Association Between Glycemic Control and Hip Fracture
Journal of the American Geriatrics Society, 08/03/2012
Puar TH et al. – The present study found an association between tight glycemic control (when HbA1c < 7%) and greater risk of hip fracture in individuals being treated for type 2 diabetes mellitus. Greater caution needs to be exercised in treating older patients with diabetes mellitus.Methods
- Case–control study.
- Cases were selected from all individuals with diabetes mellitus admitted between 2005 and 2010 to Changi General Hospital for hip fracture (N = 932).
- Cases were included if their glycosylated hemoglobin (HbA1c) had been measured within 3 months of the fracture and they were undergoing treatment with oral hypoglycemic medications or insulin.
- Each case was matched with one control for sex, age, race, duration of diabetes mellitus, and comorbidities.
- Information on baseline characteristics, HbA1c, and use of diabetic medications was obtained.
- The likelihood of hip fracture was determined comparing four different values of HbA1c [<6%, 6.1–7.0%, 7.1–8.0%, >8% (reference group)] and use of diabetic medications.
- The mean age of cases was 77.3 ± 7.7, and 73.3% were female.
- After adjusting for age, sex, race, comorbidities, and other covariates, participants with tighter glycemic control (HbA1c < 6% and 6.1–7.0%) were more likely to have a hip fracture than those with HbA1c >8% (odds ratio (OR) = 3.01, 95% confidence interval (CI) = 2.01–4.51, P < .001; and OR = 2.34, 95% CI=1.71–3.22, P < .001, respectively).
- The use of insulin and sulfonylurea was similar between cases and controls.