BACKGROUND
We aimed to evaluate longitudinal changes in bone health over 4 years, examine differences based on diabetes duration, and identify predictors of skeletal outcomes in children and adolescents with T1DM.
METHODS
A single-centre, retrospective, longitudinal observational study was conducted at tertiary care centre in Western Maharashtra, India (December 2015-December 2022). Longitudinal data of children and adolescents from Sweetlings cohort on anthropometry, body composition, biochemical parameters, and bone health (DXA, pQCT) were extracted.
RESULTS
A total of 200 participants (mean age:10.6 ± 3.9 years; diabetes duration:3.2 ± 3.2 years) were followed for 4 years. Glycaemic control worsened over time, with increased insulin requirement and HbA1c, along with reduced insulin sensitivity. Decline in TBLH aBMD Z-scores (-1.4 ± 1.1 to -1.7 ± 1.2) was observed. Significant reductions in trabecular vBMD (167.7 ± 35.6 to 150.2 ± 39.8 mg/cm3), trabecular density-for-age Z-scores (-0.9 ± 1.5 to -1.7 ± 1.2), and total density-for-age Z-scores (-0.5 ± 1.5 to -1.0 ± 1.0), along with decline in cortical thickness, despite increase in cortical vBMD were reported. Participants with diabetes duration ≥5 years had lower insulin sensitivity, lean body mass, and bone parameters at baseline and follow-up, and experienced greater declines in trabecular and total volumetric BMD. Sex, pubertal status, glycaemic control, disease duration, and dyslipidemia were significant predictors of skeletal outcomes.
CONCLUSION
Children and adolescents with T1DM demonstrate progressive deterioration in bone health over time, particularly those with longer disease duration and adverse metabolic profiles. The discordance between bone density and geometry suggests that alterations in skeletal structure may not be fully reflected by areal bone density measurements alone. Early identification of high-risk individuals and longitudinal monitoring may help preserve bone health.
Shruti A. Mondkar, Madhura Karuggipkar, Mugdha Deshpande et al.· Bone· 0 citations
Type 1 diabetes mellitus (T1DM) is an insulin dependent diabetes treated with exogenous insulin therapy. A subset of individuals with T1DM develops reduced insulin sensitivity, a phenomenon often referred to as ‘double diabetes’, which is associated with an increased risk of complications. The pathophysiology of double diabetes in T1DM is not well understood. We hypothesize that changes in peripheral blood in T1DM may act as cellular correlates and provide insights into the development of double diabetes. A retrospective study (N = 343) was performed at a tertiary care centre in western India. An estimated insulin sensitivity (eIS) score was calculated using the Coronary Artery Calcification in T1DM (CACTI) equation. A partial correlation, univariate, and multiple regression were performed to study the association of eIS with the components of hemogram (lymphocytes, neutrophils, monocytes, eosinophils, platelets, erythrocytes, and hemoglobin). Additionally, stratified multiple regression analyses were performed to assess the association of eIS with age, sex, and Body Mass Index (BMI). Peripheral blood cell counts were associated with eIS in children and youth with T1DM. Across BMI, age, and sex strata, eosinophils consistently showed modest-to-moderate positive associations with eIS, whereas monocytes, neutrophils, lymphocytes, and platelets showed negative associations that varied by subgroup. In overall cohort, neutrophils and lymphocytes demonstrated statistically significant but minimal negative associations. The development of double diabetes may occur independent of obesity and the cellular patterns observed paralleled those reported in non-obese populations. Larger studies are warranted to confirm these findings and to identify population-specific cellular correlates of declining insulin sensitivity in T1DM. Children and youth with type 1 diabetes exhibit normal-to-low BMI yet low estimated insulin sensitivity. Peripheral blood cell counts associate with estimated insulin sensitivity in children and youth with type 1 diabetes. Eosinophils associate positively, whereas neutrophils, lymphocytes, and platelets associate negatively with insulin sensitivity, with extent of association varying by age, sex, and BMI.
