葡萄糖在目标范围内时间与2型糖尿病患者骨密度的相关性研究

Correlation between Time of Glucose in Target Range and Bone Mineral Density in Patients with Type 2 Diabetes Mellitus

摘要: 目的：探讨2型糖尿病(T2DM)患者葡萄糖在目标范围内时间(TIR)与骨密度(BMD)的关系。方法：纳入2018年1月至2020年12月西安医学院第一附属医院内分泌科住院2型糖尿病患者323例，根据超声骨密度仪测得患者左手桡骨骨密度T值，将其分为骨量正常组192例，骨量降低组100例。骨质疏松(OP)组41例。收集患者基本资料和一般生化指标，所有患者均接受连续3 d的持续葡萄糖监测(CGM)，计算TIR、葡萄糖高于目标范围时间(TAR)、葡萄糖低于目标范围时间(TBR)、标准差(SD)、血糖变异系数(CV)、日间血糖平均绝对差(MODD)、糖化血红蛋白(eHbA1c)等血糖评估指标。比较组间TIR等血糖评估指标与BMD的关系。结果：骨质疏松组组间年龄、舒张压、平均血糖、标准差(SD)、日间血糖平均绝对差(MODD)、TAR、eHbA1c%、高密度脂蛋白、低密度脂蛋白水平高于其余两组，骨质疏松组TIR低于其余两组(P < 0.05)；骨质疏松TIR显著低于正常组，[71 (62, 86)比59 (45.5, 71.75) P = 0.008]；TIR四分位后，随着TIR逐渐升高，骨密度的平均T值呈现逐渐升高的趋势；随着TIR逐渐升高，骨量降低的发生率及骨质疏松的患病率均呈现降低的趋势。在校正了年龄、DBP、平均血糖、糖化白蛋白、标准差(SD)、MODD、血糖高于10的百分比、高密度脂蛋白、低密度脂蛋白后，TIR仍与骨量降低及骨质疏松之间存在良好的相关性(P < 0.05)。结论：2型糖尿病患者TIR水平与BMD具有一定程度的相关性，控制TIR对防治OP有积极作用。

Abstract: Objective: To investigate the relationship between time to target (TIR) of glucose and bone mineral density (BMD) in patients with type 2 diabetes mellitus (T2DM). Methods: A total of 323 patients were enrolled from the department of endocrinology at the First Affiliated Hospital of Xi’an Medical University between January 2018 and December 2020. According to the T value of left radius bone mineral density measured by ultrasonic bone densitometer, 192 patients were divided into normal bone mass group, 100 cases low bone mass group and 41 cases in OP group. Anthropometric and biochemical measurements of patients were performed respectively. Each patient underwent continuous glucose monitoring (CGM) for three consecutive days, then time in range (TIR), time above range (TAR), time below range (TBR), standard deviation (SD), coefficient of variation (CV), means of daily difference (MODD) and eHbA1c were calculated. To compare the relationship between TIR and BMD among the groups. Results: The levels of age, diastolic blood pressure, mean blood glucose, standard deviation (SD), mean absolute difference (MODD), TAR, eHbAc1%, high density lipoprotein and low density lipoprotein in the osteoporosis group were higher than those in the other two groups, and the TIR in the osteoporosis group was lower than that in the other two groups (P < 0.05), the TIR of osteoporosis group was significantly lower than that of normal group [71 (62, 86):59 (45.5, 71.75) P = 0.008]; with TIR quartile, with the gradual increase of TIR, the average T value of BMD showed a gradually increasing trend; with the gradual increase of TIR, the incidence of bone mass reduction and the prevalence of osteoporosis showed a downward trend. After adjusting for age, DBP, mean blood glucose, glycosylated albumin, standard deviation (SD), MODD, percentage of blood glucose higher than 10, high-density lipoprotein and low-density lipoprotein, TIR was still well correlated with osteopenia and osteoporosis (P < 0.05). Conclusions: The level of TIR in patients with T2DM has a certain degree of correlation with BMD, and the control of TIR has a positive effect on the prevention and treatment of OP.