关键词: 糖尿病, 2型, 男性, 血糖, 骨密度, 骨质疏松, 血糖波动, 早期诊断

Abstract: Background　Diabetic patients have high risk of osteoporosis.There have been many reports on the adverse effects of persistent hyperglycemia on bone mineral density（BMD），but there are few reports on the relationship between glucose variability and osteoporosis.Objective　To explore the relationship between glucose variability and osteoporosis in newly diagnosed male T2DM patients.Methods　115 newly diagnosed male T2DM patients were prospectively selected from Department of Endocrinology，People's Hospital of Ningxia Hui Autonomous Region from January 2018 to January 2019.Clinical data were collected，including calculated BMI，fasting plasma glucose，serum calcium，phosphorus，and lipid profile indicators（total cholesterol，triacylglycerol，high-density lipoprotein and low-density lipoprotein） in the sample collected from the median cubital vein in the early morning after fasting for more than 8 hours，and 2-hour postprandial glucose，fasting insulin，fasting C-peptide（FC-P），2-hour postprandial insulin，2-hour postprandial C-peptide（2 hC-P），homeostasis model assessment-insulin resistance（HOMA-IR），and glycosylated hemoglobin（HbA1c），L1-L4 BMD，glucose variability evaluated based on plasma glucose measured at 7 time points（before and after three meals，and at 2：00），and calculated standard deviation of blood glucose（SDBG），postprandial glucose excursion（PPGE），largest amplitude of glycemic excursion（LAGE），coefficient of variation for fasting plasma glucose（CV-FPG），and mean plasma glucose.The above-mentioned indicators were compared between those who were detected with osteoporosis（n=60） and those without（n=55）.Correlation of glucose variability with BMD was analyzed by Pearson correlation analysis.Results　T2DM patients with osteoporosis were found with higher mean HOMA-IR，HbA1c，SDBG，PPGE，LAGE，CV-FPG and mean plasma glucose，and lower mean high-density lipoprotein，FC-P，2 hC-P and BMD compared to those without（P<0.05）.BMD was negatively correlated with age，SDBG，PPGE，LAGE，2 hPG，low-density lipoprotein，HOMA-IR and HbA1c（r=-0.501，-0.325，-0.436，-0.111，-0.603，-0.506，-0.324，-0.712，P<0.05），and positively correlated with serum calcium and 2 hC-P （r=0.029，0.015，P<0.05）.After adjusting for age and BMI，BMD was positively correlated with 2 hC-P（r=0.008，P<0.05） and negatively correlated with HbA1c，SDBG and LAGE（r=0.519，0.285，0.399，P<0.05）.Conclusion　BMD was positively correlated with 2 hC-P and negatively correlated with HbA1c，SDBG and LAGE，indicating that glucose variability may be closely related to BMD in newly diagnosed male patients with T2DM，and controlling glucose variability may have a positive effect on the prevention and treatment of osteoporosis.

Key words: Diabetes mellitus, type 2；Male；Blood glucose；Bone density；Osteoporosis；Glucose variability；Early diagnosis