CALCIUM-METABOLISM IN DIABETES-MELLITUS - EFFECT OF IMPROVED BLOOD-GLUCOSE CONTROL
CALCIUM-METABOLISM IN DIABETES-MELLITUS - EFFECT OF IMPROVED BLOOD-GLUCOSE CONTROL
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DOI：
10.1111/j.1464-5491.1993.tb00076.x
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发表时间：
1993-05-01
影响因子：
3.5
通讯作者：
PHILOKIPROU, D
中科院分区：
文献类型：
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作者：
THALASSINOS, NC;HADJIYANNI, P;PHILOKIPROU, D
糖尿病患者骨量减少的发生频率增加，这是由于血糖控制不佳，但其发病机制尚不清楚。为了评价钙代谢的作用，对59例肾功能正常的糖尿病患者（1型22例，2型37例）进行了研究。在所有患者血浆钙（Ca），血清磷酸盐（PO 4）4血清甲状旁腺激素（PTH），和24小时尿钙（uCa）测定下，两个穷人和改善控制（至少7天），确定由四个血糖测定每天。血糖控制改善（p=0.001）与1型患者（6.9 +/- 1 vs 4.9 +/- 0.9 mmol/天，平均值+/- SEM，p=0.02）和2型患者（4.2 +/- 0.4 vs 3.2 +/-0.4 mmol/天，平均值+/- SEM，p=0.002）的uCa降低相关。相当多的1型患者（22人中有10人）的PTH值低于检测限（1.5 pmol l-1）在穷人比在改善控制（22人中有2人）。两种类型的糖尿病之间的比较显示，在控制不良的1型糖尿病中，Ca和PTH较低（p = 0.03），而uCa较高（p=0.003），在控制改善后，只有uCa继续较高（p=0.035）。这些结果表明，在血糖控制不良时观察到与“功能性甲状旁腺功能减退”相关的uCa排泄增加（特别是在1型糖尿病中），并且可能是导致糖尿病骨量减少的因素之一。
Reduced bone mass occurring with increased frequency in diabetes mellitus has been attributed to poor blood glucose control but the pathogenetic mechanisms remain unknown. To evaluate the role of calcium metabolism, 59 patients with diabetes and normal renal function (22 Type 1, 37 Type 2) were studied. In all patients plasma calcium (Ca), serum phosphate (PO4)4 serum parathyroid hormone (PTH), and 24-h urinary calcium (uCa) were determined under both poor and improved control (for at least 7 days) as ascertained by four blood glucose determinations daily. Improvement of blood glucose control (p=0.001) was associated with reduction of uCa both in Type 1 (6.9 +/- 1 vs 4.9 +/- 0.9 mmol day-1, mean +/- SEM, p=0.02) and in Type 2 patients (4.2 +/- 0.4 vs 3.2 +/- 0.4 mmol day-1, mean +/- SEM, p=0.002). Considerably more Type 1 patients (10 out of 22) had PTH values below the detection limit (1.5 pmol l-1) during poor than during improved control (2 out of 22). Comparison between the two types of diabetes showed that in Type 1 under poor control, Ca and PTH were lower (p=0.03), while uCa was higher (p=0.003), and after improved control, only uCa continued to be higher (p=0.035). These findings suggest that increased uCa excretion in association witih 'functional hypoparathyroidism' (especially in Type 1 diabetes) is observed during poor blood glucose control, and may be one of the factors leading to reduced bone mass in diabetes mellitus.