Muscle and Bone Parameters in Underprivileged Indian Children and Adolescents with T1DM.

Background: The incidence of Type 1 diabetes mellitus (T1DM) is increasing and sarcopenia and osteoporosis have been reported to be associated with long standing diabetes. There is scarcity of data on bone health status of children with T1DM. Our aim was to assess bone health parameters [by Dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography (pQCT)) and muscle strength (by hand grip) in underprivileged Indian children with T1DM. Material and methods: A cross sectional, observational study was conducted in underprivileged children with diabetes attending the out patient clinic for T1DM at a tertiary care hospital. Children with T1DM with disease duration more than 1 year were included in the study. Age and gender matched controls were also enrolled. Data on age, gender, disease duration, anthropometric parameters and HbA1c were collected. Bone mineral density (BMD) was assessed by dual energy X-ray absorptiometry (Lunar iDXA) and peripheral quantitative computed tomography (pQCT, Stratec XCT 2000) and muscle strength by handgrip. Data were analysed using SPSS 25.0. Results: 251 children with T1DM and 250 age gender matched controls were studied. Mean age of T1DM children was 10.8 +/- 4.3yrs (controls 10.3 +/- 3.6). Mean HbA1C was 9.7 +/- 2.1%. The total body less head areal BMD (TBLH aBMD) and lumbar spine bone mineral apparent density (LSBMAD) Z-scores were significantly lower in children with T1DM (-1.5 +/- 1.3, -1.3 +/- 1.6 respectively) as compared to controls (-0.5 +/- 1.3, -0.64 +/- 1.5 respectively) (p < 0.05 for both). Z-scores for trabecular and total density (vBMD) were significantly lower in patients with T1DM (-0.7 +/- 1.0, -0.7 +/- 1.0 respectively) than controls (-0.15 +/- 1.2, -0.31 +/- 1.1), (p < 0.05) and trabecular density was lower at distal radius with increasing disease duration. Hand-grip strength Z-score was lower in children with T1DM (-3.0 +/- 0.5) as compared to controls (-2.8 +/- 0.5). Trabecular density and HbA1C concentrations were negatively correlated (R = .0.18, p < 0.05) as was muscle area and HbA1C concentrations (R = -0.17, p < 0.05,). Conclusion: Bone and muscle health were affected in children with poorly controlled T1DM. With increasing disease duration, attention is required for optimising musculoskeletal health.