RESUMEN
AIM: To evaluate glycaemic control and its influence on albuminuria and bone mineral density (BMD) in children and adolescents with type 1 diabetes (T1D). METHODS: We collectively assessed 84 T1D children/adolescents (T1D group), aged between 6 and 17 years, and then divided them into two groups according to their glycaemic profile (T1D with good glycaemic control (T1DG group) and T1D with poor glycaemic control (T1DP group)). Serum glucose, glycated haemoglobin, serum urea, serum creatinine, urinary albumin-to-creatinine ratio (ACR), estimated glomerular filtration rate and BMD levels were assessed. RESULTS: Of the patients studied, 77% presented with poor glycaemic control. Patients with T1DP showed an increased ACR (P < 0.001) and a low BMD (P = 0.025) when compared to the T1DG group. In addition, five patients in the T1DP group presented with concomitant albuminuria and a low BMD for their chronological age. Significant negative correlations were identified between the ACR and glycated haemoglobin (r = 0.655, P < 0.001), BMD and glycated haemoglobin (r = -0.262, P = 0.047) and BMD and the ACR (r = -0.631, P = <0.001). In linear regression analysis, the ACR showed a negative effect on BMD (P = 0.044) in the T1D patient group. CONCLUSION: Poor glycaemic control was correlated with albuminuria, suggestive of a negative effect on bone tissue, leading to a low BMD in children and adolescents with T1D.
Asunto(s)
Albuminuria/epidemiología , Enfermedades Óseas Metabólicas/epidemiología , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/epidemiología , Hemoglobina Glucada/análisis , Índice Glucémico , Adolescente , Factores de Edad , Albuminuria/diagnóstico , Glucemia/análisis , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Brasil , Niño , Bases de Datos Factuales , Diabetes Mellitus Tipo 1/tratamiento farmacológico , Femenino , Tasa de Filtración Glomerular , Hospitales Pediátricos , Humanos , Incidencia , Modelos Lineales , Masculino , Pronóstico , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores Sexuales , Estadísticas no ParamétricasRESUMEN
AIMS: To investigate early alterations on bone mineral density (BMD) and RANK, RANKL and OPG mRNA expression in peripheral blood leukocytes (PBL) in children and adolescents with type 1 diabetes (T1D) and the relationship with glycemic control and bone biomarkers. METHODS: This cross-sectional study included 75 children and adolescents with T1D and 100 individuals without diabetes (normoglycemic-NG) aged 6-20 years old. T1D individuals were considered to have good (T1DG) or poor (T1DP) glycemic control according to the values of HbA1c. Phosphorus, magnesium, total and ionized calcium, osteocalcin, alkaline phosphatase and tartaric-resistant acid phosphatase (TRAP) values were determined in blood samples. BMD was measured by DEXA. RANK, RANKL and OPG mRNA expression was measured in PBL by real-time PCR. RESULTS: Osteocalcin values were decreased in diabetic groups in comparison to NG group (p<0.05), and a negative correlation with both serum glucose (r=-0.265, p<0.01) and Hb1Ac (r=-0.252, p<0.01) in T1D group was found. BMD was lower in diabetic groups in comparison with NG group (p<0.05) and a negative correlation was observed between BMD and both serum glucose (r=-0.357, p<0.01) and HbA1c (r=-0.351, p<0.01) in T1D group. OPG mRNA expression was significantly increased in T1D and T1DP groups in comparison with NG group (p<0.05). In conclusion, children and adolescents with early onset T1D presented low bone mineral density associated to unsatisfactory glycemic control, increased OPG mRNA expression and low osteocalcin concentration.