Department of Endocrinology and Metabolism, Molecular Endocrinology Laboratory (KMEB), Odense University Hospital, Odense 5000, Denmark.
Department of Clinical Research, University of Southern Denmark, Odense 5000, Denmark.
J Clin Endocrinol Metab. 2023 Jun 16;108(7):e371-e379. doi: 10.1210/clinem/dgad043.
Bone turnover markers (BTMs) are lower in type 2 diabetes mellitus (T2D). The relationships between bone turnover, β-cell function, and insulin sensitivity in T2D are uncertain.
To investigate if fasting levels of BTMs in persons with T2D are associated with β-cell function or insulin sensitivity.
We defined three T2D phenotypes, the insulinopenic (low β-cell function, high insulin sensitivity), the classical (low β-cell function, low insulin sensitivity), and the hyperinsulinemic (high β-cell function, low insulin sensitivity) phenotypes, in the Danish Centre for Strategic Research T2D cohort using the homeostatic model assessment. We selected age- and gender-matched subgroups to represent the three T2D phenotypes, yielding 326 glucose-lowering treatment-naïve persons with T2D. Median values of BTMs between the three T2D phenotypes were compared. Regression models were applied to assess the association between BTMs, β-cell function, and insulin sensitivity adjusted for potential confounders.
Median serum levels of procollagen type I N-terminal propeptide, C-terminal telopeptide of type I collagen, and osteocalcin were higher in the insulinopenic phenotype (52.3 μg/L, IQR 41.6, 63.3; 259.4 ng/L, IQR 163.4, 347.7; and 18.0 μg/L, IQR 14.4, 25.2, respectively) compared with the classical (41.4, IQR 31.0, 51.4; 150.4 IQR 103.5, 265.1; 13.1, IQR 10.0, 17.6, respectively) and the hyperinsulinemic (43.7, IQR 32.3, 57.3; 163.3, IQR 98.9, 273.1; 15.7 IQR 10.2, 20.8, respectively) phenotypes (all P < .01). These differences persisted after adjustment for age, sex, waist to hip ratio, or fasting plasma glucose (P < .01).
BTMs are lower in newly diagnosed persons with T2D characterized by low insulin sensitivity.
2 型糖尿病（T2D）患者的骨转换标志物（BTM）水平较低。T2D 患者中骨转换、β细胞功能和胰岛素敏感性之间的关系尚不确定。
研究 T2D 患者空腹 BTM 水平与β细胞功能或胰岛素敏感性的相关性。
我们使用稳态模型评估法在丹麦战略研究 T2D 队列中定义了三种 T2D 表型，即胰岛素分泌不足（β细胞功能低、胰岛素敏感性高）、经典（β细胞功能低、胰岛素敏感性低）和高胰岛素血症（β细胞功能高、胰岛素敏感性低）表型，选择年龄和性别匹配的亚组来代表三种 T2D 表型，得到 326 名未经降糖治疗的 T2D 患者。比较三种 T2D 表型之间 BTM 的中位数。应用回归模型评估调整潜在混杂因素后 BTM 与β细胞功能和胰岛素敏感性之间的相关性。
胰岛素分泌不足表型的血清Ⅰ型前胶原 N 端前肽、Ⅰ型胶原 C 端肽和骨钙素中位数分别为 52.3μg/L（IQR 41.6、63.3）、259.4ng/L（IQR 163.4、347.7）和 18.0μg/L（IQR 14.4、25.2），高于经典（41.4、IQR 31.0、51.4）和高胰岛素血症表型（43.7、IQR 32.3、57.3；163.3、IQR 98.9、273.1；15.7、IQR 10.2、20.8）（均 P <.01）。在调整年龄、性别、腰围与臀围比或空腹血糖后，这些差异仍然存在（均 P <.01）。
新诊断的 T2D 患者中，胰岛素敏感性低的患者 BTM 水平较低。
