THE EFFECT OF DIET-INDUCED WEIGHT LOSS ON BONE TURNOVER IN PATIENTS WITH

TYPE-II DIABETES MELLITUS

G.Aasritha WilliamVI-Pharm-D

“Diabetes is a chronic metabolic disorder resulting in hyperglycemia, a consequence of either inadequate insulin production, inadequate insulin secretion, or both”

*Type-1(insulin dependent):autoimmune destruction of pancreatic β cells resulting in an inability to produce and secrete insulin

*Type-2(non-insulin dependent):insulin resistance, a relative insulin deficiency as well or it maybe both

*Third category:gestational diabetes mellitus (GDM) is defined as the onset or recognition of diabetes during pregnancy

*Fourth category:is associated with genetic disorders,pancreatic diseases,drug and chemical use,infections

BONE TURNOVER:It refers to the total volume of bone that is both resorbed and formed over a period of time. Bone turnover can be estimated by measuring relevant bone biomarkers.

e.g.:Urinary collagen type 1 cross-linked N-telopeptide (NTX),Urinary or serum collagen type 1 cross-linked C-telopeptide (CTX)

INTRODUCTION

SYMPTOMS

**Vaginal Infections is the most common symptom in women

WORLD OF DIABETES

Top 3 countries1. INDIA2. CHINA3. USA

World 2015 415 million2040 642 million

Estimated number of people with diabetes worldwide and per region in 2015&2040

INDIA’S DIABETES WAKE-UP CALL

India is Diabetes capital of world and every fifth diabetic is an Indian

PREVALANCE OF DIABETES (IN%)

NUMBER OF DIABETES DEATHS

Source:WHO diabetes country profiles 2016

PREVALANCE OF DIABETES AND RELATED RISK FACTORS

STATISTICS ON TYPES OF

DIABETES IN INDIA

Source:WHO diabetes country profiles 2016

LINK BETWEEN DIABETES AND OBESITY

*Obesity causes inflammation, which can in turn lead to type 2 diabetes.

In obesity, extra fat triggers inflammation by releasing LTB4, which binds to receptors on nearby macrophages and activates them which promotes insulin resistance, a first step in developing type 2 diabetes.

Krakauer JC et al., conducted a study on bone loss and bone turn over in diabetes and concluded that in patients with diabetes, metabolic effects of poor glycemic control lead to increased bone resorption and bone loss.

According to Ying-Ying Wu, decreased bone turnover rate might explain the increased bone fragility in patients with diabetes because,older bone is not replaced by new bone with decreased bone turnover rate, thus decreasing bone mechanical strength.

BONE LOSS AND DIABETES

Thiazolidinediones (reduces the activity of osteoblasts)

KIDNEY DAMAGE

Prevent osteoblasts from making strong bones.

Allows calcium to leak out in urine

HIGH BLOOD SUGAR

REASONS

ORAL MEDICATIONS

ROCKY STROLLO et al.,conducted a 21-day randomized controlled trial on overweight or obese patients with T2D. Patients were randomly assigned 1:1 to the Ma-Pi 2 macrobiotic diet or a control diet based on dietary guidelines for T2D. Serum sclerostin and circulating markers of bone resorption (CTX) or bone formation (P1NP) were measured.

RESULTS: Serum sclerostin increased significantly in the two groups but Ma-Pi 2 diet group experienced a significantly greater increase in sclerostin.

Serum CTX increased in the two groups ; P1NP did not change significantly in the two

groups. 

Effect of diet induced weight loss on bone turnover in patients with type-II DM

How to maintain strong bones with Diabetes?

EXERCISE DIETWeight bearing

exercises.e.g., walking, jogging, hiking, yard work,

weight training.etc..

Intake of calcium and vitamins: D and K.

*By taking a supplement if needed or prescribed by doctor

A winning plan to lower the risk of Diabetes

Stay fit, stay healthy, enjoy life!

ROLE OF PHARMACIST

EDUCATING

IDENTIFYING FIGHTING NON-ADHERENCE

SUPPORTING E-CARE

ENCOURAGING

OPPORTUNITY KNOCKS

Better time for the pharmacist to embrace pharmaceutical care

Provide Community based lectures on diabetes and its treatment.

Control diabetes with natural remedies Explaining injecting insulin &how tough it can be? Creating roadblocks byadequately assessing and monitoring people with diabetes

Bone loss plays a prominent role in the quality of life in diabetes. Diabetes health is in our hands. Medication alone cannot overcome diabetes. It is our responsibility to manage and overcome it through our self care and by taking support from the educating groups.

Managing diabetes is not a science, its an art!

CONCLUSION

So, it is very important for the leaders of our society to concentrate on it and Diabetes being the foremost cause of all health related problems in our country, it is important to create awareness among the public for a

successful nation.

“A WORLD FREE OF DIABETES IS NOT OUR DREAM, IT’S OUR

PLEDGE”

THANK YOU

G. Aasritha William

1. Parfitt AM. Bone. 2004; 35(1):1-3.2. http://www.nature.com/nrendo/journal/v12/n6/images_article/nrendo.2016.53-f1.jpg3. http://timesofindia.indiatimes.com/india/Obesity-among-Indian-teens-swells/articleshow/

47932475.cms 4. Krakauer JC, McKenna MJ, Buderer NF et al. Bone loss and bone turnover in

diabetes. Diabetes 1995; 44(7): 775–782. 5. Okazaki R. [Management of osteoporosis in diabetes mellitus.] Nippon Rinsho2009; 67(5): 1003–1010.

Japanese. 6. http://www.everydayhealth.com/hs/type-2-diabetes-treatment-diet-exercise/bone-health-with-

diabetes/

REFERENCES