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Risk of Fracture Prevalence and Glycemic Control in Korean Older and Middle-aged Patients with Diabetes: A Retrospective Analysis of a Cohort Derived from the Korean National Health Insurance Sharing Service Database, 2009-2013

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Background: Bone fractures are high in elderly patients with type 2 diabetes mellitus (T2DM). Hyperglycemia and chronic kidneydisease may increase the risk of fracture prevalence via altered bone metabolism, but whether glycemic control and kidney functionare associated with the risk of fracture prevalence remains unclear. This study evaluated the relationship between glycemic controland baseline estimated glomerular filtration rate (eGFR) and risk of fracture prevalence in older and middle-aged patients withT2DM. Methods: Patients who underwent a general medical check-up between 2009 and 2013 were selected from the KoreanNational Health Insurance Sharing Service records. Chi-square test and multiple logistic regression analysis were used to assessthe relationship between glycemic control and eGFR and risk of fracture prevalence. Results: Cumulative fracture prevalence werehigher in patients with T2DM, irrespective of whether they had tight or less stringent glycemic control (fasting blood glucose [FBG]≥ 110 mg/dL). After adjustment for baseline age and FBG, tight and less stringent glycemic control was significantly associatedwith increased adjusted risk of fracture prevalence in middle-aged patients with T2DM (OR=1.13, 95% CI, 1.05-1.21, p=0.0005 vsOR=1.13, 95% CI, 1.06-1.20, p=0.0001), but not in older patients. Baseline eGFR was not significantly related to fracture prevalencein either older or middle-aged patients. Conclusion: Less stringent glycemic control significantly increased the adjusted risk offracture prevalence in middle-aged patients with T2DM. Further studies are needed to confirm the effect of tight glycemic controlon fracture prevalence.

Abstract

Background: Bone fractures are high in elderly patients with type 2 diabetes mellitus (T2DM). Hyperglycemia and chronic kidneydisease may increase the risk of fracture prevalence via altered bone metabolism, but whether glycemic control and kidney functionare associated with the risk of fracture prevalence remains unclear. This study evaluated the relationship between glycemic controland baseline estimated glomerular filtration rate (eGFR) and risk of fracture prevalence in older and middle-aged patients withT2DM. Methods: Patients who underwent a general medical check-up between 2009 and 2013 were selected from the KoreanNational Health Insurance Sharing Service records. Chi-square test and multiple logistic regression analysis were used to assessthe relationship between glycemic control and eGFR and risk of fracture prevalence. Results: Cumulative fracture prevalence werehigher in patients with T2DM, irrespective of whether they had tight or less stringent glycemic control (fasting blood glucose [FBG]≥ 110 mg/dL). After adjustment for baseline age and FBG, tight and less stringent glycemic control was significantly associatedwith increased adjusted risk of fracture prevalence in middle-aged patients with T2DM (OR=1.13, 95% CI, 1.05-1.21, p=0.0005 vsOR=1.13, 95% CI, 1.06-1.20, p=0.0001), but not in older patients. Baseline eGFR was not significantly related to fracture prevalencein either older or middle-aged patients. Conclusion: Less stringent glycemic control significantly increased the adjusted risk offracture prevalence in middle-aged patients with T2DM. Further studies are needed to confirm the effect of tight glycemic controlon fracture prevalence.

참고문헌 (43)

  1. Schwartz AV, "Older women with diabetes have a higher risk of falls: a prospective study", Diabetes Care, 25, pp.1749~1754 (2002)[DOI]
  2. Cortes-Sancho R, "Type 2 diabetes mellitus as a risk factor for hip fracture", J Am Geriatr Soc, 52, pp.1778~1779 (2004)[DOI]
  3. Lee RH, "Functional impairments mediate association between clinical fracture risk and Type 2 diabetes mellitus in older women", J Am Geriatr Soc, 63, pp.1546~1551 (2015)[DOI]
  4. Wallander M, "Type 2 Diabetes and risk of hip fractures and on-skeletal fall injuries in the old age: A study from the fractures and fall injuries in the old age cohort (FRAILCO)", J Bone Miner Res, 31, pp.1~12 (2016)[DOI]
  5. Conway BN, "Glycemic control and fracture risk in old age patients with diabetes", Diabetes Res Clin Pract, 115, pp.47~53 (2016)[DOI]
  6. Sanches C, "The impact of type 2 diabetes on bone metabolism", Diabetol Metab Syndr, 9, pp.1~7 (2017)[DOI]
  7. Liao CC, "Increased risk of fracture and postfracture adverse events in patients with diabetes: two nationwide population-based retrospective cohort studies", Diabetes Care, 37, pp.2246~52 (2014)[DOI]
  8. Starup-Linde J, "Use of glucose-lowering drugs and risk of fracture in patients with type 2 diabetes", Bone, 95, pp.136~142 (2017)[DOI]
  9. Janghorbani M, "Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture", Am J Epidemiol, 166, pp.495~505 (2007)[DOI]
  10. Mishima T, "Decreased cortical thickness, as estimated by a newly developed ultrasound device, as a risk for vertebral fracture in type 2 diabetes mellitus patients with eGFR of less than 60 mL", min, TEX>, pp.Osteoporos Int, 2015[DOI]
  11. Vestergaard P, "Diabetes and bone fracture: risk factors for old and middle age", Diabetologia, 57, pp.2007~2008 (2014)[DOI]
  12. Moayeri A, "Fracture risk in patients with type 2 diabetes mellitus and possible risk factors: a systematic review and meta-analysis", Ther Clin Risk Manag, 13, pp.55~68 (2017)
  13. Garber AJ, "Consensus statement by the American association of clinical endocrinologists and American college of endocrinology of the comprehensive type2 diabetes management algorithm-2018 Executive Summary", Endocr Pract, 24, pp.91~120 (2018)[DOI]
  14. Hirakawa Y, "Impact of visit-to-visit glycemic variability on the risks of macrovascular and microvascular events and all-cause mortality in type 2 diabetes: the ADVANCE trial", Diabetes Care, 37, pp.2359~2365 (2014)[DOI]
  15. Miller ME, "ACCORD Investigators. Effects of randomization to intensive glucose control on adverse events, cardiovascular disease, and mortality in older versus younger adults in the ACCORD Trial", Diabetes Care, 37, pp.634~643 (2014)[DOI]
  16. Cefalu WT, "American diabetes association Standards of medical care in diabetes-2017", Diabetes Care, 40(Suppl. 1), pp.S25~S32 (2017)[DOI]
  17. Chiang JI, "Visit-to-visit variation of fasting blood glucose is a predictor of hip fracture in older persons with type 2diabetes: the Taiwan Diabetes Study", Osteoporos Int, 27, pp.3587~3597 (2016)[DOI]
  18. Dooley AC, "Increased risk of hip fracture among men with CKD", Am J Kidney Dis, 51, pp.38~44 (2008)[DOI]
  19. Melton LJ, "Fracture Risk in Type 2 Diabetes: Update of a Population-Based Study", J Bone Miner Res, 23, pp.1334~1341 (2008)[DOI]
  20. Puar TH, "Association between glycemic control and hip fracture", J Am Geriatr Soc, 60, pp.1493~1497 (2012)[DOI]
  21. Farr JN, "Fracture prevalence and Characteristics in Young Adults Aged 18 to 49 Years: A Population-Based Study", J Bone Miner Res, 32, pp.2347~2354 (2017)[DOI]
  22. Bacchetta J, "Norio Kurumatani Early impairment of trabecular microarchitecture assessed with HR-pQCT in patients with stage II-IV chronic kidney disease", J Bone Miner Res, 25, pp.849~857 (2010)
  23. Isakova T, "Change in Estimated Glomerular Filtration Rate and Fracture Risk in the Action to Control Cardiovascular Risk in Diabetes Trial", Bone, 78, pp.23~27 (2015)[DOI]
  24. McNair P, "Bone mineral loss in insulin treated diabetes mellitus: studies on pathogenesis", Act an Endocrinol (Copenh), 90, pp.463~472 (1979)[DOI]
  25. Malluche HH, "Evaluating bone quality in patients with chronic kidney disease", Nat Rev Nephrol, 9, pp.671~680 (2013)[DOI]
  26. Schwartz AV, "Intensive Glycemic Control Is Not Associated with Fractures or Falls in the ACCORD Randomized Trial", Diabetes Care, 35, pp.1525~1531 (2012)[DOI]
  27. Savvidis C, "Obesity and bone metabolism", Hormones (Athens), 17, pp.205~217 (2018)[DOI]
  28. Losada-Grande E, "Insulin use and Excess Fracture Risk in Patients with Type 2 Diabetes: A Propensity-Matched cohort analysis", Scientific Reports, 19, pp.1~9 (2017)
  29. Schwartz AV, "Older women with diabetes have a higher risk of falls: a prospective study", Diabetes Care, 25, pp.1749~1754 (2002)[DOI]
  30. Shanbhogue VV, "Compromised cortical bone compartment in type 2 diabetes mellitus patients with microvascular disease", Eur J Endocrinol, 174, pp.115~124 (2016)[DOI]
  31. Napoli N, "Vertebral Fracture Risk in Diabetic Elderly Men: The MrOS Study", J Bone Miner Res, 33, pp.63~69 (2018)[DOI]
  32. Robert G, "Sitagliptin and risk of fractures in type 2 diabetes: Results from the TECOS trial", Diabetes Obes Metab, 19, pp.78~86 (2017)[DOI]
  33. Ivers RQ, "Diabetes and Risk of Fracture. The Blue Mountains Eye Study", Diabetes Care, 24, pp.1198~1203 (2001)[DOI]
  34. Beam HA, "The effects of blood glucose control upon fracture healing in the BB Wistar rat with diabetes mellitus", J Orthop Res, 20, pp.1210~1216 (2002)[DOI]
  35. Shu A, "Bone structure and turnover in type 2 diabetes mellitus", Osteoporos Int, 23, pp.635~641 (2012)[DOI]
  36. McCarthy AD, "Advanced glycation end products interfere with integrin-mediated osteoblastic attachment to a type-I collagen matrix", Int J Biochem Cell Biol, 36, pp.840~848 (2004)[DOI]
  37. Zanatta LC, "Osteocalcin, energy and glucose metabolism", Arq Bras Endocrinol Metab, 58, pp.444~451 (2014)[DOI]
  38. Lemming DJ, "An update on biomarkers of bone turnover and their utility in biomedical research and clinical practice", Eur J Clin Pharmacol, 62, pp.781~792 (2006)[DOI]
  39. Losada-Grande E, "Insulin use and Excess Fracture Risk in Patients with Type 2 Diabetes: A Propensity-Matched cohort analysis", Sci Rep, 19, pp.1~9 (2017)
  40. Hygum K, "Mechanisms in endocrinology: Diabetes mellitus, a state of low bone turnover - a systematic review and meta-analysis", Eur J Endocrinol, 176, pp.R137~R157 (2017)[DOI]
  41. Park BJ, "Studying on diagnosis accuracy for health insurance claims data in Korea", pp.17~29 (2003)
  42. 김지애, "Towards Actualizing the Value Potential of Korea Health Insurance Review and Assessment (HIRA) Data as a Resource for Health Research: Strengths, Limitations, Applications, and Strategies for Optimal Use of HIRA Data", Journal of Korean Medical Science, 32(5), pp.718~728 (2017), 대한의학회
  43. 김희진, "Validity of the Diagnosis of Acute Myocardial Infarction in Korean National Medical Health Insurance Claims Data: The Korean Heart Study (1)", Korean Circulation Journal, 42(1), pp.10~15 (2012), 대한심장학회

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