Literature DB >> 25143926

Response to review article "Type 1 diabetes and osteoporosis: Review of literature".

Ameya S Joshi1, Premlata K Varthakavi1, Nikhil M Bhagwat1, Manoj D Chadha1.   

Abstract

Entities:  

Year:  2014        PMID: 25143926      PMCID: PMC4138925          DOI: 10.4103/2230-8210.137505

Source DB:  PubMed          Journal:  Indian J Endocrinol Metab        ISSN: 2230-9500


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Sir, We read the review article on type 1 diabetes (T1DM) and osteoporosis with great interest. As the article mentioned our group has the only published literature as regards bone mineral density (BMD) in T1DM in India.[1] Though our study was conducted at a center in Western India, Mumbai being a cosmopolitan city and referral center for all over India our study population practically had members from most of the states. Another important aspect that we noted among our study population was that the BMD as well as the bone mineral content was remarkable low in patients with celiac autoimmunity (CA) and T1DM as compared with patients T1DM without CA and we got a significantly high prevalence of CA (12.7%) which matches with reports from other parts of India.[2] Despite such a high prevalence CA is T1DM, the screening rates for same are poor. Poor glycemic control and low insulin like growth factor-1 levels (which also is partly glycemic control as well as nutrition dependent) with normal growth hormone levels (basal as well as stimulated when indicated) were also associated with poor BMD in T1DM. This also perhaps explains why we got low BMD in T1DM as compared with control population, a finding not universally replicated across the globe (due to perhaps poor nutrition). It also underlines that measures for improvement of better glycemic control in T1DM such as encouraging more frequent monitoring, subsidizing glucostrips, insulin pumps and glucose monitoring systems and emphasizing the concept of basal and bolus or flex regimens in order to achieve better glycemic control.[3] Interpretation of BMD/bone mineral content for bone area in pediatric diseased population especially due to effect on stature and pubertal status is also difficult. The popular Molgaard approach does not consider puberty. The model which we had used was Warner model which gives predictive equations considering the effect of age, sex, puberstatus, and antropometric variables and may be used in diseased population.[45] We would like to reiterate that at least from our study experience timely screening of CA as well as measures to improve glycemic control apart from improving nutrition and physical activity may help in better bone health in T1DM.
  5 in total

1.  Measured and predicted bone mineral content in healthy boys and girls aged 6-18 years: adjustment for body size and puberty.

Authors:  J T Warner; F J Cowan; F D Dunstan; W D Evans; D K Webb; J W Gregory
Journal:  Acta Paediatr       Date:  1998-03       Impact factor: 2.299

2.  Whole body bone mineral content in healthy children and adolescents.

Authors:  C Mølgaard; B L Thomsen; A Prentice; T J Cole; K F Michaelsen
Journal:  Arch Dis Child       Date:  1997-01       Impact factor: 3.791

3.  Immunogenetics of autoimmune diseases in Asian Indians.

Authors:  N K Mehra; Gurvinder Kaur; Uma Kanga; Nikhil Tandon
Journal:  Ann N Y Acad Sci       Date:  2002-04       Impact factor: 5.691

Review 4.  Diabetes mellitus, bone mineral density, and fracture risk.

Authors:  Elsa S Strotmeyer; Jane A Cauley
Journal:  Curr Opin Endocrinol Diabetes Obes       Date:  2007-12       Impact factor: 3.243

5.  A study of bone mineral density and its determinants in type 1 diabetes mellitus.

Authors:  Ameya Joshi; Premlata Varthakavi; Manoj Chadha; Nikhil Bhagwat
Journal:  J Osteoporos       Date:  2013-03-31
  5 in total

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