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New research: Children and adolescents with diabetes get weaker bones

A special scan discloses that children with diabetes may get weaker bones already at the age of 13. Researchers from the University of Southern Denmark and Odense University Hospital believe that this is connected with blood glucose levels that are too high.

A new research project from Odense University Hospital and the University of Southern Denmark show surprising bone changes in Danish children with type 1 diabetes.

- It has been known for long that diabetes can cause complications in the small blood vessels in kidneys, eyes and nerves, but it is relatively new that the bones are also affected, and that this can be seen already in children, says doctor Gitte Fuusager, first author of a newly published article about this in the British Medical Journal Open Diabetes Research & Care.

New research shows that adults with type 1 diabetes have bone changes that give an up to 6 times higher risk of bone fracture. If you look closely, the bone changes already start in children and adolescents.

New scan discloses more details

As something new, Gitte Fuusager and her fellow researchers at H.C. Andersen Children’s Hospital and the Department of Endocrinology have used a very special CT scan that provides a lot more details than the regular DEXA scan, a so-called high resolution peripheral quantitative CT scan.

- We have not been able to detect an increased risk of bone fracture or abnormally reduced bone mineralisation at the regular scan in our Danish children with type 1 diabetes, says Gitte Fuusager, who has spent a year on the project and hopes to get the opportunity to investigate the subject further.

- Maybe because their diabetes is relatively well-regulated. But when we used the special HR-pQCT scanner, we saw surprisingly distinct changes already in the teenage years. The study included 84 children and adolescents with type 1 diabetes aged 6-17 years, and 55 of their siblings participated as healthy control subjects.

Blood glucose and bone strength are connected

For the researchers, the major discovery of the project was that there was connection between changes in the bones of children and adolescents with diabetes 1 and their blood glucose levels in the past year.

If you have diabetes, your body cannot regulate its own blood glucose levels because the pancreas does not produce enough insulin. People with diabetes therefore need to have insulin as medicine, but the balance is difficult, which is why elevated blood glucose levels are frequent. The insulin treatment must be managed by the family or the adolescent themselves with the support of the hospital.

The insulin is regulated based on knowledge of diet and exercise as well as rapid determinations of blood glucose levels. With the special blood sample HbA1c, the average blood glucose level over a number of months can be determined. The HbA1c is a useful expression of the diabetes regulation.

- In the children in the project, we can see clear changes in many of the detailed conditions of the bones and the total calculated bone strength. We also see a connection between a higher HbA1c within the past year and these bone changes.

This suggests that the high blood glucose levels are the cause of bone changes already in children and teenagers with type 1 diabetes. But this has not yet been proven. Therefore, there is a need for further research into the connection between diabetes and bones, and whether a better regulation of the blood glucose levels can strengthen the bones.

Risk of bone fracture

The consequences of reduced bone strength are primarily an increased risk of bone fracture.

- A better diabetes control reduces the risk of the already known complications in kidneys, eyes and nerves. If we can demonstrate that better diabetes control also improves the bone strength already in children and teenagers with type 1 diabetes, this could be a new target for the diabetes treatment in the future, Gitte Fuusager predicts.

The results give the researchers hope that the bone strength in children and adolescents with type 1 diabetes can be restored relatively quickly through better control of the treatment.

- We found that bone strength especially was connected to the blood glucose levels of the past year – and not the blood glucose levels throughout the course of the disease. This suggests that the adolescents’ bones are influenced by their blood glucose status within a relatively short period of time. Conversely, this can provide hope that improved blood glucose status relatively quickly can improve the bone strength of adolescents with type 1 diabetes, Gitte Fuusager concludes.   

Meet the Researcher

M.D. Gitte Fuusager

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Meet the Researcher

Professor, PhD, consultant Henrik Christesen

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Facts

Over 20 years, the number of new children and adolescents under the age of 20 with diabetes has increased from 300 to 550 per year in Denmark. The total number is approximately 4,000.

H.C. Andersen Children’s and Youth Hospital at Odense University Hospital sees 250 children and adolescents with diabetes type 1 every year. 

Diabetes is also seen with increased frequently in other countries. The reason is unknown. High blood glucose levels give symptoms such as thirst, tiredness, increased urination and weight loss, in some cases impaired consciousness. It has been shown that the risk of late complications can be reduced in vessels, nerves and eyes by a tighter diabetes regulation, expressed as a lower HbA1c. 

The research project about bone status in children with diabetes has been carried out by M.D. and researcher at Department of Clinical Research, University of Southern Denmark, Gitte Fuusager in collaboration with H.C. Andersen Children’s Hospital and the Department of Endocrinology, Odense University Hospital, Denmark. 


PUBLICATIONS

  • Lower estimated bone strength and impaired bone microarchitecture in children with type 1 diabetes. Gitte Fuusager, Nikolaj Milandt, Vikram Vinod Shanbhogue, Anne Pernille Hermann, Anders Jørgen Schou, Henrik Thybo Christesen. BMJ Open Diabetes Research & Care, 2020; 8: e001384.
    https://drc.bmj.com/content/8/1/e001384
  • Glycemic control and bone mineral density in children and adolescents with type 1 diabetes. Fuusager GB, Christesen HT, Milandt N, Schou AJ. Pediatr Diabetes. 2019;20: 629-636.
    https://pubmed.ncbi.nlm.nih.gov/31017353/