Altered bone metabolic markers in type 2 diabetes mellitus: impact of glycemic control

To study the influence of glycemic control on bone minerals and biochemical markers of bone metabolism in patients with type 2 diabetes mellitus. A Case-control study was conducted at Uhod Hospital, KSA from October 2003 to August 2004 to study 60 premenopausal, multipareous female patients with type 2 diabetes mellitus for >5 years, under oral anti-diabetics, with no diabetic complications. They were divided according to their glycemic control into: controlled group [n=22] and poorly controlled group [n=38] and were compared to 30 age matched healthy women. Osteocalcin [OC], urinary deoxypyridinoline [Dpd], Parathyroid hormone [PTH] were measured by chemiluminescent enzyme immunometric assay and 25 hydroxy vitamin D [25 OH-D] was measured by high performance liquid chromatography. In both diabetic groups, there were higher ALP [177 +/- 39.88 and 287 +/- 41.4 mg/dl] and PTH [49 +/- 9.87 and 56.25 +/- 12.3 Pg/ml] than in controls [144 +/- 22.54 mg/dl, 26.9 +/- 5.60 Pg/ml respectively], but lower serum calcium [8.87 +/- 0.3 and 8.79 +/- 0.7 mg/dl], and 25 OH-D [50.9 +/- 12.6, 45.4 +/- 18.9 micro g/l] and osteocalcin [4.09 +/- 1.48 and 1.89 +/- 0.24 ng/ml] than controls [9.96 +/- 1.9l, 57.9 +/- 13.6 micro g/l, 6.5 +/- 1.5 ng/ml respectively], Urinary calcium and urinary Dpd were higher [270.66 +/- 41.7 and 300.56 +/- 55.67 mg/d and 10.8 +/- 4.6, 12.06 +/- 5.12 nM/mM creatinine] than in controls [244.23 +/- 51.5 mg/d, 6.2 +/- 0.8 nM/mM creatinine]. Glycemic indices [FBG, HbA1C] showed significant positive correlation with ALP [r=0.290 and 0.294], urinary calcium [r=0.340 and 0.260] and Dpd [r=0.468 and 0.228]. Our data give evidence of altered bone metabolic markers in both controlled and uncontrolled female patients with type 2 diabetes mellitus with more significant alterations in the uncontrolled group. This could reflect the strong impact of glycemic control on diabetic bone turnover

study of vitamin D insufficiency in postmenopausal type 2 diabetic women

Type 2 diabetic elderly women are at increased risk for osteoporotic fractures. Low levels of vitamin D increases this risk. We aimed to measure levels of 25 hydroxy vitamin D [25 OH-D] in these patients to help assess the level of risk. In this cross sectional case-control study, the serum concentrations of 25 OH-D were measured by high performance liquid chromatography [HPLC] in 60 ambulatory, postmenopausal, type 2 diabetic female patients under oral anti-diabetic treatment. Thirty control females were comparable for weight, age and years since menopause. Calcium and Vitamin D intake [obtained by 24 hour dietary recall], sun exposure, parathyroid hormone [PTH], serum calcium, phosphorus and alkaline phosphatase were also assessed. The prevalence of 25 OH-D insufficiency was significantly higher in diabetic patients than in control subjects [38.3% vs. 20%, p<0.01]. About 13% of diabetics with vitamin D insufficiency had high PTH levels. While most of the control group with 25 OH-D insufficiency had elevated PTH levels. Out of 66 diabetic women, only 11.7% had adequate vitamin D intake and 30% had adequate calcium intake. Similarly, in non-diabetic women, only 13.3% had adequate vitamin D intake and 26.7% had adequate calcium intake. However, a highly significantly percentage of diabetic women [43.4%] with inadequate vitamin D intake develop vitamin D insufficiency compared with non-diabetic women [23.1%] [p<0.001]. Diabetic patients with 25 OH-D insufficiency tend to be older, with higher BMI, and HBA[IC] [P<0.01, <0.01, <0.001 respectively]. We documented increased risk of vitamin D insufficiency in type 2 diabetic postmenopausal women in the face of inadequate dietary vitamin D and low sun exposure. This finding might partially explain the increased risk for osteoporosis among this group and warrants consideration of dietary vitamin D supplementation

Effects of smoking on the cutaneous microcirculation

Fifteen adult male smokers and fifteen age and sex matched nonsmokers [as controls] were included in this work. An assessment of cutaneous perfusion and skin blood flow in the fingers was done using laser Doppler flowmetry by thermal stimulation. Duplex study of the carotid arteries and assessment of the intima/media thickness were also done. The comparative study showed a significant higher minimum, lower maximum, mean and percentage of change flux in smokers compared with the nonsmokers. This denoted the alteration of the microcirculatory vasomotion in smokers. Smoking exerted a deleterious effect on the cutaneous microcirculation expressed as chronic vasoconstriction and reduced peripheral blood flow compared with nonsmokers, as indicated by the use of the new sensitive laser Doppler flowmetry with the aid of thermal stimulation technique