Abstract
Background and ObjectivesVitamin D status is closely related to blood glucose and bone metabolism in patients with type 2 diabetes (T2DM). Vitamin D affects bone density and bone metabolism, leading to osteopenia and osteoporosis. Insulin resistance increases the risk of osteoporosis in patients with T2DM. Our previous studies have shown a negative correlation between insulin resistance and 25-hydroxy vitamin D [25(OH)D] levels. The aim of the present study was to determine the association between vitamin D status and insulin resistance and bone metabolism in patients with T2DM.Subjects and MethodsA retrospective cross-section research was carried out among 109 non-osteoporosis patients with T2DM. Their fasting blood glucose (FBG), 25(OH)D, fasting blood insulin (FINS), glycosylated hemoglobin (HbA1c), serum creatinine (SCr), calcium (Ca), phosphorus (P), insulin-like growth factor-1 (IGF-1), bone alkaline phosphatase (BALP), body mass index (BMI), glomerular filtration rate (eGFR), homeostatic model estimates of insulin resistance (HOMA-IR), and calcium-phosphorus product were measured routinely.ResultsBoth in men and women, 25(OH)D was negatively correlated with BALP (β = −0. 369, p ≤ 0.001)and HOMA-IR (β = −0.349, p ≤ 0.001), and positively associated with IGF-1(β = 0.672, p ≤ 0.05). There was a negative correlation between HOMA-IR and IGF-1 (β = −0.464, p ≤ 0.001), and a positive correlation between HOMA-IR and BALP (β = 0.344, p ≤ 0.05), adjusted by confounding factors.ConclusionOur study demonstrates that 25(OH)D concentrations are negatively correlated with insulin resistance and bone turnover. Insulin resistance increases with the decrease of 25(OH)D concentration, which can enhance bone turnover, and increases the risk of osteoporosis in non-osteoporosis patients with T2DM. This is the first study to clarify the relationship between serum vitamin D status, insulin resistance, and bone metabolism in non-osteoporosis patients with T2DM in China.
Highlights
Both osteoporosis and diabetes are metabolism diseases, which increase rapidly in the world, especially in Asia
Based on Levey et al.’s research [9], we identified 109 patients with T2DM without osteoporosis [10], who were treated in the outpatient Department of Endocrinology and Metabolism of Xiamen Second Hospital from January 1, 2014 to March 31, 2014, considering the effect of different seasons to vitamin D status
We found a significant negative interaction between vitamin D status and homeostatic model estimates of insulin resistance (HOMA-IR), independent of eGFR, body mass index (BMI), and age. 25(OH)D concentration showed a negative correlation with bone alkaline phosphatase (BALP) and a positive correlation with insulin-like growth factor1 (IGF-1), indicating the decline of osteoblast, risk of osteoporosis
Summary
Both osteoporosis and diabetes are metabolism diseases, which increase rapidly in the world, especially in Asia. Hip fractures occurring in Asia will be responsible for 50% of that in the world by the year 2050 in forecast reports [2, 3]. Diabetic osteopathy is a complication that leads to the decrease of bone formation and bone density and increases the risk of fracture healing difficulty. Accumulated research studies have shown that vitamin D deficiency was commonly found in patients with type 2 diabetes (T2DM) [4,5,6]. Insulin resistance increases the risk of osteoporosis in patients with T2DM. The aim of the present study was to determine the association between vitamin D status and insulin resistance and bone metabolism in patients with T2DM
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