ESPE Abstracts (2019) 92 P2-50

Bone Mineral Density in Children with Type 1 Diabetes Mellitus (T1DM) and Analysis of Possible Factors Affecting Their Bone Health; A controlled study

Shaymaa Elsayed Abdel Meguid Ahmed, Salma Mohamed Saleh Elsayed, Mohamed Hazem Gouda, Doaa Mokhtar Emara, Ahmed Elawwa, Ashraf Soliman

University of Alexandria, Alexandria, Egypt

Type 1 diabetes mellitus (T1DM) may be associated with reduced bone mineral density (BMD). Possible pathogenic mechanisms include impaired bone anabolic effect due to decreased insulin and insulin-like growth factor 1 (IGF-I). In addition, hyperglycemia can impair osteoblast function.

We measured anthropometric data, glycemic control (HbA1C), insulin dose /kg, calcium, PO4 and alkaline phosphatase and BMD by (DEXA scan at the spine (L2–L4) and at the Femur) in 25 children and adolescents with T1DM on insulin therapy for > 5 years and poor glycemic control (HbA1C > 8.5%) attending the diabetic clinic in Alexandria University Children's Hospital, Egypt and compared them . Their data were compared with 5 children with IDDM with good glycemic control and 30 apparently healthy children of matched age and sex.


Table 1: BMD and biochemical data of T1DM versus controls
CaPO4ALPBMD TotalFemurSpine
IDDM-Bad Control9.444.07268.00−1.46−0.41−1.37
IDDM-Good control9.383.60232.00−0.74−0.14−0.70
Normal Children9.204.29176.00−0.580.12−0.49
ANOVA- P value0.450.070.001*0.02*0.290.03*
Table 2: Clinical, biochemical and BMD T1DM with good control vs bad control.
AgeDuration of T1DMT- StageInsulin/kgHbA1cHtSDSBMI.SDGFRBMD-FemBMD-Spine
Bad control12.427.582.331.0611.15−0.930.27149.54−0.41−1.37
Good control10.98.802.401.067.80−0.800.49137−0.14−0.70
M-W-P0.27 .27134 .1770 .27134 .0002*0.780.270.370.080.05*

BMD was significantly lower in children with T1DM compared to controls and spine BMD was lower in T1DM with high HbA1C vs those in good control. Serum ALP level was higher and phosphate was lower in children with bad control versus other groups. BMD was correlated with HtSDS (r = 0.34, P = 0.056) but not with age of patients, HbA1c, duration of disease, age or insulin dose.

Conclusion: Decreased BMD is common in children with T1DM especially those with bad control. We recommend the assessment of BMD in children with T1DM on long term insulin therapy for the early management of their bone health.

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