Population Health Sciences Institute, Newcastle University Faculty of Medical Sciences, Newcastle upon Tyne, UK
Division of Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.
BMJ Open Diabetes Res Care. 2020 Nov;8(2). doi: 10.1136/bmjdrc-2020-001779.
Exercise acutely alters markers of bone resorption and formation. As risk of fracture is increased in patients with type 1 diabetes, understanding if exercise-induced bone turnover is affected within this population is prudent. We assessed bone turnover responses to acute exercise in individuals with long-duration type 1 diabetes and matched controls.
Participants with type 1 diabetes (n=15; age: 38.7±13.3; glycosylated hemoglobin: 60.5±6.7 mmol/mol; diabetes duration: 19.3±11.4 years) and age-matched, fitness-matched, and body mass index-matched controls (n=15) completed 45 min of incline walking (60% peak oxygen uptake). Blood samples were collected at baseline and immediately, 30 min, and 60 min postexercise. Markers of bone resorption (β-C-terminal cross-linked telopeptide of type 1 collagen, β-CTx) and formation (procollagen type-1 amino-terminal propeptide, P1NP), parathyroid hormone (PTH), phosphate, and calcium (albumin-adjusted and ionized) were measured. Data (mean±SD) were analyzed by a mixed-model analysis of variance.
Baseline concentrations of P1NP and β-CTx were comparable between participants with type 1 diabetes and controls. P1NP did not change with exercise (p=0.20) but β-CTx decreased (p<0.001) in both groups, but less so in participants with type 1 diabetes compared with controls (-9.2±3.7%; p=0.02). PTH and phosphate increased immediately postexercise in both groups; only PTH was raised at 30 min postexercise (p<0.001), with no between-group differences (p>0.39). Participants with type 1 diabetes had reduced albumin and ionized calcium at all sample points (p<0.01).
Following exercise, participants with type 1 diabetes displayed similar time-course changes in markers of bone formation and associated metabolites, but an attenuated suppression in bone resorption. The reduced albumin and ionized calcium may have implications for future bone health. Further investigation of the interactions between type 1 diabetes, differing modalities and intensities of exercise, and bone health is warranted.
运动可显著改变骨吸收和形成标志物。1 型糖尿病患者的骨折风险增加，因此了解该人群中运动引起的骨转换是否受到影响是谨慎的。我们评估了骨转换对患有长期 1 型糖尿病的个体和匹配对照者急性运动的反应。
15 名 1 型糖尿病患者（年龄：38.7±13.3；糖化血红蛋白：60.5±6.7mmol/mol；糖尿病病程：19.3±11.4 年）和年龄匹配、体能匹配和体重指数匹配的对照组（n=15）完成了 45 分钟的倾斜步行（60%峰值摄氧量）。在基线和运动后即刻、30 分钟和 60 分钟采集血样。测量骨吸收标志物（Ⅰ型胶原 C 端交联肽-β，β-CTX）和形成标志物（前胶原 I 氨基端前肽，P1NP）、甲状旁腺激素（PTH）、磷酸盐和钙（白蛋白校正和离子化）。数据（平均值±标准差）通过混合模型方差分析进行分析。
1 型糖尿病患者和对照组的基线 P1NP 和 β-CTX 浓度相当。运动后 P1NP 没有变化（p=0.20），但两组的 β-CTX 均降低（p<0.001），1 型糖尿病患者的降低幅度小于对照组（-9.2±3.7%；p=0.02）。PTH 和磷酸盐在两组中均在运动后即刻升高；仅 PTH 在运动后 30 分钟升高（p<0.001），两组间无差异（p>0.39）。1 型糖尿病患者在所有采样点的白蛋白和离子化钙均降低（p<0.01）。
运动后，1 型糖尿病患者的骨形成标志物和相关代谢物的时间进程变化相似，但骨吸收抑制减弱。白蛋白和离子化钙的减少可能对未来的骨骼健康有影响。需要进一步研究 1 型糖尿病、不同运动方式和强度以及骨骼健康之间的相互作用。
