At present,the most intuitive examination index of OP is bone mineral density(BMD).It has been reported that for every standard deviation reduction in femoral neck BMD,the risk of hip fracture increases by 2.A 6-fold decrease in BMD is a risk factor for fracture.Type 2 diabetes patients with osteoporosis situation is not optimistic,it becomes more and more brought to the attention of the clinical research workers,this study is of elderly patients with type 2 diabetes,gender,age,height,body weight,body mass index,blood pressure,glycosylated hemoglobin,serum albumin,serum total cholesterol,serum high-density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),serum triglycerides,fasting blood glucose,blood uric acid,peripheral blood lymphocyte count,hemoglobin and CONUT score affect bone metabolism were studied.The aim is to provide some clinical ideas for the prevention and treatment of osteoporosis in elderly patients with type 2 diabetes.Part 1 The study on the influencing factors of osteoporosis in elderly patients with type 2 diabetesObjectiveBone mineral density(BMD)was detected in elderly patients with type 2 diabetes,and general and hematological data were collected to study the influencing factors of osteoporosis in elderly patients with type 2 diabetes.Methods1.From January 2018 to July 2019,205 elderly patients with type 2 diabetes who met the inclusion criteria in the geriatric ward and outpatient department of qilu hospital of shandong university were included in the study.Inclusion criteria:all the selected patients met the diagnostic criteria for diabetes issued by WHO(1999).205 patients were divided into 52 patients in the normal bone mass group,89 patients in the low bone mass group,and 64 patients in the osteoporosis group with BMD measured by DEXA.Osteoporosis was diagnosed according to the diagnostic criteria recommended by WHO(1994),that is,the BMD of subjects was 2.5 standard deviations lower than the mean value of the peak value of the same sex(T value<-2.5),then osteoporosis was diagnosed.Exclusion criteria:diseases with chronic liver,kidney,cardiovascular and cerebrovascular diseases or diabetic ketoacidosis,neoplastic diseases,taking drugs affecting osteoporosis and bone metabolism,rheumatism and acute infectious diseases(glucocorticoid)etc.2.General data:205 patients were selected to determine the bone mineral density by dual-energy X-ray method,and the 205 patients were divided into two groups:52 patients in the normal group,31 males and 21 females.There were 89 patients in the low bone mass group,including 47 males,42 females and 64 patients in the osteoporosis group.Collect the gender,age(years old),height(cm),weight(kg),body mass index(BMI),shrinkage(mmHg),diastolic blood pressure(mmHg),peripheral blood lymphocyte count(LYM),hemoglobin(HGB),fasting blood glucose(FBG),glycosylated hemoglobin(HbAlc)(propagated),serum albumin,serum total cholesterol(TC),high density cholesterol(HDL-C),serum low density cholesterol(LDL-C),serum triglyceride(TG),blood uric acid(UA),blood urea nitrogen(BUN),serum creatinine(Cr),blood calcium(Ca),blood phosphorus(P),ratio of neutrophil count to lymphocyte count in peripheral blood(NLR),age-adjusted Charlson complication index(aCCI),types of drugs that reduce bone density.3.Statistical methods:SPSS 22.0 statistical software was used,and measurement data consistent with normal distribution were expressed as "mean±standard deviation",and enumeration data as percentage(%).Univariate mean t-test was used to compare the differences between groups of data that were in line with normal distribution,and chi-square test was used to analyze the counting data.Comparisons between multiple groups were analyzed by univariate ANVOA.Non-parametric test was used for the data conforming to the characteristics of skewed distribution.Pearson or Spearman method was used for correlation analysis.Multivariate analysis was performed using Logistic regression.P<0.05 was considered statistically significant.ResultsIn this study,205 elderly patients with type 2 diabetes were divided into 52 cases in the normal group,31 cases in the male group,21 cases in the female group,89 cases in the low bone mass group,including 47 cases in the male group,42 cases in the female group,and 64 cases in the osteoporosis group,including 11 cases in the male group and 53 cases in the female group.Kolmogorov Smirnov has-through single sample inspection for the overall sample size can be seen that present age,diastolic skewness distribution(P<0.05),using the method of level data description statistics,height,weight,BMI,systolic blood pressure,TC,HDL,LDL-C-C,UA,HGB,HbA1C,propagated,TG,LYM,aCCI,BUN,Cr,Ca,P,NLR,PLT present normal distribution characteristics(P>0.05).According to the results of correlation analysis,the height,weight,BMI,HDL-C,LYM,NLR,ALB and the occurrence of osteoporosis,Logistic regression analysis results showed that the intensity of the effect on osteoporosis by high exactly respectively:ALB(P<0.05),LYM(P<0.05),NLR(P<0.05),HDL-C(P<0.05),height(P<0.05),weight(P<0.05)and BMI(P<0.05),the corresponding regression coefficient values are:-0.50,0.24,0.21,0.15,-0.14,-0.11,and-0.07 indicate that weight,height,BMI,and ALB are negatively correlated with osteoporosis,while NLR,LYM,and HDL-C are positively correlated with osteoporosis.Conclusion1.Elderly patients with type 2 diabetes should eat a reasonable diet,to maintain a balanced nutrition,and appropriately increase the intake of protein.Maintaining a reasonable weight is a protective factor for osteoporosis in elderly patients with type 2 diabetes;2.NLR,LYM and HDL-C are risk factors for osteoporosis in elderly patients with type 2 diabetes,indicating that inflammation and blood lipid are also influencing factors for osteoporosis.Good control of inflammation and reasonable control of blood lipid can reduce the occurrence of osteoporosis.Part 2 The correlation analysis between osteoporosis and CONUT Score in elderly patients with type 2 diabetesObjectiveCONUT score was used as a tool for early evaluation of nutritional status of patients.Through the study of osteoporosis and CONUT score in elderly patients with type 2 diabetes,the correlation between nutritional status and osteoporosis in elderly patients with type 2 diabetes was discussed.Methods1.205 elderly patients with type 2 diabetes who met the inclusion criteria in geriatric ward and outpatient department of qilu hospital of shandong university from January 2018 to July 2019 were included as subjects.Inclusion criteria:all the selected patients met the diagnostic criteria for diabetes issued by WHO(1999).According to the diagnostic criteria recommended by WHO(1994),the BMD of the subjects was 2.5 standard deviations lower than the mean value of peak values of the same sex(T value ?-2.5),so osteoporosis was diagnosed.According to the CONUT score,they were divided into normal group and abnormal group.In this study,the sample CONUT score was 0-8,the normal group was 0-1,and the abnormal group was 2-8.Among the 205 elderly patients with type 2 diabetes in this study,104 patients were in the CONUT normal score group(CONUT score:0-1),including 45 males and 59 females.There were 101 patients in the CONUT score abnormal group(CONUT score:2-8),including 44 males and 57 females.CONUT score normal group:height(163.87±7.76)cm,weight(68.28±13.00)kg,BMI(25.34±4.00)kg/m2,systolic blood pressure(140.88±19.82)mmHg,diastolic blood pressure(mmHg):44-66(15,15%),67-89(72,69%),>89(17,16%).Abnormal group height(164.22±7.91)cm,weight(70.09±12.38)kg,BMI(26.15±4.39)kg/m2,systolic blood pressure(136.55±20.99)mmHg,diastolic blood pressure(mmHg):44-66(18,18%),67-89(72,71%),>89(11,11%).Exclusion criteria:diseases with chronic liver,kidney,cardiovascular and cerebrovascular diseases or diabetic ketoacidosis,neoplastic diseases,taking drugs affecting osteoporosis and bone metabolism,rheumatism and acute infectious diseases(glucocorticoid)etc.2.General information:(1)gender,age,height and weight;(2)hematological indicators:total lymphocyte count of peripheral blood,serum albumin and total cholesterol.(3)calculation of CONUT score:the CONUT score was obtained by the comprehensive score of serum albumin,peripheral total lymphocyte count and serum total cholesterol.3.Statistical methods SPSS 22.0 statistical software was used.Measurement data characterized by normal distribution are expressed as mean±standard deviation,and enumeration data are expressed as percentage(%).Univariate mean t-test was used to compare the differences between groups of data that were consistent with the characteristics of normal distribution,and chi-square test was used to analyze the counting data.Pearson or Spearman method was used to analyze the correlation between gender,age,height,weight and CONUT score and osteoporosis.Logistic regression analysis was used to study the influence of various factors on abnormal bone mass.P<0.05 was considered statistically significant.Results1.There was no statistical difference in height,weight,BMI,systolic blood pressure and diastolic blood pressure between the two groups.2.In elderly patients with type 2 diabetes,bone mineral density was negatively correlated with CONUT score.ConclusionNutritional status is the influencing factor of osteoporosis in elderly patients with type 2 diabetes.Elderly patients should increase the intake of dietary albumin,reasonable control of total blood cholesterol,maintain good body function,help to reduce the incidence of type 2 elderly osteoporosis. |
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