Test characteristics of the ankle-brachial index and ankle-brachial difference for medial arterial calcification on X-ray in type 1 diabetes

Abstract Context: Type 1 and type 2 diabetes mellitus are associated with an increased risk of fracture. Objective: The objective of the study was to compare the bone structure and density between type 1 and type 2 diabetes patients and to investigate fracture associations. Design: This was a cross-sectional study. Setting and Patients: Physician-diagnosed type 1 and type 2 diabetes patients were included from the outpatient clinics at two university hospitals participated in the study. Main Outcome Measures: Bone density and structure were assessed by dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. Blood samples were collected for bone turnover markers. Prevalent vertebral fractures were assessed by vertebral fracture assessment and x-ray, and incident fractures were collected from The Danish National Hospital Discharge Register. Results: Bone mineral density (BMD) was higher in type 2 than type 1 diabetes patients at the hip, femur, and spine; however, only the hip differed in multivariate-adjusted models. Bone tissue stiffness at the tibia was increased in type 2 diabetes patients also in adjusted models. Sclerostin levels were inversely associated with fracture in type 1 diabetes patients. The patients with the highest tertile of sclerostin had an 81% decreased risk of a fracture compared with the lowest tertile. Conclusions: Type 1 and type 2 diabetes patients differ in BMD of the hip and tissue stiffness at the tibia. Sclerostin may be a marker independent of BMD to predict fractures in type 1 diabetes patients and thus potentially of clinical importance. Studies with longer follow-up are needed.

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Distortion of dual energy X-ray images by faecal masses in a child with type 1 diabetes

BMJ Case Reports ◽

10.1136/bcr-2020-235312 ◽

2020 ◽

Vol 13 (5) ◽

pp. e235312

Author(s):

Nikhil Shah ◽

Veena Ekbote ◽

Vaman Khadilkar ◽

Anuradha Khadilkar

Keyword(s):

Bone Mineral Density ◽

Type 1 Diabetes ◽

Dual Energy ◽

Regions Of Interest ◽

Mineral Density ◽

Dxa Scan ◽

X Ray ◽

Numeric Data ◽

Dxa Scans

Dual energy X-ray absorptiometry (DXA) scanning is the most common investigating modality used to assess bone mineral density (BMD). Conditions causing tissue calcification and artefacts such as metallic objects may mislead the results of the DXA scan. We present here a case of a child with diabetes where the DXA images were distorted by faecal lumps, leading to falsely elevated BMD and an error in interpretation of the DXA scans. Our case suggests that DXA software may not, at times, differentiate between bone and other high-attenuating material within the regions of interest. Thus, DXA images should also be visually examined and verified with the numeric data before report preparation in these patients.

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Body fat measurement in adolescent girls with type 1 diabetes: a comparison of skinfold equations against dual‐energy X‐ray absorptiometry

Acta Paediatrica ◽

10.1111/apa.13366 ◽

2016 ◽

Vol 105 (10) ◽

pp. 1211-1215 ◽

Cited By ~ 2

Author(s):

S Särnblad ◽

A Magnuson ◽

U Ekelund ◽

J Åman

Keyword(s):

Type 1 Diabetes ◽

Body Fat ◽

Adolescent Girls ◽

Dual Energy ◽

X Ray

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Generalised arterial calcification in normoalbuminuric patients with type 1 diabetes with and without cardiovascular autonomic neuropathy

Diabetes and Vascular Disease Research ◽

10.1177/1479164118805904 ◽

2018 ◽

Vol 16 (1) ◽

pp. 98-102 ◽

Cited By ~ 4

Author(s):

Henrik Øder Hjortkjær ◽

Tonny Jensen ◽

Jannik Hilsted ◽

Ulrik Madvig Mogensen ◽

Peter Rossing ◽

...

Keyword(s):

Type 1 Diabetes ◽

Autonomic Neuropathy ◽

Cardiovascular Autonomic Neuropathy ◽

Arterial Calcification

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Ankle-brachial index and diabetic neuropathy: study of 225 patients

Arquivos de Neuro-Psiquiatria ◽

10.1590/0004-282x20170084 ◽

2017 ◽

Vol 75 (8) ◽

pp. 533-538 ◽

Cited By ~ 1

Author(s):

Liliana Chevtchouk ◽

Marcio Heitor Stelmo da Silva ◽

Osvaldo José Moreira do Nascimento

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Neuropathic Pain ◽

Disease Onset ◽

Ankle Brachial Index ◽

Cross Sectional Study ◽

Cross Sectional ◽

Diabetes Patients

ABSTRACT Objective To evaluate neuropathic pain and peripheral vascular disease in diabetics and compare this with the length of time since diagnosis in type 1, and type 2 diabetes. Methods A cross-sectional study with 225 diabetics chosen from their responses on the DN4 questionnaire, who were then evaluated with the ankle-brachial index (ABI), separating type 1 diabetes from type 2 diabetes. Results A higher incidence of neuropathic pain in those over 60 years of age showed an ABI > 1.3. Neuropathic pain was related to an abnormal ABI in 144 patients (64.2%). A statistically significant value was obtained in type 2 diabetes patients with more than 10 years from disease onset, 69 with altered ABI and 25 with normal ABI. There was an altered ABI (< 0.9) observed in 33% of type 1 diabetes patients and in 67% of type 2 diabetes patients. Conclusion The ABI test in type 1 diabetes and type 2 diabetes patients is important even in those who are asymptomatic. A diagnosis of more than 10 years prior, regardless of the presence of neuropathic pain or ischemic signs, altered the ABI.

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Bone Health in Type 1 Diabetes: Where We Are Now and How We Should Proceed

Advances in Endocrinology ◽

10.1155/2014/982129 ◽

2014 ◽

Vol 2014 ◽

pp. 1-12 ◽

Cited By ~ 3

Author(s):

Volha V. Zhukouskaya ◽

Alla P. Shepelkevich ◽

Iacopo Chiodini

Keyword(s):

Risk Factors ◽

Bone Mineral Density ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Fracture Risk ◽

Bone Mineral ◽

Bone Health ◽

Mineral Density ◽

X Ray

Type 1 diabetes (T1D) is autoimmune disease with chronic hyperglycaemic state. Besides diabetic retinopathy, nephropathy, and neuropathy, T1D is characterized by poor bone health. The reduced bone mineralization and quality/strength, due to hyperglycemia, hypoinsulinemia, autoimmune inflammation, low levels of insulin growth factor-1 (IGF-1), and vitamin D, lead to vertebral/hip fractures. Young age of T1D manifestation, chronic poor glycemic control, high daily insulin dose, low BMI, reduced renal function, and the presence of complications can be helpful in identifying T1D patients at risk of reduced bone mineral density. Although risk factors for fracture risk are still unknown, chronic poor glycemic control and presence of diabetic complications might raise the suspicion of elevated fracture risk in T1D. In the presence of the risk factors, the assessment of bone mineral density by dual-energy X-ray absorptiometry and the search of asymptomatic vertebral fracture by lateral X-ray radiography of thorax-lumbar spine should be recommended. The improvement of glycemic control may have a beneficial effect on bone in T1D. Several experiments showed promising results on using anabolic pharmacological agents (recombinant IGF-1 and parathyroid hormone) in diabetic rodents with bone disorder. Randomized clinical trials are needed in order to test the possible use of bone anabolic therapies in humans with T1D.

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