| アブストラクト | 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: This work aimed 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 in the Clinical Practice Research Datalink. The base population consisted of patients with newly diagnosed T2DM from 1995 to 2017. Cases were patients with a low-trauma fracture after T2DM diagnosis. We matched 4 controls to each case. Exposures of interest were glycemic control (last glycated hemoglobin [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 35 219 controls. Patients with current metformin use and HbA1c levels of less than 7.0% and between 7.0-8.0% had a reduced risk of fractures (adjusted odds ratio 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 1 or 2 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 receiving current metformin monotherapy had a lower risk of fracture compared with untreated patients, glycemic control in patients receiving treatment other than metformin was not associated with risk of fracture. |
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| ジャーナル名 | The Journal of clinical endocrinology and metabolism |
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| 投稿日 | 2020/11/4 |
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| 投稿者 | Charlier, Sarah; Vavanikunnel, Janina; Becker, Claudia; Jick, Susan S; Meier, Christian; Meier, Christoph R |
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| 組織名 | Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology,;Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.;Hospital Pharmacy, University Hospital Basel, Basel, Switzerland.;Division of Endocrinology, Diabetes & Metabolism, University Hospital Basel,;Basel, Switzerland.;Boston Collaborative Drug Surveillance Program, Lexington, Massachusetts.;Boston University School of Public Health, Boston University, Boston,;Massachusetts. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/33141149/ |
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