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Association Between Glycemic Control and Risk of Fracture in Diabetic Patients: A Nested Case-Control Study

Vavanikunnel, Janina ; Charlier, Sarah ; Becker, Claudia ; Schneider, Cornelia ; Jick, Susan S ; Meier, Christoph R ; Meier, Christian

The journal of clinical endocrinology and metabolism, 2019-05, Vol.104 (5), p.1645-1654 [Periódico revisado por pares]

Washington, DC: Endocrine Society

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Título:
Association Between Glycemic Control and Risk of Fracture in Diabetic Patients: A Nested Case-Control Study
Autor: Vavanikunnel, Janina ; Charlier, Sarah ; Becker, Claudia ; Schneider, Cornelia ; Jick, Susan S ; Meier, Christoph R ; Meier, Christian
Assuntos: Adult ; Biomarkers - analysis ; Blood Glucose - analysis ; Body Mass Index ; Care and treatment ; Case-Control Studies ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus, Type 1 - physiopathology ; Diabetes Mellitus, Type 2 - physiopathology ; Diabetes therapy ; Diabetics ; Family medicine ; Female ; Follow-Up Studies ; Fractures ; Glycated Hemoglobin A - analysis ; Glycosylated hemoglobin ; Hemoglobin ; Humans ; Hyperglycemia - epidemiology ; Hypoglycemia - epidemiology ; Incidence ; Male ; Medical research ; Medicine, Experimental ; Middle Aged ; Osteoporotic Fractures - etiology ; Osteoporotic Fractures - pathology ; Pioglitazone ; Population studies ; Prognosis ; Risk Factors ; Rosiglitazone ; Statistical analysis ; Trauma ; United Kingdom - epidemiology ; Young Adult
É parte de: The journal of clinical endocrinology and metabolism, 2019-05, Vol.104 (5), p.1645-1654
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Descrição: Abstract Context Diabetes mellitus (DM) has been associated with an increased risk of fractures. However, the effect of glycemic control on the risk of fracture is not well understood. Objective To evaluate the association between glycemic control and the risk of low-trauma fractures in patients with type 1 DM (T1DM) and type 2 DM (T2DM). Design Nested case-control analysis. Setting UK-based Clinical Practice Research Datalink. Patients or Other Participants The study population was patients whose T1DM or T2DM had been newly diagnosed between 1995 and 2015. The cases were patients with a low-trauma fracture after DM onset. We matched four controls to each case by age, sex, general practice, fracture date, and DM type and duration. Statistical Analysis Conditional logistic regression analyses were performed, adjusted for covariates, including body mass index, smoking, DM complications and medications. Results The study population included 3329 patients with T1DM and 44,275 patients with T2DM. The median duration between DM onset and fracture date was 4.5 years for both T1DM and T2DM. The risk of fracture was increased in the patients with T1DM with a mean hemoglobin A1c >8.0% (adjusted OR, 1.39; 95% CI, 1.06 to 1.83) compared with those patients with T1DM and a mean hemoglobin A1c ≤7.0%. No such effect was found in the patients with T2DM. Independently of glycemic control, the risk of fracture was elevated in patients with T2DM and the current use of rosiglitazone and pioglitazone. Conclusions The effect of glycemic control on the risk of low-trauma fracture differs between patients with T1DM and T2DM. Poor glycemic control increased the risk of fractures in patients with T1DM but not in those with T2DM. The effect of glycemic control on fracture risk differed between patients with T1DM and T2DM with short-term disease. Poor glycemic control increased the risk of fracture in T1DM but not T2DM.
Editor: Washington, DC: Endocrine Society
Idioma: Inglês

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Association Between Glycemic Control and Risk of Fracture in Diabetic Patients: A Nested Case-Control Study

Vavanikunnel, Janina ; Charlier, Sarah ; Becker, Claudia ; Schneider, Cornelia ; Jick, Susan S ; Meier, Christoph R ; Meier, Christian

Washington, DC: Endocrine Society

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