Title:The Effects of Obesity on Bone Turnover Markers in Diabetic Patients with
Diabetic Ketosis or Ketoacidosis
Volume: 23
Issue: 13
Author(s): Min Gong, Chenglin Xu, Song Wen*, Yue Yuan, Liling Yang, Mingyue Zhou, Yanyan Li and Ligang Zhou*
Affiliation:
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399,
China
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University Pudong Medical Center, Shanghai 201399,
China
- Shanghai Key Laboratory
of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Shanghai, China
Keywords:
Diabetic ketoacidosis, obesity, Bone metabolism, non-thyroidal illness syndrome, BMI, cushing syndrome.
Abstract:
Purpose: Despite the fact that diabetes individuals are often associated with a higher risk of
bone fracture, our previous research demonstrated that Diabetic ketosis (DK) or ketoacidosis (DKA)
induced significant alterations in bone biomarkers. It is unknown whether there is a difference in bone
metabolism between obese and non-obese diabetic populations while they are in DK or DKA; hence
the current study will investigate this further to aid in the prognosis and prediction of bone fracture risk
in patients with different BMIs.
Methods: We categorized patients into four groups based on their BMI utilizing data from our hospital's
medical record system from 2018 to 2020 in the Department of Endocrinology: obese DK or DKA
patients (OB+DK/DKA, n = 41), non-obese DK or DKA patients (DK/DKA, n = 201), obese type 2
diabetes patients without DK or DKA (OB+T2D, n = 93), and patients with type 2 diabetes only (T2D
only, n = 304). The comparisons were made on glycosylated hemoglobin (HbA1c), body mass index
(BMI), fasting plasma C-peptide (FPCP), and plasma lipids, in addition to bone metabolism indicators
such as total 25-OH-VitD3 (25-OH-VitD3), N-terminal middle molecular fragment of osteocalcin
(NMID), -C terminal cross-linking telopeptide of type 1 collagen (-CTX), parathyroid hormone (PTH),
and blood calcium (Ca2+).
Results: The OB+DK/DKA group had a lower average age (p < 0.05) than the DK/DKA group, while
the DK/DKA group had a significantly lower FPCP (p < 0.05). The 25-OH-VitD3 levels of DK/DKA
patients were considerably lower than those of the T2D-only group (p < 0.05). In contrast, NMID and
Ca2+ levels were significantly lower than those of non-ketosis or acidosis patients (p < 0.05), and PTH
levels in the DK/DKA group were significantly lower than those of OB+ T2D patients (p < 0.05). In
contrast, the β-CTX of the DK or DKA group (OB+DK/DKA and DK+DKA) was significantly greater
than that of the non-DK or DKA group (p < 0.05), although there was no significant difference in blood
phosphorus between OB+DK/DKA and DK/ DKA (p > 0.05). The levels of thyroid-stimulating hormone
(TSH) and free T4 (FT4) did not differ significantly among the four groups (p > 0.05); however,
the levels of total T3 (TT3), T4 (TT4), and free T3 (FT3) were significantly lower in the DK/DKA
group (p < 0.05); the ratio of TT3 to TT4 (TT3/TT4) was significantly decreased in the DK/DKA group,
whereas the ratio of FT3/FT4 was significantly lower (p < 0.05).
Conclusion: Obese patients with DK or DKA have a younger onset age, superior pancreatic function,
and better blood glucose management than non-obese patients with DK/DKA. Despite having higher
bone absorption signals than non-DK/DKA patients, OB+DK/DKA patients have stronger bone formation
markers than non-obese DK/DKA patients, according to a recent study. Changes in markers of
bone metabolism may be linked to non-thyroidal illness syndrome in cases of DK or DKA.
