Poor Glycemic Control in Type 1 Diabetes Tied to Fracture Risk
Fracture risk up with T2DM and current use of rosiglitazone, pioglitazone regardless of glycemic control
TUESDAY, Jan. 22, 2019 (Pharmacist's Briefing) -- Poor glycemic control is associated with an increased risk for fracture in patients with type 1 diabetes mellitus (T1DM) but not in patients with type 2 diabetes mellitus (T2DM), according to a study published online Jan. 16 in the Journal of Clinical Endocrinology & Metabolism.
Using data from the U.K.-based Clinical Practice Research Datalink, Janina Vavanikunnel, M.D., from University Hospital Basel in Switzerland, and colleagues evaluated the association between level of glycemic control and risk for low-trauma fractures among 3,329 patients with T1DM and 44,275 patients with T2DM (diagnosed between 1995 and 2015). Four controls were matched to each case based on age, sex, general practice, fracture date, and diabetes type and duration.
The researchers found that the median duration between diabetes onset and fracture date was 4.5 years for both T1DM and T2DM. Among patients with T1DM, the risk for fracture was increased with mean glycated hemoglobin (HbA1c) >8 percent (adjusted odds ratio, 1.39) versus patients with mean HbA1c values ≤7 percent. For patients with T2DM, no such effect was seen. The risk for fracture was elevated in patients with T2DM and current use of rosiglitazone and pioglitazone regardless of glycemic control.
"The impact of glycemic control on the risk of non-vertebral low-trauma fractures differed in T1DM and T2DM patients with short-term disease," the authors write. "This might be attributed to a protective effect of insulin resistance in early disease."