Glycemic Control and Insulin Treatment Alter Fracture Risk in Older Men With Type 2 Diabetes Mellitus
Glycemic Control and Insulin Treatment Alter Fracture Risk in Older Men With Type 2 Diabetes Mellitus
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DOI：
10.1002/jbmr.3826
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发表时间：
2019-10-09
影响因子：
6.2
通讯作者：
Colon-Emeric, Cathleen
中科院分区：
文献类型：
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作者：
Lee, Richard H.;Sloane, Richard;Colon-Emeric, Cathleen
老年男性糖尿病与骨密度增加有关，但矛盾的是增加了骨折风险。考虑到药物治疗、血糖控制和糖尿病相关合并症之间的相互作用，每个因素的相对影响仍不清楚。这项回顾性研究包括652，901名年龄>= 65岁、患有糖尿病和基线血红蛋白A1 c（HbA 1c）值的男性退伍军人。2000年至2010年，所有受试者均在退伍军人健康管理局（VHA）接受初级保健。行政数据包括ICD 9诊断和药房记录，并与医疗保险服务费数据相关联。使用竞争风险风险模型计算任何临床骨折和髋部骨折的风险比（HR），调整骨折风险因素，包括年龄、人种/种族、体重指数（BMI）、酒精和烟草使用、类风湿性关节炎、皮质类固醇使用以及糖尿病相关合并症，包括心血管疾病、慢性肾脏疾病和周围神经病变。HbA 1c = 8.5%，A1 c 6.5%至7.5%的患者中也未出现。使用胰岛素与骨折风险增加独立相关（HR = 1.10，95% CI 1.07-1.12）。胰岛素使用和HbA 1c水平之间存在显著的相互作用（p < 0.001），因此，使用胰岛素和HbA 1c水平的患者
Diabetes mellitus among older men has been associated with increased bone mineral density but paradoxically increased fracture risk. Given the interactions among medication treatment, glycemic control, and diabetes-associated comorbidities, the relative effects of each factor remains unclear. This retrospective study includes 652,901 male veterans aged >= 65 years with diabetes and baseline hemoglobin A1c (HbA1c) value. All subjects received primary care in the Veterans Health Administration (VHA) from 2000 to 2010. Administrative data included ICD9 diagnoses and pharmacy records and was linked to Medicare fee-for-service data. Hazard ratios (HR) for any clinical fracture and hip fracture were calculated using competing risk hazards models, adjusted for fracture risk factors including age, race/ethnicity, body mass index (BMI), alcohol and tobacco use, rheumatoid arthritis, corticosteroid use, as well as diabetes-related comorbidities including cardiovascular disease, chronic kidney disease, and peripheral neuropathy. HbA1c = 8.5%, nor among those with A1c 6.5% to 7.5%. Use of insulin was independently associated with greater risk of fracture (HR = 1.10, 95% CI 1.07-1.12). There was a significant interaction between insulin use and HbA1c level, (p < 0.001), such that those using insulin with HbA1c