Bone Health in Young Adults with Type 1 Diabetes Mellitus in South India

Patients with type 1 diabetes mellitus (T1DM) have a higher lifetime fracture risk. The rising obesity incidence in T1DM is causing hybrid diabetes. There is scarce data of bone health and body composition in T1DM from India. This South Indian study compared bone health and body composition of patients with T1DM to healthy age- and sex-matched controls.

Fifty-one adults with T1DM and 52 healthy controls were enrolled and underwent dual-energy X-ray absorptiometry (DXA) for bone mineral density (BMD) and body composition. Bone turnover markers-C-terminal telopeptide of type 1 collagen (CTX) and procollagen type 1 N pro-peptide (P1NP), parathormone (PTH) and 25 hydroxy-vitamin D levels were measured in patients.

The mean age of patients with T1DM was 27 years, the median duration of illness was 15 years and the median glycated haemoglobin (HbA1c) was 8%. BMD at the lumbar spine and hip were similar among patients and healthy controls. Patients with T1DM had decreased levels of CTX compared to controls (cases 0.347 (0.233-0.463) ng/mL, controls 0.440 (0.320-0.684) ng/mL, P = 0.005), whereas both had similar levels of P1NP. One-third of patients with T1DM were obese. Patients with T1DM with disease duration more than 10 years showed higher abdomen fat% (<10 years 20.4% [14-39.5], 10-20 years 37.2% [30.1-41.9], >20 years 41.5% [36.4-42.7] P = 0.013) and trunk fat% (<10 years 22.6% [14.8-37.2], 10-20 years 36.7% [30.1-40.5], >20 years 37.6% [33.55-40.5]).

Young adults with T1DM have normal BMD and low bone resorption markers compared to healthy controls, whereas truncal obesity increases with a longer duration of illness. This may indicate a change in T1DM bone health and body composition characters, probably due to better glycaemic management.