Objective: Strontium and calcium play an essential role in bone metabolism but a paucity of epidemiological or experimental studies referring the role of strontium in the development type 2 diabetes (T2D). Prior studies have reported conflicting results for the relationships between plasma strontium and T2D. We therefore investigated the association between plasma strontium as well as the ratio of calcium to strontium (Ca/Sr) and newly diagnosed T2D.

Methods: After propensity score matching for age and sex, 2,5newly-diagnosed T2D patients and 2,5controls with normal glucose tolerance were recruited in the case-control study. Plasma strontium and calcium levels were determined by inductively coupled plasma mass spectrometry (ICP-MS). Multivariate logistic regression analysis was used to evaluate the independent association of plasma strontium levels and Ca/Sr values with the likelihood of T2D.

Results: Compared with the middle quintile, the multivariate-adjusted odds ratios (ORs) and 95% confidence intervals of T2D associated with the lowest quintile and the highest quintile of plasma strontium were 2.01 (1.66, 2.44) and 2.01 (1.65, 2.44), of plasma Ca/Sr were 2.11 (1.75, 2.54) and 2.01 (1.66, 2.43), respectively. In spline analysis, the U-shaped associations were consistently indicated, with the lowest odds of T2D at the plasma strontium concentration of 42.52 μg/L, and Ca/Sr value of 1500 approximately. We also discovered the pattern of high plasma calcium and low strontium level was associated with the highest odds of T2D, while the pattern of high plasma calcium and moderate to high strontium level was associated with the lowest odds of T2D.

Conclusions: Our results suggested U-shaped associations between plasma strontium, Ca/Sr and T2D; both low and high levels of plasma strontium and Ca/Sr were associated with higher odds of newly diagnosed T2D. We should not only pay attention to calcium, but also to strontium and the homeostasis of the both.


L. Chen: None. Q. Wang: None. X. Hu: None. X. Wang: None. T. Sun: None. W. Bao: None. L. Liu: None.

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