IMPAIRED OSTEOGENESIS AS A LINK IN THE CHAIN OF ATHEROSCLEROSIS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS: PATHWAYS TO OVERCOMING IT

Cardiovascular diseases in patients with type 2 diabetes mellitus exhibit a more aggressive course compared to those without this metabolic disorder. Concurrently, shared mechanisms exist between bone tissue development and atherosclerotic arterial calcification. The aim of this study was to establish potential associations between osteocalcin levels and cardiovascular complications in patients with type 2 diabetes mellitus, as well as the impact of additional glucose-lowering therapy using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium-glucose cotransporter-2 inhibitors (SGLT2is). Methods. A total of 99 patients with type 2 diabetes mellitus were examined, including 62 men and 37 women. The mean age of the participants was 59.18 ± 1.32 years (range: 46 to 67 years). Patients had no documented history of severe cardiovascular complications, such as myocardial infarction, stroke, or stenting/bypass of coronary, carotid, or peripheral arteries. Among them, 34 patients received GLP-1 RAs in addition to baseline therapy with metformin and sulfonylurea derivatives for one year, while 25 received SGLT2is. Osteocalcin levels were measured, and echocardiographic examinations were performed. Results. Low serum osteocalcin levels were associated with the development of diastolic dysfunction characterized by impaired relaxation, left ventricular hypertrophy, and atherosclerotic aortic wall involvement in patients without clinical signs of cardiovascular disease. This was not observed in patients with type 2 diabetes mellitus who had higher osteocalcin levels. Additional use of GLP-1 RAs with baseline glucose-lowering therapy significantly increased blood osteocalcin levels. Additional use of SGLT2is did not demonstrate changes in osteocalcin levels. Conclusion. Low serum osteocalcin levels in patients with type 2 diabetes mellitus may be considered a marker for future severe cardiovascular diseases. Additional use of GLP-1 RAs with baseline glucose-lowering therapy increases blood osteocalcin levels, indicating a positive impact on the cardiovascular system.