Glycated Hemoglobin Level and Risk of Hip Fracture in Older People with Type 2 Diabetes: A Competing Risk Analysis of Taiwan Diabetes Cohort Study
Glycated Hemoglobin Level and Risk of Hip Fracture in Older People with Type 2 Diabetes: A Competing Risk Analysis of Taiwan Diabetes Cohort Study
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DOI：
10.1002/jbmr.2462
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发表时间：
2015-07-01
影响因子：
6.2
通讯作者：
Li, Tsai-Chung
中科院分区：
文献类型：
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作者：
Li, Chia-Ing;Liu, Chiu-Shong;Li, Tsai-Chung
髋部骨折与严重的发病率和长期死亡率有关，给医疗保健系统带来了重大负担。糖尿病是骨质疏松症的危险因素，而骨质疏松症是髋部骨折的关键危险因素。然而，调查2型糖尿病患者髋部骨折风险的流行病学研究有限。本研究探讨了65岁及以上2型糖尿病患者中血红蛋白A1c(HbA1c)与髋部骨折风险的关系。我们对参加国家糖尿病病例管理计画的20025名老年2型糖尿病患者进行了一项回溯性队列研究。分析基线时的HbA1c水平和平均7.41年的髋部骨折发生率(最大和标准差分别为10.9年和2.42年)。共记录了1514例髋部骨折病例。基线糖化血红蛋白水平分别为6%、6%~7%、7%~8%、8%~9%、9%~10%和10%的患者髋部骨折发生率分别为9.15、8.02、9.58、10.61、12.51和13.43/1000人年。经多因素调整后，HbA1c水平在9%-10%和10.0%的患者与HbA1c水平为6-7%的患者相比，髋部骨折的风险增加(危险比1.24；95%可信区间1.02-1.49和1.32；1.09-1.58)。各组间HbA1c呈显著的线性关系(P
Hip fracture, which is associated with substantial morbidity and long-term mortality, imposes a major burden on the healthcare system. Diabetes is a risk factor for osteoporosis, which is a crucial risk factor of hip fracture. However, epidemiological studies investigating the risk of hip fracture among patients with type 2 diabetes are limited. This study explored the association between hemoglobin A1c (HbA1c) and the risk of hip fracture in people with type 2 diabetes aged 65 years and older. We conducted a retrospective cohort study of 20025 older patients with type 2 diabetes who participated in the National Diabetes Case Management Program in Taiwan. The HbA1c level at the baseline and hip fracture incidence over an average of 7.41 years of follow-up were analyzed (maximum and standard deviation were 10.9 and 2.42 years, respectively). A total of 1514 hip fracture cases were recorded. The incidence rates of hip fracture were 9.15, 8.02, 9.58, 10.61, 12.51, and 13.43 per 1000 person-years in patients with baseline HbA1c levels of < 6%, 6-7%, 7%-8%, 8%-9%, 9%-10%, and 10%, respectively. After multivariate adjustment, the risk of hip fracture increased among patients with HbA1c levels of 9%-10% and 10.0% compared with patients with HbA1c levels of 6-7% (hazard ratio, 1.24; 95% confidence interval, 1.02-1.49 and 1.32; 1.09-1.58, respectively). Significant linear trends among various HbA1c levels were observed (P