Muscle functions and bone strength are impaired in adolescents with type 1 diabetes

Maratová, Klara; Souček, Ondřej; Matysková, Jana; Hlávka, Zdeněk; Petruželková, Lenka; Obermannová, Barbora; Průhová, Štěpánka; Koloušková, Stanislava; Šumnı́k, Zdenĕk

doi:10.1016/j.bone.2017.10.005

Cited by 61 publications

(63 citation statements)

References 39 publications

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“…Our results also demonstrate reduced BMC or BMD Z-scores and an impairment of the relationship between the fat and muscle tissue. Several previous studies also investigated this association and found similar results [ 16 – 18 , 20 , 21 , 29 , 44 – 46 , 58 , 59 ]. Our observations of reduced relative bone strength of T1DM patients, and more so in the poor metabolic control patients, have led us to speculate that maintaining such status may be associated with increased risk of fractures later in life.…”

Section: Discussionsupporting

confidence: 63%

“…In the pubertal period, fast body weight and height gain takes place [ 31 – 33 ], which in children with T1DM often results in a worsening of metabolic control parameters [ 5 – 7 ]. Indeed, a negative association between disease duration and bone or muscle parameters in adolescents with T1DM has been previously reported [ 19 , 20 , 45 , 46 , 51 , 52 , 65 , 66 ]. However, other studies have reported normal or minimal deterioration of skeletal outcomes [ 17 , 27 , 44 , 47 , 53 , 55 , 56 , 60 , 67 ].…”

Section: Discussionmentioning

confidence: 97%

“…It was hypothesised that improved glycaemic control would prevent the negative effects of T1DM on bone, muscle, and fat tissues in adolescents with T1DM. While poorer glycaemic control and bone complications have already been described in the literature [ 8 – 12 ], the evidence examining the skeletal status and body composition in adolescents with T1DM is limited [ 16 , 17 , 20 , 27 , 34 ].…”

Section: Discussionmentioning

confidence: 99%

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Skeletal Status, Body Composition, and Glycaemic Control in Adolescents with Type 1 Diabetes Mellitus

Wierzbicka

Świercz

Płudowski

et al. 2018

Journal of Diabetes Research

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Background Disturbed bone turnover, osteoporosis, and increased fracture risk are late complications of insulin-dependent diabetes mellitus. Little is known about how far and to what extent can glycaemic control of type 1 diabetes mellitus (T1DM) prevent disturbances of bone health and body composition during the growth and maturation period. Objective The aim of this cross-sectional study was to compare the skeletal status outcomes and body composition between patients stratified by glycaemic control (1-year HbA1c levels) into well- and poorly-controlled subgroups in a population of T1DM adolescents, that is, <8% and ≥8%, respectively. Subjects and Methods Skeletal status and body composition were evaluated in 60 adolescents with T1DM (53.3% female; mean aged: 15.1 ± 1.9 years; disease duration: 5.1 ± 3.9 years) using dual energy X-ray absorptiometry (GE Prodigy). The results were compared to age- and sex-adjusted reference values for healthy controls. The calculated Z-scores of different metabolic control subgroups were compared. Clinical data was also assessed. Results As evidenced by Z-scores, patients with T1DM revealed a significantly lower TBBMD (total body bone mineral density), TBBMC (total body bone mineral content), S24BMD (bone mineral density of lumbar spine L2–L4), and TBBMC/LBM ratio (total body bone mineral content/lean body mass), but higher FM (fat mass) and FM/LBM ratio (fat mass/lean body mass) values compared to an age- and sex-adjusted general population. The subset (43.3% patients) with poor metabolic control (HbA1c ≥ 8%) had lower TBBMD, TBBMC, and LBM compared to respective values noted in the HbA1c < 8% group, after adjusting for confounders (mean Z-scores: −0.74 vs. −0.10, p = 0.037; −0.67 vs. +0.01, p = 0.026; and −0.45 vs. +0.20, p = 0.043, respectively). Additionally, we found a significant difference in the TBBMC/LBM ratio (relative bone strength index) between the metabolic groups (−0.58 vs. −0.07; p = 0.021). A statistically significant negative correlation between 1-year HbA1c levels and Z-scores of TBBMD, TBBMC, and LBM was also observed. In patients with longer disease duration, a significant negative correlation was established only for TBBMD, after adjusting for confounders. The relationships between densitometric values and age at onset of T1DM and sex were not significant and showed no relation to any of the analysed parameters of the disease course. Conclusion Findings from this study of adolescents with T1DM indicate that the lower Z-scores of TBBMD, TBBMC, and LBM as well as the TBBMC/LBM ratio are associated with increased HbA1c levels. Their recognition can be crucial in directing strategies to optimise metabolic control and improve diabetes management for bone development and maintenance in adolescents with T1DM.

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Section: Discussionsupporting

confidence: 63%

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Skeletal Status, Body Composition, and Glycaemic Control in Adolescents with Type 1 Diabetes Mellitus

Wierzbicka

Świercz

Płudowski

et al. 2018

Journal of Diabetes Research

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“…Supporting this theory, a study investigating bone turnover in patients with chronic kidney disease concluded that those with a low turnover of bone had decreased trabecular thickness . In children and adolescents with T1D only, a few studies have examined trabecular bone; however, most of these have reported on reduced trabecular BMD (along with other structural changes) Unfortunately, none of the studies on bone architecture in children and adolescents with T1D investigated BTM.…”

Section: Discussionmentioning

confidence: 99%

Decreased markers of bone turnover in children and adolescents with type 1 diabetes

et al. 2020

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Background and aim: Adults with type 1 diabetes (T1D) have increased risk of bone fractures and decreased bone mineral density (BMD). Alterations in bone turnover have been suggested as the link between T1D and the impaired bone health. Furthermore, bone turnover has been suggested to have beneficial effects on glucose metabolism. This study aimed at describing bone turnover markers (BTM), and the relationship with glycemic control, in children and adolescents with T1D.Methods: A total of 173 (47% girls) children and adolescents aged 7.7 to 17.5 years with T1D for more than 1 year were included. Participants were evaluated by BMD together with measurements of selected BTM; two formation markers: osteocalcin (OCN) and procollagen type-1 amino-terminal propeptide (P1NP) and one resorption marker, C-terminal cross-linked telopeptide of type-1 collagen (CTX). BTM were converted into Z-scores utilizing new national references.Results: Mean OCN Z-score (−0.68 ± 1.31), P1NP Z-score (−0.33 ± 1.03) and CTX Z-score (−0.43 ± 1.10) were all significantly lower than the reference population (P < .001). No associations were seen between BTM and T1D duration. BMD Z-score was comparable to the reference population and associated with none of individual BTMs. CTX Z-score was negatively associated with HbA1c (P = .007) independent of both exogenous and residual endogenous insulin.Conclusions: Markers of bone formation and resorption were decreased in children and adolescents with T1D. CTX Z-score associated negatively with HbA1c adjusted for insulin treatment and endogenous insulin production indicating a potential

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“…The same method of muscle force assessment was used by Maratova et al They revealed alterations in muscle function in adolescents with T1DM, especially those with disease duration longer than nine years. They also suggested that those alterations may contribute to the development of osteoporosis reported in adults with DM [42].…”

Section: Discussionmentioning

confidence: 97%

Alterations in postural control, gait pattern, and muscle function in diabetes mellitus: does it matter in children and adolescents with type 1 diabetes?

Ławnicki

Hansdorfer-Korzon

Myśliwiec

2019

pedm

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Muscle functions and bone strength are impaired in adolescents with type 1 diabetes

Cited by 61 publications

References 39 publications

Skeletal Status, Body Composition, and Glycaemic Control in Adolescents with Type 1 Diabetes Mellitus

Skeletal Status, Body Composition, and Glycaemic Control in Adolescents with Type 1 Diabetes Mellitus

Decreased markers of bone turnover in children and adolescents with type 1 diabetes

Alterations in postural control, gait pattern, and muscle function in diabetes mellitus: does it matter in children and adolescents with type 1 diabetes?

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