Association Analysis of Insulin Resistance and Osteoporosis Risk in Chinese Patients with T2DM

Figures & data

Figure 1 Flowchart of the study.

Table 1 Comparison of General Information and Blood Indicators of Different Gender Groups

	Total	Female	Male	P-value
N	234	95	139
Age	57.5 ± 10.8	59.2 ± 10.9	56.4 ± 10.6	0.047
Menopause	——	81 (85.3%)	——	——
BMI (kg/m^2)	24.9 ± 3.9	25.1 ± 4.4	24.8 ± 3.5	0.613
Waist-to-hip ratio	0.93 ± 0.06	0.93 ± 0.06	0.93 ± 0.06	0.808
Disease course (years)	7.0 (2.0–10.0)	10.0 (2.0–14.0)	5.5 (2.0–10.0)	0.013
Drug control	122 (52.1%)	59 (62.1%)	63 (45.3%)	0.012
Fasting blood-glucose (mmol/L)	8.67 ± 2.33	8.71 ± 2.35	8.64 ± 2.32	0.835
Fasting C-peptide (pmol/L)	1.73 (1.16–2.39)	1.64 (1.14–2.40)	1.74 (1.18–2.29)	0.531
HOMA-IR (CP)	3.50 ± 1.31	3.41 ± 1.11	3.57 ± 1.43	0.358
HOMA-islet (CP-DM)	32.50 (19.65–58.56)	32.06 (19.15–58.25)	33.69 (20.02–59.16)	0.295
HbA1c (%)	9.64 ± 2.14	9.69 ± 2.19	9.61 ± 2.12	0.789
Uric acid (μmol/L)	304.63 ± 92.86	287.66 ± 96.68	316.24 ± 88.65	0.023
Total cholesterol (mmol/L)	4.66 ± 1.14	4.85 ± 1.07	4.53 ± 1.17	0.038
Triacylglycerol (mmol/L)	1.86 (1.34–2.86)	2.01 (1.43–2.86)	1.81 (1.30–2.79)	0.628
High-density lipoprotein (mmol/L)	1.02 ± 0.26	1.08 ± 0.25	0.98 ± 0.25	0.005
Low-density lipoprotein (mmol/L)	2.47 ± 0.81	2.65 ± 0.79	2.35 ± 0.80	0.006
Osteoporosis	34 (14.5%)	15 (15.8%)	19 (13.7%)	0.651

Note: the data are expressed as Mean ± SD/Median (Q1 - Q3)/N (%).

Abbreviations: BMI, body mass index; HOMA-IR (CP), homeostasis model assessment for insulin resistance based on C-peptide; HOMA-islet (CP-DM), homeostasis model assessment islet beta-cell function based on C-peptide; HbA1c, hemoglobin A1c.

Table 2 Univariate Analysis of Clinical Data, Blood Indicators, and Osteoporosis of Different Gender Groups

	Female	Male
	OR (95% CI) P-value	OR (95% CI) P-value
Age	1.05 (1.00, 1.12) 0.066	1.01 (0.97, 1.06) 0.644
Menopause	1.15 (0.23, 5.74) 0.867	——
BMI (kg/m^2)	0.99 (0.87, 1.12) 0.835	1.03 (0.90, 1.18) 0.686
Waist-to-hip ratio	1.72 (0.00, 32,015.04) 0.914	0.68 (0.00, 1914.25) 0.924
Disease course (years)	1.03 (0.97, 1.10) 0.293	1.06 (0.98, 1.14) 0.138
Drug control	0.90 (0.29, 2.78) 0.855	1.80 (0.68, 4.79) 0.241
Fasting blood glucose (mmol/L)	1.12 (0.89, 1.41) 0.329	0.84 (0.66, 1.06) 0.141
Fasting C peptide (pmol/L)	1.36 (0.79, 2.34) 0.262	0.89 (0.56, 1.41) 0.613
HOMA-IR (CP)	1.55 (0.99, 2.42) 0.055	0.80 (0.51, 1.26) 0.333
HOMA-islet (CP-DM)	0.99 (0.97, 1.02) 0.627	1.00 (0.99, 1.01) 0.531
HbA1c (%)	1.18 (0.91, 1.52) 0.214	0.86 (0.68, 1.10) 0.244
Uric acid (μmol/L)	0.99 (0.99, 1.00) 0.074	1.00 (1.00, 1.01) 0.323
Total cholesterol (mmol/L)	1.02 (0.60, 1.74) 0.941	0.78 (0.49, 1.24) 0.291
Triacylglycerol (mmol/L)	0.82 (0.52, 1.28) 0.385	0.94 (0.75, 1.17) 0.575
High-density lipoprotein (mmol/L)	2.46 (0.26, 23.58) 0.434	1.09 (0.16, 7.31) 0.933
Low-density lipoprotein (mmol/L)	1.08 (0.53, 2.21) 0.830	0.68 (0.34, 1.35) 0.265

Abbreviations: BMI, body mass index; HOMA-IR (CP), homeostasis model assessment for insulin resistance based on C-peptide; HOMA-islet (CP-DM), homeostasis model assessment islet beta-cell function based on C-peptide; HbA1c, hemoglobin A1c.

Table 3 Multivariable Logistic Regression Analysis of the Effect of HOMA-IR (CP) on Osteoporosis

Gender	Non-Adjusted	Adjust I	Adjust II
Female	1.55 (0.99, 2.42) 0.055	1.66 (0.96, 2.89) 0.071	2.63 (1.15, 5.99) 0.022
Male	0.80 (0.51, 1.26) 0.333	0.74 (0.45, 1.22) 0.238	0.80 (0.46, 1.38) 0.395
P for interaction	0.031	0.020	0.009

Notes: OR (95% CI) P-value. Non-adjusted model was adjusted for: None. Adjust I model was adjusted for: Age; uric acid. Adjust II model was adjusted for: Age; BMI; waist-to-hip ratio; disease course; HOMA-islet (CP-DM); uric acid; triacylglycerol; high-density lipoprotein.

Abbreviations: HOMA-IR (CP), homeostasis model assessment for insulin resistance based on C-peptide; BMI, body mass index; HOMA-islet (CP-DM), homeostasis model assessment for islet beta-cell function based on C-peptide.

Figure 2 The relationship between HOMA-IR (CP) and osteoporosis risk. Adjust for: age, BMI, waist-to-hip ratio, disease course, HOMA-islet (CP-DM), uric acid, triacylglycerol, and high-density lipoprotein.

Abbreviations: HOMA-IR (CP), homeostasis model assessment for insulin resistance based on C-peptide; BMI, body mass index; HOMA-islet (CP-DM), homeostasis model assessment islet beta-cell function based on C-peptide.

Table 4 Nonlinear Relationship Between HOMA-IR (CP) and Osteoporosis

	OR (95% CI)	P-value
Model I: univariate linear regression	2.63 (1.15, 5.99)	0.022
Model II: two-piecewise regression model
Inflection point (K)	4.00
< K point effect 1	0.61 (0.16, 2.36)	0.474
> K point effect 2	26.88 (2.75, 262.69)	0.005
Log-likelihood ratio test		0.005

Notes: Adjusted variables: age, BMI, waist-to-hip ratio, disease course, HOMA-islet (CP-DM), uric acid, triacylglycerol, and high-density lipoprotein.

Abbreviations: HOMA-IR (CP), homeostasis model assessment for insulin resistance based on C-peptide; BMI, body mass index; HOMA-islet (CP-DM), homeostasis model assessment islet beta-cell function based on C-peptide.