Antidiabetic treatment, level of glycemic control, and risk of fracture in diabetes type 2: A nested case-control study
Abstract
CONTEXT
Patients with type 2 diabetes mellitus (T2DM) have an increased risk of low-trauma fractures. However, the effect of antidiabetic medication in relation to glycemic control on the risk of fracture is poorly understood.
OBJECTIVE
To evaluate the association between the level of glycemic control, use of antidiabetic medication, and risk of low-trauma fractures in patients with newly diagnosed T2DM.
METHODS
We conducted a nested case-control analysis among individuals registered within the Clinical Practice Research Datalink. The base population consisted of patients with newly diagnosed T2DM from 1995-2017. Cases were patients with a low-trauma fracture after T2DM diagnosis. We matched four controls to each case. Exposure of interest was glycemic control (last HbA1c level before fracture) and type of diabetes treatment. We conducted conditional logistic regression analyses adjusted for several confounders.
RESULTS
We identified 8809 cases and 35219 controls. Patients with current metformin use and HbA1 levels of <8.0% had a reduced risk of fractures (aOR 0.89, 95% CI 0.83-0.96 and 0.81, 95% CI 0.73-0.90, respectively) compared with untreated patients. However, in patients receiving metformin plus one or two other antidiabetic drugs, or insulin (alone or in addition to other antidiabetic medication), the level of glycemic control was not associated with the risk of fracture compared with untreated patients.
CONCLUSIONS
While patients with good or medium glycemic control…
How strong is the evidence?
Evidence Hub reads this as a case-control, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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