Korean J Clin Pharm.  2018 Sep;28(3):194-203. 10.24304/kjcp.2018.28.3.194.

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

• Sin HY

• KMID: 2438545
• DOI: http://doi.org/10.24304/kjcp.2018.28.3.194

Abstract

BACKGROUND
Bone fractures are high in elderly patients with type 2 diabetes mellitus (T2DM). Hyperglycemia and chronic kidney disease may increase the risk of fracture prevalence via altered bone metabolism, but whether glycemic control and kidney function are associated with the risk of fracture prevalence remains unclear. This study evaluated the relationship between glycemic control and baseline estimated glomerular filtration rate (eGFR) and risk of fracture prevalence in older and middle-aged patients with T2DM.
METHODS
Patients who underwent a general medical check-up between 2009 and 2013 were selected from the Korean National Health Insurance Sharing Service records. Chi-square test and multiple logistic regression analysis were used to assess the relationship between glycemic control and eGFR and risk of fracture prevalence.
RESULTS
Cumulative fracture prevalence were higher 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 associated with increased adjusted risk of fracture prevalence in middle-aged patients with T2DM (OR=1.13, 95% CI, 1.05-1.21, p=0.0005 vs OR=1.13, 95% CI, 1.06-1.20, p=0.0001), but not in older patients. Baseline eGFR was not significantly related to fracture prevalence in either older or middle-aged patients.
CONCLUSION
Less stringent glycemic control significantly increased the adjusted risk of fracture prevalence in middle-aged patients with T2DM. Further studies are needed to confirm the effect of tight glycemic control on fracture prevalence.

Keyword

Fracture prevalence; type 2 diabetes mellitus; glycemic control; glomerular filtration rate

MeSH Terms

Aged
Blood Glucose
Cohort Studies*
Diabetes Mellitus, Type 2
Fractures, Bone
Glomerular Filtration Rate
Humans
Hyperglycemia
Kidney
Logistic Models
Metabolism
National Health Programs*
Prevalence*
Renal Insufficiency, Chronic
Retrospective Studies*
Blood Glucose