Factors Associated With Low Bone Mineral Density in Adults With Type 1 Diabetes: A Cross-Sectional Study
Notice bibliographique
Résumé
Abstract Context: Individuals with type 1 diabetes (T1D) have a two- to threefold increase in fracture risk at any site, and up to a sevenfold increase in hip fracture risk compared to those without diabetes. The mechanisms accounting for this bone fragility are not yet fully understood. Objectives: 1) To determine factors associated with low bone mineral density (BMD) in patients with T1D; 2) To assess the association between skin advanced glycation end products (AGEs) and low BMD in patients with T1D. Methods: These are preliminary data from patients with T1D included in a cross-sectional study aiming at comparing the prevalence of vertebral fractures between adult patients with T1D from two tertiary care centers and age- and sex-matched controls without diabetes. Patients were eligible if they were aged ≥20 years and had a diagnosis of T1D for at least 5 years. Patients were classified as having a low BMD if Z-score was ≤-2.0 at any site (lumbar spine, femoral neck, total hip, radius) in patients aged <50 years or if T-score was ≤-1.0 at any site in patients aged ≥50 years or in postmenopausal women. Skin AGEs (surrogate marker of overall including bone AGEs) were measured by skin autofluorescence (AGE Reader ®). Unpaired t-tests or Chi-squared tests were used to compare characteristics between patients with or without a low BMD. Variables associated with a low BMD were determined by univariate analysis and were subsequently included in a multivariate logistic regression analysis if p<0.1 in the univariate analysis. All variables were tested for multicollinearity. Results: 106 patients with T1D were included (mean age 45.2±15.0 years; mean BMI 26.3±5.1 kg/m2; 54.7% women; mean duration of diabetes 28.2±13.6 years; 44.3% with a microvascular complication). Mean HbA1C over the past 3 years was 7.5±0.8%. A third of the patients (31.1%) had a low BMD (3 patients using Z-score; 30 patients using T-score). Patients with a low BMD were older (58.3 vs 39.3 years, p<0.001), had a lower mean HbA1C over the past 3 years (7.3% vs 7.6%, p=0.047), a longer diabetes duration (36.1 vs 24.6 years, p<0.001), higher skin AGEs (2.50 vs 2.03, p<0.001), a higher prevalence of microvascular complications (63.6% vs 37.7%, p=0.02) and a higher prevalence of abnormal albumin to creatinine ratio (ACR ≥2.0) on the day of assessment (38.7% vs 11.8%, p=0.003). In multivariate regression analysis, age (p<0.001), abnormal ACR (p=0.003) and lower mean HbA1C over the past 3 years (p=0.02) remained significantly associated with a low BMD. Skin AGEs were correlated with age (r=0.56) and diabetes duration (r=0.47). Conclusion: In this population with T1D, a low BMD was independently associated with older age, abnormal ACR and, unexpectedly, with a lower mean HbA1C over the past 3 years, but not with skin AGEs.
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Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».