Jakob Starup-Linde1,2*
1 Faculty of Health, Aalborg University, Aalborg, Denmark
2 Department of Endocrinology and Internal Medicine, Aarhus University Hospital THG, Aarhus, Denmark
Diabetes mellitus is known to have late complications including micro vascular and macro vascular disease. This review focuses on another possible area of complication regarding diabetes; bone. Diabetes may affect bone via bone structure, bone density, and biochemical markers of bone turnover.The aim of the present review is to examine in vivo from humans on biochemical markers of bone turnover in diabetics compared to non-diabetics. Further more, the effect of glycemic control on bone markers and the similarities and differences of type 1- and type 2-diabetics regarding bone markers will be evaluated. A systematic literature search was conducted using PubMed, Embase, Cinahl, and SveMed+ with the search terms: “Diabetes mellitus,” “Diabetes mellitus type 1,” “Insulin dependent diabetes mellitus,” “Diabetes mellitus type 2,” “Non-insulin dependent diabetes mellitus,” “Bone,” “Bone and Bones,” “Bone diseases,” “Bone turnover,” “Hemoglobin A Glycosylated,” and “HbA1C.” After removing duplicates from this search 1,188 records were screened by title and abstract and 75 records were assessed by full text for inclusion in the review. In the end 43 records were chosen. Bone formation and resorption markers are investigated as well as bone regulating systems. T1D is found to have lower osteocalcin and CTX, while osteo calcin and tartrate-resistant acid are found to be lower in T2D, and sclerostin is increased and collagen turnover markers altered. Other bone turnover markers do not seem to be altered in T1D or T2D. A major problem is the lack of histomorphometric studies in humans linking changes in turnover markers to actual changes in bone turnover and further research is needed to strengthen this link.
Keywords: diabetes mellitus, bone, bone turnover, markers of bone turnover, biochemical markers, glycemic contro
Huan Tao1 , Adrienne O’Neil 2,3, Yunseon Choi 4 , Wei Wang5 , Junfeng Wang6 , Yafeng Wang7 *, Yongqian Jia1 * and Xiong Chen8 *
1 Department of Hematology and Research Laboratory of Hematology, West China Hospital, Sichuan University, Chengdu, China, 2 The Centre for Innovation in Mental and Physical Health and Clinical Treatment, Deakin University, Geelong, VIC, Australia, 3 Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia, 4 Department of Radiation Oncology, Busan Paik Hospital, Inje University College of Medicine, Busan, South Korea, 5 School of Mathematical Sciences, Shanghai Jiao Tong University, Shanghai, China, 6 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands, 7 Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China, 8 Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
Objective: The relationship between diabetes and all- and cause-specific mortality in individuals with common cancers (breast, colorectal, and prostate) remains both under-researched and poorly understood.
Methods: Cancer survivors (N = 37,993) from the National Health Interview Survey with linked data retrieved from the National Death Index served as our study participants. Cox proportional-hazards models were used to assess associations between pre- and post-diabetes and all-cause and cause-specific mortality.
Results: Over a median follow-up period of 13 years, 2,350 all-cause, 698 cancer, and 506 CVD deaths occurred. Among all cancer survivors, patients with diabetes had greater risk of: all-cause mortality [hazard ratio (HR) 1.35, 95% CI = 1.27–1.43], cancer-specific mortality (HR: 1.14, 95% CI = 1.03–1.27), CVD mortality (HR: 1.36, 95% CI = 1.18–1.55), diabetes related mortality (HR: 17.18, 95% CI = 11.51–25.64), and kidney disease mortality (HR: 2.51, 95% CI = 1.65–3.82), compared with individuals without diabetes. The risk of all-cause mortality was also higher amongst those with diabetes and specific types of cancer: breast cancer (HR: 1.28, 95% CI = 1.12–1.48), prostate cancer (HR: 1.20, 95% CI = 1.03–1.39), and colorectal cancer (HR: 1.29, 95% CI = 1.10–1.50). Diabetes increased the risk of cancer-specific mortality among colorectal cancer survivors (HR: 1.36, 95% CI = 1.04–1.78) compared to those without diabetes. Diabetes was associated with higher risk of diabetes-related mortality when compared to non-diabetic breast (HR: 9.20, 95% CI = 3.60–23.53), prostate (HR: 18.36, 95% CI = 6.01–56.11), and colorectal cancer survivors (HR: 12.18, 95% CI = 4.17–35.58). Both pre- and post-diagnosis diabetes increased the risk of all-cause mortality among all cancer survivors. Cancer survivors with diabetes had similar risk of all-cause and CVD mortality during the second 5 years of diabetes and above 10 years of diabetes as compared to non-diabetic patients.
Conclusions: Diabetes increased the risk of all-cause mortality among breast, prostate, and colorectal cancer survivors, not for pre- or post-diagnosis diabetes. Greater attention on diabetes management is warranted in cancer survivors with diabetes.
Keywords: diabetes, all-cause, cancer, cardiovascular disease, mortality, cohort study
擅长:脊柱外科、脊柱微创技术、显微创伤外科、腰椎间盘突出症脊柱侧弯等。
熟练掌握了骨科常见病、多发病及疑难病症的诊治技术,成功抢救了各种多发伤、多发骨折等急诊、危重病人。能够熟练应用各种新型内固定材料手术治疗四肢及关节复杂骨折、复杂骨盆及髋臼骨折、骨不连等,手外伤的急诊手术、关节置换及翻修术、关节镜下手术,以及骨肿瘤、脊柱手术等各类骨科手术、手术治疗效果良好。能够熟练应用DHS、DCS、PFNA、髋动力锁定钢板、各种交锁髓内钉、解剖钢板及Liss钢板治疗四肢及关节复杂骨折、复杂骨盆及髋臼骨折手术、骨不连手术及手外伤的急诊手术、关节置换及翻修术、膝关节镜下半月板切除及交叉韧带重建术,以及骨肿瘤、脊柱手术等各类骨科手术、对创伤骨科微创治疗具有丰富的临床经验。
临床工作经验丰富,具有极为熟练的外科技能,在骨科各领域有较深的造诣。尤其在关节外科方面,已开展全身六大关节的关节镜检查和镜下手术,总体水平在广东领先,率先在广东开展关节镜下膝关节前、后交叉韧带重建术、膝关节半月板修补术、关节内骨折关节镜监视下复位固定术等高难度手术。并已开展四肢大关节的人工关节置换术,被广东省定为人工关节置换术指导专家。在复杂关节畸形的人工关节置换方面颇有研究。
擅长:危重烧伤救治/重度吸入性损伤的救治/小儿重度烧伤救治/严重皮肤撕脱伤及复合伤救治/烧伤瘢痕整复及功能重建/糖尿病足保肢治疗。
伤口世界平台生态圈,以“关爱人间所有伤口患者”为愿景,连接、整合和拓展线上和线下的管理慢性伤口的资源,倡导远程、就近和居家管理慢性伤口,解决伤口专家的碎片化时间的价值创造、诊疗经验的裂变复制、和患者的就近、居家和低成本管理慢性伤口的问题。
2019广东省医疗行业协会伤口管理分会年会
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