Objective To investigate the relationship between four metabolic indices reflecting insulin resistance(IR)and the risk of diabetic kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM).Methods 157 T2DM patients with DKD(DKD group)and 198 T2DM patients(T2DM group)were included in our study.The general data and clinical indicators were collected.Triglyceride/high density lipoprotein cholesterol ratio(TG/HDL-C),triglyceride glucose(TyG)index,triglyceride glucose-body mass index(TyG-BMI)and metabolic score for IR(METS-IR)were calculated.Results Compared with T2DM group,TG/HDL-C,TyG index,TyG-BMI and METS-IR in DKD group were significantly increased(P<0.05).Logistic regression analysis showed that TyG index(OR=8.303,95%CI 1.787～38.573,P=0.007)was an independent risk factor for DKD.The risk of DKD in the fourth quantile of TyG index group was 5.652 times than the first quantile group(P<0.05).ROC curve analysis showed that when the cutoff value of TyG index was 9.03,its sensitivity and specificity for predicting DKD were 56.7%and 71.7%,respectively.Conclusions Among the four simple IR indicators,TyG index is an independent risk factor for the occurrence of DKD in T2DM patients.Increased TyG index indicates increased UACR level and high risk of DKD.

Objective To analyze the efficacy and safety of denosumab(DEN)in the treatment of type 2 diabetes mellius(T2DM)complicated with osteoporosis(OP).Methods The DEN's efficacy on bone metabolism and glucose metabolism in patients with T2DM and OP was retrospectively analyzed through a before-and-after self-controlled design.Forty-one T2DM patients combined with OP who were treated in The First Hospital of Changsha from January 2022 to December 2022 were selected.All patients were observed with subcutaneous injection of DEN 60 mg every 6 months for 12 months.The changes of HbA1c,FPG,bone metabolism indexes,25-hydroxyvitamin D[25(OH)D]and bone mineral density(BMD)of patients before and after DEN treatment were compared.The adverse reactions of DEN were recorded.Results After 12 months of treatment,25(OH)D,the BMD oflumbar vertebra(L1～4),left femoral neck and left hip were higher than before treatment(P<0.05),while the osteocalcin,β-collagen special series,parathyroid hormone and alkaline phosphatase were lower than before treatment(P<0.05),and the adverse reactions were reduced.Conclusions DEN can significantly improve bone metabolism in patients with T2DM and osteoporosis,increase BMD of lumbar spine and whole hip with fewer adverse reactions.

Objective To investigate the relationship between four metabolic indices reflecting insulin resistance(IR)and the risk of diabetic kidney disease(DKD)in patients with type 2 diabetes mellitus(T2DM).Methods 157 T2DM patients with DKD(DKD group)and 198 T2DM patients(T2DM group)were included in our study.The general data and clinical indicators were collected.Triglyceride/high density lipoprotein cholesterol ratio(TG/HDL-C),triglyceride glucose(TyG)index,triglyceride glucose-body mass index(TyG-BMI)and metabolic score for IR(METS-IR)were calculated.Results Compared with T2DM group,TG/HDL-C,TyG index,TyG-BMI and METS-IR in DKD group were significantly increased(P<0.05).Logistic regression analysis showed that TyG index(OR=8.303,95%CI 1.787～38.573,P=0.007)was an independent risk factor for DKD.The risk of DKD in the fourth quantile of TyG index group was 5.652 times than the first quantile group(P<0.05).ROC curve analysis showed that when the cutoff value of TyG index was 9.03,its sensitivity and specificity for predicting DKD were 56.7%and 71.7%,respectively.Conclusions Among the four simple IR indicators,TyG index is an independent risk factor for the occurrence of DKD in T2DM patients.Increased TyG index indicates increased UACR level and high risk of DKD.

Objective To analyze the efficacy and safety of denosumab(DEN)in the treatment of type 2 diabetes mellius(T2DM)complicated with osteoporosis(OP).Methods The DEN's efficacy on bone metabolism and glucose metabolism in patients with T2DM and OP was retrospectively analyzed through a before-and-after self-controlled design.Forty-one T2DM patients combined with OP who were treated in The First Hospital of Changsha from January 2022 to December 2022 were selected.All patients were observed with subcutaneous injection of DEN 60 mg every 6 months for 12 months.The changes of HbA1c,FPG,bone metabolism indexes,25-hydroxyvitamin D[25(OH)D]and bone mineral density(BMD)of patients before and after DEN treatment were compared.The adverse reactions of DEN were recorded.Results After 12 months of treatment,25(OH)D,the BMD oflumbar vertebra(L1～4),left femoral neck and left hip were higher than before treatment(P<0.05),while the osteocalcin,β-collagen special series,parathyroid hormone and alkaline phosphatase were lower than before treatment(P<0.05),and the adverse reactions were reduced.Conclusions DEN can significantly improve bone metabolism in patients with T2DM and osteoporosis,increase BMD of lumbar spine and whole hip with fewer adverse reactions.

Objective To analyze the correlation between sleep disorder and bone mineral density(BMD)and fracture risk in middle-aged and elderly patients with type 2 diabetes mellitus(T2DM).Methods 150 T2DM patients over 50 years old who were hospitalized in the Endocrine Metabolism Department of Changsha First Hospital from September 2022 to April 2023 were selected.According to the Pittsburgh Sleep Quality Index(PSQI),they were divided into a non-sleep disorder group(66 cases)and a sleep disorder group(84 cases).The general data and biochemical indicators of the two groups were compared.The relationship between sleep disorder and BMD,fracture risk was analyzed.Results Compared with the non-sleep disorder group,HbA1c,FPG,female proportion,the proportion of hypnotics and risk scores of vertebral fracture in the sleep disorder group were higher,and BMI,BMD of femoral neck and hip were lower(P<0.05).Pearson correlation analysis showed a negative correlation between PSQI score and BMD of femoral neck and hip(P<0.05).Pearson or Spearman correlation analysis showed that the risk scores of vertebral fracture was positively correlated with age,duration of DM,use of hypnotics and sleep disorder(P<0.05 or P<0.01),and negatively correlated with BMD of femoral neck and hip(P<0.01).Binary logistic regression analysis showed that FPG,use of hypnotics and hip BMD were influencing factors of sleep disorders,while sleep disorders and PSQI scores were influencing factors of osteoporosis.Conclusions For middle-aged and elderly T2DM patients,improving sleep may help reduce the occurrence of osteoporosis and reduce the risk of fractures.

Objective:To investigate the association of body weight and body mass index (BMI) with bone mineral density (BMD) and osteoporotic risk in elderly men with type 2 diabetes mellitus (T2DM).Methods:210 elderly male patients with T2DM admitted to the Department of Endocrinology of the First Hospital of Changsha from June 2017 to May 2018 were selected as the research objects. The height, weight and bone mass index (BMI) were measured. BMDs of the left hip [including femoral neck (FN), greater trochanter (G.T.), intertrochanter (InTro), and total hip (TH)] and lumbar spine (LS) were measured in 210 elderly male patients with T2DM by dual-energy X-ray absorption method. Patients were divided into three groups according to BMI: the overweight group (24.0 kg/m 2≤BMI<28.0 kg/m 2), the obesity (BMI≥28.0 kg/m 2) group, and the normal group (18.5 kg/m 2≤BMI<24.0 kg/m 2). The influence of body weight and BMI on BMD and osteoporotic risk in these elderly men with T2DM was analyzed. Results:The BMDs in various sites of the hip of the overweight group and obesity group were higher compared with those in the normal weight group ( P<0.05). There was a positive correlation between weight and BMI with BMDs in various sites of the hip femoral neck (including FN, G. T., InTro, and TH) ( r=0.239-0.427, P<0.05). All patients were divided into different tertiles (T1-T3) stratified by weight and BMI respectively. The BMDs in various sites of the hip increased with tertiles stratified by weight ( P<0.05). The TH-BMD also increased with tertiles stratified by BMI ( P<0.05). The odd ratios ( OR) were calculated using T3 as the control group and T1 as the case group, using T2 as the control group and T1 as the case group, respectively. The osteoporotic risks of T1/T3, T1/T2 at FN stratified by weight were significantly increased by 4.50 times ( OR=4.50, 95% CI: 1.41-14.35) and 9.27 times ( OR=9.27, 95% CI: 2.03-42.30); The osteoporotic risks of T1/T3, T1/T2 at TH were significantly increased by 3.25 times ( OR=3.25, 95% CI: 1.10-9.59) and 8.50 times ( OR=8.50, 95% CI: 1.85-38.99). The osteoporotic risks of T1/T3, T1/T2 at FN stratified by BMI respectively were significantly increased by 4.13 times ( OR=4.13, 95% CI: 1.28-13.25) and 5.58 times ( OR=5.58, 95% CI: 1.53-20.42); while the osteoporotic risks of T1/T3, T1/T2 at TH stratified by BMI were not significantly increased ( P>0.05). There was no statistically significant difference in BMDs and the osteoporotic risks of the LS among T1, T2, and T3, regardless of stratified by weight or BMI ( P>0.05). Conclusions:For elderly males with T2DM, weight and BMI are important factors affecting BMDs in the hip, and also affecting the osteoporotic risks of the hip, especially that of FN. Osteoporotic risks of the FN decrease with the increase of weight and BMI within a certain range.

BACKGROUND: Transforming growth factor-β1(TGF-β1) is an important cytokine in the regulation of bone remodeling. Whether it can be used as a sensitive marker to bone turnover is incompletely understood. OBJECTIVE: To investigate the relationship of TGF-β1 with bone formation and resorption markers, and bone mineral density (BMD) at the anteroposterior lumbar spine. METHODS: Totally 663 healthy women from Changsha were analyzed, aged 20-80 years. Levels of TGF-β1, serum bone alkaline phosphatase (sBAP) and serum C-terminal cross-linked telopeptides (sCTx) were measured by ELISA, at the same time, the BMD of anteroposterior lumbar spine was measured by dual-energy x-ray absorptiometry. The associations between TGF-β1 and other indexes were analyzed. RESULTS AND CONCLUSION: The TGF-β1 levels reached a peak in the 30-39 and 40-49 years groups, which had a negative correlation with age, but no correlation with body mass index (BMI). After corrected for BMI, TGF-β1 was negatively correlated to sBAP and sCTx, but was positively correlated with BMD of spine after correction of BMI or age. TGF-β1 can act as a sensitive cytokine to reflect the changes of bone turnover.