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

use of oral thiazoldinediones in correction of hormonal abnormalities among unmarried women with resistant PCO

Polycystic disease of the ovary is complex of symptoms with virious clinical, hormonal and biochemical abnormalities. AL-Elwyia Maternity Teaching Hospital To test the ability of pioglitazone in correcting biochemical and hormonal changes among unmarried women with PCO. Prospective. 23 women with PCO in whom previous treatment with metformin has failed were recruited to participate in the study. All the women were single with chronic unovulation and menstrual abnormalities and hirsutism. They "were put on pioglitazone 30 mg daily for 6 months. FSH, LH, LH/ FSH, fasting insulin level, free testosterone, estradiol, and serum sex binding globulin as well as mid luteal progesterone were assessed prior to treatment and six months later. There was significant reduction in the mean serum fasting insulin level [53.08+12. 75 vs. 22.43+4.29: P< 0.001]. In addition there was significant reduction in the mean serum free testosterone, LH and LH/ FSH ratio [3.21 + 0.36 vs. 1.68+0.43: P<0.001], [15.19+4.43 vs. 10.72+3.08: P<0.001], [2.41+0.23 vs. 1.71+0.12: P<0.001] respectively. In addition mean serum progesterone at mid luteal phase increased significantly [2.44+1.11 vs. 18.61+2.28: P<0.001]. No woman during the treatment course has shown any sign of liver impairment or toxicity. Pioglitazone is an insulin sensitizing drug which may be useful among women with PCO in whom previous treatment with metformin has failed. Yet, caution should be practiced in prescribing the drug until further studies confirm its safety and efficacy