Quantitative ultrasound of bone in type 1 and 2 diabetes mellitus

Aims: This study aimed to investigate for any possible relationships of quantitative ultrasound of bone (QUS) parameters with metabolic control and with parameters indicative of diabetic complications, namely neuropathy and angiopathy, in patients with type 1 (T1DM) and 2 (T2DM) diabetes. Methods: We studied 265 patients (145 males and 120 females) with T1DM (51 patients, 23 males and 28 females) and T2DM (214 patients, 122 men and 92 women) consecutively referred to a diabetic clinic from general practitioners. In all patients we checked anthropometric and serologic parameters including glycated haemoglobin (HbA1C) and lipid profile. Large-fiber sensory nerve function was quantified by vibration perception threshold (VPT) using a handheld BIO-Thesiometer at the medial malleolus and hallux. Autonomic dysfunction tests, including Beat-to-beat HRV, Deep Breathing, Expiration-To-Inspiration Ratio, Heart Rate Response To Standing, Systolic Blood Pressure Response To Standing and Cough Test were measured by clinical evaluation. QUS parameters at calcaneus (speed of sound, SOS; broadband ultrasound attenuation, BUA and QUI index) were assessed with Sahara device (Hologic). Results: As expected, in all patients, QUS parameters showed an inverse significant (p<0.001) relationship with age. QUI and BUA resulted positively correlated with BMI and waist. QUI and BUA showed a stronger correlation with BMI, waist and also with Fat± (BIA, Tanita) after selecting women with T2DM. In all patients a significant correlation between BUA and HDL cholesterol, creatinine, uric acid and HbA1C was found. In the whole population SOS negatively correlated with VPT at the malleolus (p<0.05), hallux (p<0.001) and positively correlated with deep breathing (p<0.05) and lying to standing tests (p<0.01). A stronger correlation was observed between QUS parameters, namely QUI and SOS, and VPT, deep breathing, lying to standing and cough tests in male patients with T1DM. In male patients, QUI and SOS showed a significant inverse correlation with carotid intimal thickness, this relationship resulted stronger after selection of T1DM. Conclusions: The complications of diabetes, such as peripheral and autonomic neuropathy, micro and macro angiopathy, were associated with reduced QUS parameters. Bone ultrasonography provides useful information in the skeletal assessment of patients with diabetes and may represent an additional method to evaluate the entity of the neuropathic damage in DM.