新诊断男性2型糖尿病患者血糖波动与骨质疏松症的相关性研究

背景　糖尿病患者罹患骨质疏松症（OP）的风险较高，持续高血糖对骨密度（BMD）的不良影响已有较多报道，但血糖波动与OP的关系鲜有报道。目的　探讨新诊断男性2型糖尿病（T2DM）患者血糖波动与OP的相关性。方法　前瞻性选取2018年1月-2019年1月于宁夏回族自治区人民医院内分泌科就诊的115例新诊断男性T2DM患者，计算其体质指数（BMI）；空腹8 h以上于次日清晨抽取肘静脉血，检测空腹血糖（FPG）、血钙（Ca）、血磷（P）、血脂指标〔总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）〕，测定餐后2 h血糖（2 hPG）、空腹胰岛素（FINS）、空腹C肽（FC-P）、餐后2 h胰岛素（2 hINS）、餐后2 h C肽（2 hC-P），评估胰岛素抵抗指数（HOMA-IR），测定糖化血红蛋白（HbA1c）和腰椎（L1~4）的BMD。通过监测患者的7段血糖（三餐前血糖、三餐后2 h血糖、2：00血糖）评估血糖波动，计算血糖的标准差（SDBG）、餐后血糖波动幅度（PPGE）、最大血糖波动幅度（LAGE）、空腹血糖变异系数（CV-FPG）、平均血糖（MPG）。依据患者是否合并OP分为T2DM合并OP组60例及T2DM组55例。分析两组各指标的差异及血糖波动与BMD的相关性。结果　T2DM 合并OP组HOMA-IR、HbA1c、SDBG、PPGE、LAGE、CV-FPG、MPG高于T2DM组，HDL、FC-P、2 hC-P、BMD低于T2DM组（P<0.05）。Pearson相关分析结果显示，新诊断男性T2DM患者的BMD与年龄、2 hPG、LDL、HOMA-IR、HbA1c、SDBG、PPGE、LAGE呈负相关（r值分别为-0.501、-0.325、-0.436、-0.111、-0.603、-0.506、-0.324、-0.712，P<0.05），与Ca、2 hC-P呈正相关（r值分别为0.029、0.015，P<0.05）；校正年龄、BMI后，BMD与2 hC-P呈正相关（r=0.008，P<0.05），与HbA1c、SDBG、LAGE呈负相关（r值分别为0.519、0.285、0.399，P<0.05）。结论　对于新诊断男性T2DM患者来说BMD与2 hC-P呈正相关，与HbA1c、SDBG、LAGE呈负相关，血糖波动与其BMD密切相关，控制血糖波动对防治OP有积极作用。

Glucose Variability and Osteoporosis in Newly Diagnosed Male Patients with Type 2 Diabetes Mellitus

Background　Diabetic patients have high risk of osteoporosis.There have been many reports on the adverse effects of persistent hyperglycemia on bone mineral density（BMD），but there are few reports on the relationship between glucose variability and osteoporosis.Objective　To explore the relationship between glucose variability and osteoporosis in newly diagnosed male T2DM patients.Methods　115 newly diagnosed male T2DM patients were prospectively selected from Department of Endocrinology，People's Hospital of Ningxia Hui Autonomous Region from January 2018 to January 2019.Clinical data were collected，including calculated BMI，fasting plasma glucose，serum calcium，phosphorus，and lipid profile indicators（total cholesterol，triacylglycerol，high-density lipoprotein and low-density lipoprotein） in the sample collected from the median cubital vein in the early morning after fasting for more than 8 hours，and 2-hour postprandial glucose，fasting insulin，fasting C-peptide（FC-P），2-hour postprandial insulin，2-hour postprandial C-peptide（2 hC-P），homeostasis model assessment-insulin resistance（HOMA-IR），and glycosylated hemoglobin（HbA1c），L1-L4 BMD，glucose variability evaluated based on plasma glucose measured at 7 time points（before and after three meals，and at 2：00），and calculated standard deviation of blood glucose（SDBG），postprandial glucose excursion（PPGE），largest amplitude of glycemic excursion（LAGE），coefficient of variation for fasting plasma glucose（CV-FPG），and mean plasma glucose.The above-mentioned indicators were compared between those who were detected with osteoporosis（n=60） and those without（n=55）.Correlation of glucose variability with BMD was analyzed by Pearson correlation analysis.Results　T2DM patients with osteoporosis were found with higher mean HOMA-IR，HbA1c，SDBG，PPGE，LAGE，CV-FPG and mean plasma glucose，and lower mean high-density lipoprotein，FC-P，2 hC-P and BMD compared to those without（P<0.05）.BMD was negatively correlated with age，SDBG，PPGE，LAGE，2 hPG，low-density lipoprotein，HOMA-IR and HbA1c（r=-0.501，-0.325，-0.436，-0.111，-0.603，-0.506，-0.324，-0.712，P<0.05），and positively correlated with serum calcium and 2 hC-P （r=0.029，0.015，P<0.05）.After adjusting for age and BMI，BMD was positively correlated with 2 hC-P（r=0.008，P<0.05） and negatively correlated with HbA1c，SDBG and LAGE（r=0.519，0.285，0.399，P<0.05）.Conclusion　BMD was positively correlated with 2 hC-P and negatively correlated with HbA1c，SDBG and LAGE，indicating that glucose variability may be closely related to BMD in newly diagnosed male patients with T2DM，and controlling glucose variability may have a positive effect on the prevention and treatment of osteoporosis.