Skeletal health in adolescents with poorly controlled type 1 diabetes: results from a randomized controlled trial
Abstract
Introduction: Poorly controlled type 1 diabetes (T1D) has been associated with impaired bone health, but the mechanisms remain unclear. We aimed to investigate whether changes in glycemic control and glucose variability are associated with skeletal health and to evaluate the roles of insulin-like growth factor I (IGF-I) and advanced glycation end-products (AGEs) in bone mineral accrual.
Research design and methods: This longitudinal study included adolescents with poorly controlled T1D (HbA1c >9%/75 mmol/mol), who underwent dual-energy X-ray absorptiometry (DXA) at baseline and after 12 months. Glycemic control was assessed using glycohemoglobin (HbA1c), continuous glucose monitoring (CGM) parameters, and glycemic load. Serum IGF-I and AGEs, specifically methyl-glyoxal-hydro-imidazolone (MG-HI), were measured. Correlation analyses and linear regression models were used to evaluate the associations between glycemic markers, IGF-I, AGEs and bone parameters.
Results: Altogether, 37 adolescents (48.6 % female) with T1D, with mean HbA1c 9.9% (85 mmol/mol), were followed up from mean age of 14.3 for 12 months. DXA-derived bone mineral density (BMD) z-scores at lumbar spine, proximal femur, and total body less head were approximately 0.5 SDS lower than reference values (p=0.005-0.04). The only significant change in BMD z-scores during the 12-month follow-up was an increase in proximal femur in girls. In the whole group, an increase in IGF-1 was associated with BMD accrual, while…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design. Reported size: 37 participants or records.
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