Hypoglycaemia is associated with increased risk of fractures in patients with type 2 diabetes mellitus: a cohort study
Hypoglycaemia is associated with increased risk of fractures in patients with type 2 diabetes mellitus: a cohort study
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DOI：
10.1530/eje-18-0458
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发表时间：
2019-01-01
影响因子：
5.8
通讯作者：
Nirantharakumar, Krishnarajah
中科院分区：
文献类型：
--
作者：
Ntouva, Antiopi;Toulis, Konstantinos A.;Nirantharakumar, Krishnarajah
目的：2型糖尿病与骨折风险增加相关。当个体化治疗时，应考虑任何逐渐增加这种风险的因素。低血糖症是抗糖尿病药物的常见并发症，并被认为是骨折的危险因素;然而，其实际临床影响尚不清楚。设计：一项基于人群的回顾性开放队列研究，使用1995年1月1日至2016年5月1日期间在健康改善网络（THIN）数据库中常规收集的数据。将有记录的低血糖事件的2型糖尿病患者与随机匹配的无记录的低血糖事件的2型糖尿病患者（与暴露患者在年龄、性别、糖尿病病程和BMI方面匹配）进行比较。主要结局是任何意外骨折。结果：共纳入41163例2型糖尿病患者，其中暴露组14147例，未暴露组27016例。与无低血糖事件记录的患者相比，有低血糖事件记录的患者更可能发生任何骨折：校正的IRR = 1.20（95% CI：1.12-1.30; P < 0.0001）。与对照组相比，有低血糖事件记录的患者更容易发生脆性骨折：校正的IRR = 1.24（95%CI：1.13-1.37; P < 0.0001）。结论：低血糖事件是糖尿病患者骨折的重要危险因素。当个体化血糖控制目标和选择抗糖尿病药物时，该观察结果具有临床意义。
Objective: Type 2 diabetes is associated with an increased risk of fracture. Any factor that incrementally increases this risk should be taken into account when individualising treatment. Hypoglycaemia is a common complication of antidiabetes medications and suggested as a risk factor for fractures; yet, its real-life clinical impact is unclear.Design: A population-based, retrospective open cohort study using routinely collected data between 1st of January 1995 and 1st of May 2016 in The Health Improvement Network (THIN) database.Methods: Patients with type 2 diabetes mellitus with documented hypoglycaemic events were compared to randomly matched patients with type 2 diabetes mellitus without documented hypoglycaemic events matched to exposed patients on age, sex, duration of diabetes and BMI. The primary outcome was any incident fracture. Secondary outcome was incident fragility (osteoporotic) fracture.Results: A total of 41 163 patients with type 2 diabetes were included: 14 147 patients in the exposed cohort and 27 016 patients in the unexposed cohort. Patients with a documented hypoglycaemic event were significantly more likely to sustain any fracture compared to patients with no record of hypoglycaemic events: adjusted IRR = 1.20 (95% Cl: 1.12-1.30; P < 0.0001). Patients who had a documented hypoglycaemic event were significantly more likely to suffer a fragility fracture compared to controls: adjusted IRR = 1.24 (95% Cl: 1.13-1.37; P < 0.0001).Conclusions: Hypoglycaemic events are a significant risk factor for fractures in patients with diabetes mellitus. This observation is clinically relevant when individualising targets for glycaemic control and selecting antidiabetic agents.