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Association Between Glycemic Control and Hip Fracture
Author(s) -
Puar Troy H.,
Khoo Joan J.,
Cho Li W.,
Xu Ying,
Chen Yuan T.,
Chuo Adeline M.,
Poh Cheng B.,
Ng Jen M.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.04052.x
Subject(s) - medicine , glycemic , hip fracture , odds ratio , diabetes mellitus , confidence interval , type 2 diabetes mellitus , hemoglobin a , insulin , osteoporosis , hemoglobin , endocrinology
Objectives To determine whether tight glycemic control is associated with greater risk of hip fractures in individuals being treated for type 2 diabetes mellitus. Design Case–control study. Setting Tertiary hospital. Participants Cases were selected from all individuals with diabetes mellitus admitted between 2005 and 2010 to C hangi G eneral H ospital for hip fracture (N = 932). Cases were included if their glycosylated hemoglobin ( H b A 1c) 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. Measurements Information on baseline characteristics, H b A 1c, and use of diabetic medications was obtained. The likelihood of hip fracture was determined comparing four different values of H b A 1c [<6%, 6.1–7.0%, 7.1–8.0%, >8% (reference group)] and use of diabetic medications. Results 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 ( H b A 1c < 6% and 6.1–7.0%) were more likely to have a hip fracture than those with H b A 1c >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. Conclusion 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.