Показники кісткового ремоделювання у хворих на цукровий діабет 2-го типу з різним конституційно-метаболічним фенотипом

Abstract

SummaryIntroduction. According to the latest data, osteocalcin – hormonally active productof bone tissue – plays an active role in the humoral control of homeostatic processes. Inparticular, osteocalcin was shown to regulate sensitivity of peripheral tissues to insulin,carbohydrate metabolism, transport and deposition of lipids.An inverse correlations were found between the level of osteocalcin and the degreeof insulin resistance, levels of glucose, insulin and adipokines, manifestation of themetabolic syndrome, visceral obesity, type 2 diabetes, cardiovascular risk. Osteocalcinmay be a significant factor of regulation of energy processes and formation of certainconstitutional and metabolic phenotypic characteristics of the organism, in particular interms of regional distribution and metabolic activity of adipose tissue.Purpose of the study was to study the relationship between the level of osteocalcinand constitutionally-metabolic phenotypic traits.Materials and methods. 44 patients with type 2 diabetes over 50 years old wereallocated into 3 groups by the serum osteocalcin level. Anthropometric measurements(height, weight, waist circumference), determining of insulin resistance degree (HOMAIR), lipid spectrum were carried out. Visceral adiposity index (VAI) was calculated byempirical formulas for men and women, which includes body mass index, waistcircumference, blood level of triglycerides, and high density lipoprotein. The controlgroup included 23 people of the same age without diabetes.Results. In the groups 1–3 of men osteocalcin levels were: <2.0 ng/ml;(2.75±0.21) ng/ml; (5.3±0.39) ng/ml, respectively. In the groups 1–3 of women:<2.0 ng/ml; (2.91±0,15) ng/ml; (6.01±0,56) ng/ml. In all groups of diabetic patientsmean osteocalcin levels were significantly lower than in control subjects withoutdiabetes (in men (10.78±1.08) ng/ml; in women (8.12±1.03) ng/ml; p<0.05).Reducing of osteocalcin level in subjects with type 2 diabetes was associated with asignificant increase in the degree of insulin resistance. Especially high values ofHOMA-IR were observed in patients of group 1 with low osteocalcin levels (HOMA-IRin men (7.25±1.04); in women (8.25±1.45)), comparing with high osteocalcin group 3(in men (4.23±0.87); in women (2.78±0.34); p<0.05).It was found that the decrease of osteocalcin in groups of men with type 2 diabetes wasaccompanied by a significant increase in VAI (in men groups 1–3: (4.21±1.09); (3.05±0.38);(1.43±0.27); p<0.05; in women groups 1–3: (4.86±1.17); (3.15±0.58); (2.75±0.53)).Increase of VAI characterizes the worsening of morphological and functional characteristicsof adipose tissue. In women, such changes were not significant.Our results show the relationship between slowing of osteosynthesis andconstitutional manifestations and metabolic disorders, which in turn are associated withphenotypic changes in patients with type 2 diabetes.Conclusions. Reduction of serum osteocalcin in patients with type 2 diabetesoccurred in parallel with the strengthening of insulin resistance, visceral obesity, anddyslipidemia. The visceral obesity index, which includes both humoral andanthropometric parameters, was more precise and standardized parameter for revealingof constitutional and metabolic phenotypic changes as compared with the waistcircumference.