Glycemic Control and Fracture Risk in T2D Patients

This study evaluated how hypoglycemia and poor glycemic control affect the risk of fracture in patients with type 2 diabetes (T2D). The study population included 4,706 patients (mean age, 66 years; men, n = 2,755; postmenopausal women, n = 1,951) who were stratified by severe hypoglycemia status and glycemic control. Patients were followed for a median 5.3 years; follow-up rate was 97.6%. The main outcome measure was fracture. Overall, 662 patients sustained a fracture (249 men, 413 women). When adjusting for age and sex, incidence rates per 1,000 person-years were as follows: 71.2 (multiple episodes of severe hypoglycemia), 43.1 (one episode), 25.2 (HbA1c < 53 mmol/mol [< 7%] without severe hypoglycemia), 28.7 (HbA1c 53 to < 64 mmol/mol [7% to < 8%] without severe hypoglycemia), 27.7 (HbA1c 64 to < 75 mmol/mol [8% to < 9%] without severe hypoglycemia), and 40.5 (HbA1c ≥ 75 mmol/mol [≥ 9%] without severe hypoglycemia). In multivariate-adjusted analyses, hazard ratios for fracture compared to patients with HbA1c < 53 mmol/mol (< 7%) without severe hypoglycemia were 2.24 in patients with multiple episodes of severe hypoglycemia and 1.42 in patients with HbA1c ≥ 75 mmol/mol (≥ 9%) without severe hypoglycemia. The researchers concluded that while severe hypoglycemia and poor glycemic control were both observed as risk factors for fracture in T2D patients, the risk was stronger in the presence of severe hypoglycemia.