Calcium Metabolism in Diabetes Mellitus: Effect of Improved Blood Glucose Control

Thalassinos, N; Hadjiyanni, P.; Tzanela, Marinella; Alevizaki, C. C.; Philokiprou, D.

doi:10.1111/j.1464-5491.1993.tb00076.x

Cited by 66 publications

(46 citation statements)

References 20 publications

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“…It has been proposed that conditions of poor metabolic control may affect bone turnover by increasing urinary calcium and phosphorus excretion. In fact, a direct relationship between fasting glucose levels and calciuria has been demonstrated [14, 15]. The resulting negative mineral balance could activate compensatory mechanisms which might result in accelerated bone resorption.…”

Section: Discussionmentioning

confidence: 99%

Increased Urinary Excretion of Collagen Crosslinks in Type 1 Diabetic Children in the First 5 Years of Disease

et al. 1999

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To analyze possible early abnormalities in bone resorption in type 1 diabetes mellitus the urinary excretion of the collagen crosslinks pyridinoline and deoxypyridinoline was evaluated by immunoassay in 26 prepubertal diabetic patients (mean age 7.8 ± 1.6 years, mean duration 3.0 ± 1.1 years) and 46 healthy children (age 8.3 ± 1.3 years). Relationships with growth parameters (height-standard deviation score, body mass index and height velocity during the year preceding the study) and metabolic control were sought. Longitudinal and ponderal growth was normal in diabetic children. Urinary collagen crosslink excretion was 88.4 ± 25 nmol/mmol creatinine (median 86, range 44–146) in diabetic patients and 65.6 ± 19 nmol/mmol creatinine (median 61, range 32–108) in controls (p = 0.0002). It was positively influenced by diabetic status (beta = 20.5) and negatively by age (beta = –6.41), controlling by sex and BMI (p = 0.0001). A positive correlation was found between collagen crosslinks and blood glucose (r = 0.48, p = 0.01) or HbA1c levels (r = 0.44, p = 0.02) evaluated at the time of the study, while no significant correlation was found with the mean HbA1c values assessed in the last year or throughout the whole duration of diabetes. Collagen crosslink excretion was significantly increased in patients who presented worsening of their metabolic control in the last 3 months. No relationship was found with the duration of disease or growth parameters. In conclusion, the elevated urinary excretion of collagen crosslinks in diabetic children indicates that bone resorption may be disturbed. Poor metabolic control influences the increased rate of bone resorption and may expose growing diabetic patients to a risk of bone loss.

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Section: Discussionmentioning

confidence: 99%

Increased Urinary Excretion of Collagen Crosslinks in Type 1 Diabetic Children in the First 5 Years of Disease

et al. 1999

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“…Although insulin resistance seems to be the main pathophysiology of the stone formation (5,7,12,16), our finding suggests that glycemic control may contribute to the risk of kidney stones independently of insulin resistance. Past studies have shown that urinary calcium excretion was positively correlated with urinary glucose excretion among diabetic subjects (17,18). It is speculated that glycosuria due to poor glycemic control increases urinary calcium levels and eventually leads to the formation of calcium stones.…”

Section: Ciationmentioning

confidence: 99%

Associations of Insulin Resistance and Glycemic Control with the Risk of Kidney Stones

et al. 2012

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Objective The associations of insulin resistance and glycemic control with the risk of kidney stones were explored. Methods Generally healthy Japanese (n=2,171) who visited Saiseikai Central Hospital (Tokyo, Japan) for a health check were included in a cross-sectional study. We calculated odds ratios (OR) of having kidney stones in terms of four measures: fasting serum insulin, homeostasis model assessment of insulin resistance (HOMA-IR), fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c), adjusting for possible risk factors for kidney stones. Results Fasting serum insulin and HOMA-IR were non-significantly associated with the risk of kidney stones, whereas FPG and HbA1c were significantly associated. Compared with those with an FPG of <100 mg/dL, the ORs in those with an FPG of 100 to <126 mg/dL and !126 mg/dL were 1.38 (95% confidence interval [CI] =0.95-2.00) and 1.83 (95% CI =1.09-3.06) (p for trend =0.016). In relation to those with an HbA1c of <5.5%, the ORs in those with an HbA1c of 5.5 to <6.0%, 6.0% to <6.5% and !6.5% were 1.16 (95% CI =0.76-1.79), 1.25 (95% CI =0.70-2.23) and 1.98 (95% CI =1.11-3.52), respectively (p for trend = 0.027). The significant associations between glycemic control measures and the risk of kidney stones were preserved even after the adjustment for factors related to insulin resistance. Conclusion Glycemic control could be an independent risk factor for kidney stones.

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“…A reduced bone mineral density (BMD) has been variously documented in children and adolescents with type 1 diabetes [2, 3, 4, 5, 6, 7, 8, 9, 10], but there are still conflicting data on whether it may be influenced by duration of the disease or poor metabolic control. Pathogenetic mechanisms leading to diabetic osteopenia have been alternatively ascribed either to a low turnover status, with decreased bone resorption and formation [11, 12, 13], or to a high turnover status, with increased bone resorption, hypercalciuria, and hyperphosphaturia [14, 15, 16]. We recently reported that the rate of bone resorption, evaluated by measuring the urinary excretion of the collagen cross-links pyridinoline and deoxypyridinoline (Dpyd) [17], was increased in poorly controlled children with type 1 diabetes mellitus [18].…”

Section: Introductionmentioning

confidence: 99%

The Lumbar Bone Mineral Density Is Affected by Long-Term Poor Metabolic Control in Adolescents with Type 1 Diabetes mellitus

Valerio

Puente²,

Puente³

et al. 2002

Horm Res Paediatr

113

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Aim: To analyze whether bone mineral density (BMD) and bone resorption status are influenced by long-term metabolic control and duration of disease in adolescents with long-standing type 1 diabetes mellitus. Methods: Twenty-seven adolescents (age 13.1 ± 1.7 years, duration of diabetes 6.9 ± 3.0 years) were studied. The BMD, expressed as z score, was measured at the lumbar spine (L1–L4) using dual-energy X-ray absorptiometry, while the urinary excretion of total deoxypiridinoline (Dpyd), a marker of bone resorption, was measured by immunoassay and was corrected by creatinine (Cr). Linear and multivariate correlations between lumbar BMD z score or Dpyd/Cr excretion and age and disease variables [short-term (Hb A_1clatest) or long-term (Hb A_{1cwholeduration}) metabolic control, duration, ‘diabetes impact index’ (mean Hb A_{1cwholeduration} x duration of disease in months)] were sought. Results: In diabetic subjects the mean BMD z score was –0.44 ± (SD) 1.02 (95% CI: –0.03; –0.84), and the Dpyd/Cr excretion was not increased. A negative correlation was found between lumbar BMD z score and age (r –0.59; p = 0.001), duration (r –0.39; p = 0.04), and the diabetes impact index (r –0.4; p = 0.04). The Dpyd/Cr ratio correlated negatively with age (r –0.40; p = 0.04) and positively with height velocity (r 0.42; p = 0.04). By using multiple linear regression, age showed a significant inverse correlation with lumbar BMD z score (β = –0.39; p = 0.0005). A negative correlation was found between lumbar BMD z score and Hb A_{1cwholeduration} (β = –0.40; p = 0.02) or diabetes impact index (β = –0.001; p = 0.01). Conclusions: Poor metabolic control may expose adolescents with long-standing type 1 diabetes to the risk of developing osteopenia in adult age. Optimization of metabolic control in growing diabetic children may prevent osteoporosis in later life.

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Calcium Metabolism in Diabetes Mellitus: Effect of Improved Blood Glucose Control

Cited by 66 publications

References 20 publications

Increased Urinary Excretion of Collagen Crosslinks in Type 1 Diabetic Children in the First 5 Years of Disease

Increased Urinary Excretion of Collagen Crosslinks in Type 1 Diabetic Children in the First 5 Years of Disease

Associations of Insulin Resistance and Glycemic Control with the Risk of Kidney Stones

The Lumbar Bone Mineral Density Is Affected by Long-Term Poor Metabolic Control in Adolescents with Type 1 Diabetes mellitus

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