Bone, muscle strength decreased among children with type 1 diabetes
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Youths with type 1 diabetes have weaker bone and lower muscle strength than their healthy peers, according to a presenter at the American Society for Bone and Mineral Research virtual meeting.
“Type 1 diabetes patients have a significantly higher fracture risk than that of general population, beginning from childhood and continuing with the lifelong implications into adulthood,” Jin Long, PhD, an epidemiologist senior biostatistician and data scientist in the department of pediatrics at Stanford University School of Medicine, told Healio. “Our study contributes to the better understanding of the musculoskeletal fragility of type 1 diabetes patients. High-resolution peripheral quantitative computed tomography provides an accurate way to assess bone microarchitectures and bone strength, which made it possible for us to detect the bone deficits and explore their etiology.”
Long and colleagues recruited 50 children aged 10 to 18 years who had type 1 diabetes for at least 3 years. All participants were from Stanford Children’s Health or local type 1 diabetes support groups. There were also 182 healthy youths aged 10 to 18 years recruited from the community who served as controls. Researchers used high-resolution peripheral quantitative CT scans of the tibia and radius to assess bone failure load, whole-body DXA scans to measure regional lean muscle mass, and dynamometry to measure leg and arm strength. Boys with type 1 diabetes (n = 28) were compared with healthy male controls (n = 95), and girls with type 1 diabetes (n = 22) were also compared with healthy females (n = 87).
At the tibia, boys with type 1 diabetes had worse distal tibia failure loads (z score = –0.57; P = .01) and proximal tibia failure loads (z score = –0.71; P < .01) than those without diabetes, independent of insulin-like growth factor I or muscle mass levels. Boys with type 1 diabetes also had lower leg muscle (z score = –0.67; P < .01) and arm muscle strength (z score = –0.49; P = .03) than the control cohort.
In the unadjusted data, there was no significant association with tibia or radius failure loads between girls with and without type 1 diabetes. However, girls with type 1 diabetes had a higher BMI z score (0.76) than the control group (0.31). After adjusting for BMI, girls with type 1 diabetes had a greater proximal tibia failure load than those without diabetes (z score = –0.45; P = .03).
Researchers adjusted data for IGF-I z score and leg lean mass z score, but the findings were negligible for both boys and girls.
“We found that in males with type 1 diabetes, the lower trabecular bone mineral density and cortical area accounted for 47% and 33% of tibia distal bone strength deficits, respectively. But at tibia proximal site, 84% of the bone strength deficit was accounted for by the lower cortical area,” Long said. “These findings in microstructures confirmed that there are deficits in bone formation, not bone adsorption, among type 1 diabetes patients comparing to nondiabetic population. Our study also showed worse muscle quality among type 1 diabetes patients, which was not due to their muscle quantity. This may be related to recent reports of adverse type 1 diabetes effects on muscle mitochondrial oxidative capacity.”
Long added that having a higher BMI might protect muscle and bone development; however, a future study analyzing BMI and fracture risk among youths with type 1 diabetes is needed to explore this possible association.
Researchers also said future studies are needed to explore the effects physical activity and glycemic control have on the physical function and skeletal development in children with type 1 diabetes.
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Long J, et al. Type 1 Diabetes is Associated with Bone and Muscle Deficiencies in Children and Adolescents. Presented at: American Society for Bone and Mineral Research Annual Meeting; Sept. 11-15, 2020 (virtual meeting).
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