World Diabetes Day, observed annually on November 14, was established in 1991 by the International Diabetes Federation (IDF) and the World Health Organization (WHO) in response to the escalating health threat posed by diabetes.

This day serves as a global platform to address the increasing concerns surrounding diabetes, a condition resulting from elevated sugar levels in the blood. Over time, that imbalance can cause serious and costly health problems including heart disease, stroke, kidney disease and eye problems.

To highlight the groundbreaking research conducted at Massachusetts General Hospital to improve diabetes care, we spoke with Dr. Elaine Yu, a distinguished researcher and endocrinologist as well as the Chen Institute MGH Research Scholar for 2023-2028.

In the Q&A below, Dr. Yu shares insights from her recently published review in Frontiers in Clinical Diabetes and Healthcare titled "Vascular deficits contributing to skeletal fragility in type 1 diabetes."

Dr. Yu's research vision is to harness the power of existing large datasets to bridge critical gaps in our current understanding of skeletal health across diverse populations.

Q: What Question Were You Investigating?

A: Skeletal fragility is an underrecognized problem of type 1 diabetes (T1D).  Although vascular disease is a well-known complication of T1D, many people are unaware that having T1D also increases the risk of fractures (broken bones), including a seven-fold increased risk of breaking a hip.  With this review, we are exploring whether vascular disease directly impacts bone health in T1D.

Q: What is Microvascular Disease and How Does it Affect Patients With T1D?

A: Diabetes-associated microvascular disease classically involves damage to small blood vessels affecting the eyes (retinopathy), kidneys (nephropathy), and nerves (neuropathy).  However, any organ system with can potentially be affected by microvascular disease.  Bone is a highly vascular organ, with many networks of arteries and capillaries that provide essential nutrients to bone cells.  In this review, we discuss current knowledge about how bone blood flow might be altered in T1D, and how that might impact bone health.

Q: Can You Explain the Relationship Between Osteoporosis and T1D?

A: Adults with T1D have a three-fold increase in risk of overall fractures, and a seven-fold increase in the risk of hip fractures. As compared to individuals without diabetes, adults with T1D have lower bone density which indicates weaker bone strength.  However, many other factors beyond low bone density likely contribute to increased fracture risk in the T1D population.  This could include factors separate from bone, such as higher fall risk, as well as other factors specific to the bone, such as alterations in bone quality or bone structure that further weaken bone strength.

Q: What are Some New Findings you Discovered in This Review?

A: The purpose of the review is to summarize our current knowledge about how vascular disease might impact bone health in T1D; therefore no new findings were discovered.  We concluded that there are substantial existing data demonstrating that vascular disease is a prominent complication of T1D, and some early research that suggests vascular defects are also be present within bone.  Nevertheless, we need much more additional research to further understand whether diabetic vascular disease is directly damaging the skeleton.

Q: What are the Clinical Implications or Potential Patient Impact of Your Work?

A: Understanding the causes of skeletal fragility in T1D is a first step to identifying potential therapies to improve bone health outcomes and hopefully reduce fracture risk for individuals with T1D.

Q: Where Is Your Research Headed?

A: We have ongoing studies investigating how vascular disease and intraskeletal blood flow (blood flow within bone) impact bone health among adults with T1D.  Many of these studies involve a Boston-area cohort that we are actively recruiting, called T1D BEACON (Bone Health Connection).

We also hope to present some of our preliminary research at upcoming national conferences (such as ENDO 2024, the annual Endocrine Society meeting in June 2024); stay tuned!