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. 2011 Oct;34(10):2186-91.
doi: 10.2337/dc11-0764. Epub 2011 Aug 18.

Low bone mineral density and its predictors in type 1 diabetic patients evaluated by the classic statistics and artificial neural network analysis

Cristina Eller-Vainicher  1 , Volha V Zhukouskaya, Yury V Tolkachev, Sergei S Koritko, Elisa Cairoli, Enzo Grossi, Paolo Beck-Peccoz, Iacopo Chiodini, Alla P Shepelkevich
Affiliations

Low bone mineral density and its predictors in type 1 diabetic patients evaluated by the classic statistics and artificial neural network analysis

Cristina Eller-Vainicher et al. Diabetes Care. 2011 Oct.

Abstract

Objective: To investigate factors associated with bone mineral density (BMD) in type 1 diabetes by classic statistic and artificial neural networks.

Research design and methods: A total of 175 eugonadal type 1 diabetic patients (age 32.8 ± 8.4 years) and 151 age- and BMI-matched control subjects (age 32.6 ± 4.5 years) were studied. In all subjects, BMI and BMD (as Z score) at the lumbar spine (LS-BMD) and femur (F-BMD) were measured. Daily insulin dose (DID), age at diagnosis, presence of complications, creatinine clearance (ClCr), and HbA(1c) were determined.

Results: LS- and F-BMD levels were lower in patients (-0.11 ± 1.2 and -0.32 ± 1.4, respectively) than in control subjects (0.59 ± 1, P < 0.0001, and 0.63 ± 1, P < 0.0001, respectively). LS-BMD was independently associated with BMI and DID, whereas F-BMD was associated with BMI and ClCr. The cutoffs for predicting low BMD were as follows: BMI <23.5 kg/m(2), DID >0.67 units/kg, and ClCr <88.8 mL/min. The presence of all of these risk factors had a positive predictive value, and their absence had a negative predictive value for low BMD of 62.9 and 84.2%, respectively. Data were also analyzed using the TWIST system in combination with supervised artificial neural networks and a semantic connectivity map. The TWIST system selected 11 and 12 variables for F-BMD and LS-BMD prediction, which discriminated between high and low BMD with 67 and 66% accuracy, respectively. The connectivity map showed that low BMD at both sites was indirectly connected with HbA(1c) through chronic diabetes complications.

Conclusions: In type 1 diabetes, low BMD is associated with low BMI and low ClCr and high DID. Chronic complications negatively influence BMD.

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Figures

Figure 1
Figure 1
Semantic connectivity map of studied variables. The figures on the connections represent the strength of the link on a 0–1 scale. Low BMD femur, presence of low F-BMD; Low BMD spine, presence of low LS-BMD. Males and females are both connected to neuropathy but with a different conditional probability. The link for females is stronger (0.95) than it is for males (0.93).
See this image and copyright information in PMC

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