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Glycemic Control and Insulin Treatment Alter Fracture Risk in Older Men With Type 2 Diabetes Mellitus
Journal of bone and mineral research, 2019-11, Vol.34 (11), p.2045-2051
Lee, Richard H
Sloane, Richard
Pieper, Carl
Lyles, Kenneth W
Adler, Robert A
Houtven, Courtney
LaFleur, Joanne
Colón‐Emeric, Cathleen
2019
Details
Autor(en) / Beteiligte
Lee, Richard H
Sloane, Richard
Pieper, Carl
Lyles, Kenneth W
Adler, Robert A
Houtven, Courtney
LaFleur, Joanne
Colón‐Emeric, Cathleen
Titel
Glycemic Control and Insulin Treatment Alter Fracture Risk in Older Men With Type 2 Diabetes Mellitus
Ist Teil von
Journal of bone and mineral research, 2019-11, Vol.34 (11), p.2045-2051
Ort / Verlag
United States: Wiley Subscription Services, Inc
Erscheinungsjahr
2019
Link zum Volltext
Quelle
Electronic Journals Library
Beschreibungen/Notizen
ABSTRACT Diabetes mellitus among older men has been associated with increased bone mineral density but paradoxically increased fracture risk. Given the interactions among medication treatment, glycemic control, and diabetes‐associated comorbidities, the relative effects of each factor remains unclear. This retrospective study includes 652,901 male veterans aged ≥65 years with diabetes and baseline hemoglobin A1c (HbA1c) value. All subjects received primary care in the Veterans Health Administration (VHA) from 2000 to 2010. Administrative data included ICD9 diagnoses and pharmacy records and was linked to Medicare fee‐for‐service data. Hazard ratios (HR) for any clinical fracture and hip fracture were calculated using competing risk hazards models, adjusted for fracture risk factors including age, race/ethnicity, body mass index (BMI), alcohol and tobacco use, rheumatoid arthritis, corticosteroid use, as well as diabetes‐related comorbidities including cardiovascular disease, chronic kidney disease, and peripheral neuropathy. HbA1c <6.5% was associated with a higher risk of any clinical fracture (HR = 1.08, 95% confidence interval [CI] 1.06–1.11) compared with the reference HbA1c of 7.5% to 8.5%. Fracture risk was not increased among those with A1c ≥8.5%, nor among those with A1c 6.5% to 7.5%. Use of insulin was independently associated with greater risk of fracture (HR = 1.10, 95% CI 1.07–1.12). There was a significant interaction between insulin use and HbA1c level, (p < 0.001), such that those using insulin with HbA1c <6.5% had HR = 1.23 and those with HbA1c 6.5% to 7.5% had HR = 1.15. Metformin use was associated with decreased fracture risk (HR = 0.88, 95% CI 0.87–0.90). We conclude that among older men with diabetes, those with HbA1c lower than 6.5% are at increased risk for any clinical and hip fracture. Insulin use is associated with higher fracture risk, especially among those with tight glycemic control. Our findings demonstrate the importance of the treatment regimen and avoiding hypoglycemia for fracture prevention in older men with diabetes. © 2019 American Society for Bone and Mineral Research.
Sprache
Englisch
Identifikatoren
ISSN: 0884-0431
eISSN: 1523-4681
DOI: 10.1002/jbmr.3826
Titel-ID: cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6854289
Format
–
Schlagworte
AGED
,
Body mass index
,
Bone mineral density
,
Cardiovascular diseases
,
Corticosteroids
,
Diabetes
,
DIABETES MELLITUS
,
Diabetes mellitus (non-insulin dependent)
,
FRACTURE
,
Fractures
,
Health risk assessment
,
Hemoglobin
,
Hip
,
Hypoglycemia
,
Insulin
,
Kidney diseases
,
MALE
,
Metformin
,
Peripheral neuropathy
,
Rheumatoid arthritis
,
RISK FACTORS
,
Tobacco
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