Xiamen Second Hospital Affiliated Xiamen Medical College, Xiamen, China.
Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, China.
Front Public Health. 2022 Feb 11;9:727132. doi: 10.3389/fpubh.2021.727132. eCollection 2021.
Vitamin 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.
A 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.
Both in men and women, 25(OH)D was negatively correlated with BALP (β = -0. 369, ≤ 0.001)and HOMA-IR (β = -0.349, ≤ 0.001), and positively associated with IGF-1(β = 0.672, ≤ 0.05). There was a negative correlation between HOMA-IR and IGF-1 (β = -0.464, ≤ 0.001), and a positive correlation between HOMA-IR and BALP (β = 0.344, ≤ 0.05), adjusted by confounding factors.
Our 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.
2 型糖尿病（T2DM）患者的维生素 D 状态与血糖和骨代谢密切相关。维生素 D 影响骨密度和骨代谢，导致骨量减少和骨质疏松症。胰岛素抵抗增加了 T2DM 患者骨质疏松症的风险。我们之前的研究表明，胰岛素抵抗与 25-羟维生素 D [25（OH）D]水平呈负相关。本研究的目的是确定 T2DM 患者维生素 D 状态与胰岛素抵抗和骨代谢之间的关系。
对 109 例非骨质疏松 T2DM 患者进行回顾性横断面研究。常规检测空腹血糖（FBG）、25（OH）D、空腹胰岛素（FINS）、糖化血红蛋白（HbA1c）、血清肌酐（SCr）、钙（Ca）、磷（P）、胰岛素样生长因子-1（IGF-1）、骨碱性磷酸酶（BALP）、体重指数（BMI）、肾小球滤过率（eGFR）、稳态模型评估的胰岛素抵抗（HOMA-IR）和钙磷乘积。
无论男性还是女性，25（OH）D 与 BALP（β=-0.369，≤0.001）和 HOMA-IR（β=-0.349，≤0.001）呈负相关，与 IGF-1（β=0.672，≤0.05）呈正相关。HOMA-IR 与 IGF-1 呈负相关（β=-0.464，≤0.001），HOMA-IR 与 BALP 呈正相关（β=0.344，≤0.05），调整混杂因素后。
本研究表明，25（OH）D 浓度与胰岛素抵抗和骨转换呈负相关。随着 25（OH）D 浓度的降低，胰岛素抵抗增加，骨转换增强，增加了非骨质疏松 T2DM 患者发生骨质疏松症的风险。这是在中国首次阐明非骨质疏松 T2DM 患者血清维生素 D 状态、胰岛素抵抗与骨代谢的关系。
