Context:Type 2 diabetes mellitus has profound implications on the skeleton. Even though bone mineral density is increased in type 2 diabetes mellitus patients, they are more prone for fractures. The weakening of bone tissue in type 2 diabetes mellitus can be due to uncontrolled blood sugar levels leading to high levels of bone turnover markers in blood.Aims:The aim of this study is to find the association between glycemic status and bone turnover markers in type 2 diabetes mellitus.Settings and Design:This case–control study was carried out in a tertiary health care hospital.Subjects and Methods:Fifty clinically diagnosed type 2 diabetes mellitus patients in the age group between 30 and 50 years were included as cases. Fifty age- and gender-matched healthy nondiabetics were included as controls. Patients with complications and chronic illness were excluded from the study. Depending on glycated hemoglobin (HbA1c) levels, patients were grouped into uncontrolled (HbA1c >7%, n = 36) and controlled (HbA1c <7%, n = 14) diabetics. Based on duration of diabetes, patients were grouped into newly diagnosed, 1–2 years, 3–5 years, and >5 years. Serum osteocalcin (OC), bone alkaline phosphatase (BAP), acid phosphatase (ACP), and HbA1c levels were estimated. OC/BAP and OC/ACP ratio was calculated.Statistical Analysis Used:Student's t-test, analysis of variance, and Chi-square tests were used for analysis. Receiver operating characteristic (ROC) curve analysis was done for OC/BAP and OC/ACP ratios.Results:Serum OC, HbA1c, and OC/BAP ratio were increased in cases when compared to controls and were statistically significant (P < 0.001). OC/ACP ratio was decreased in type 2 diabetes mellitus and was statistically significant (P = 0.01). In patients with >5-year duration of diabetes, HbA1c level was high and was statistically significant (P < 0.042). BAP levels were high in uncontrolled diabetics but statistically not significant. ROC curve showed OC/BAP ratio better marker than OC/ACP ratio.Conclusions:Uncontrolled type 2 diabetes mellitus affects bone tissue resulting in variations in bone turnover markers. Bone turnover markers are better in predicting recent changes in bone morphology and are cost effective.
Diabetes mellitus is a chronic disease that requires long-term medication to limit the development of its ruinous complications. The complications of diabetes are metabolic imbalance, blood vessel degeneration; effect on electrolyte concentration can offset the proportion of electrolytes. Since there is a direct association of serum electrolytes with diabetes mellitus (DM), the study was planned to investigate the electrolytes disturbance and their association with glycemic status in T2DM patients. This was cross-sectional hospital-based study; 60 participants who were diagnosed to have T2DM between the age group 30 to 60 years were recruited. Fasting glucose, glycated hemoglobin and serum electrolytes such as sodium, potassium, calcium and magnesium were estimated. Descriptive statistics was expressed as mean & SD. Pearson’s correlation analysis was performed to find the association and degree of relationship between serum electrolytes and glycemic status in T2DM. All the biochemical parameters were altered in T2DM patients. There was no significant association between FBS, HbA1c and serum electrolytes. The present study showed an alteration in electrolytes status, but there was no statistically significant association between fasting blood glucose, glycemic control and serum electrolytes consideration of the multifactorial origin of electrolyte imbalance, a cause-specific treatment is required to avoid any risk.
Diabetic retinopathy (DR) is the most common cause for preventable blindness in India. The onset of micro and macrovascular complications in T2DM is multifactorial and difficult to predict. The status of micronutrients, several inflammatory cytokines, elevated triacylglycerols, oxidative stress etc., are being studied extensively. Hypomagnesemia plays a pivotal role in worsening of insulin resistance. Although, Vascular Endothelial Growth Factor-A (VEGF-A) and Endothelin-1 (ET-1) are known to be elevated in DR, yet few reports cite their role, especially in Indian population. In this study, we included thirty subjects with T2DM in each of the three groups namely, T2DM cases without retinopathy, Non Proliferative DR (NPDR) and Proliferative DR (PDR) retinopathy. The glycemic status, circulating plasma VEGF-A, ET-1 levels, serum magnesium and lipids were estimated and compared among the groups. An ROC was drawn to evaluate VEGF-A, ET-1 and serum magnesium levels as the predictive markers for PDR. On comparison VEGF-A, ET-1 and serum magnesium levels showed a significant difference among the three groups. PDR cases had higher circulating levels of VEGF-A, ET-1 and low serum magnesium levels when compared to others. ROC for VEGF-A and ET-1 showed an optimum cutoff of 1521 ng/ml (AUC 0.975) and 16 pg/ml (AUC 0.96) respectively. A negative ROC was drawn to check the lower cutoff limit for serum magnesium; we documented an optimum cut off of 1.7 mg/dl (AUC 0.837). ET-1, VEGF-A and serum Magnesium levels are significantly altered in PDR and can be used as the predictive markers of PDR.
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