Intensive Glycemic Control and Skeletal Health

患有2型糖尿病的老年人有更高的骨折风险，增加了这种疾病的健康负担。 糖尿病患者更频繁的跌倒和可能降低的骨强度被认为是关键 促成因素。然而，尚不清楚更好地控制糖尿病是否足以减少骨折 风险或是否应给予额外的治疗。观察性研究表明， 改善血糖控制可通过预防福尔斯、降低福尔斯的严重程度以及 减少骨质流失。先前的试验表明，改善控制可以减少糖尿病 并发症，特别是周围神经病变和视网膜病变，是福尔斯的危险因素。密集 血糖控制可以通过降低晚期糖基化终产物的水平来保持骨强度， 骨，改善骨细胞功能，减少骨丢失。另一方面，低血糖增加 伴随严格血糖控制的发作可促进老年糖尿病人群的福尔斯下降， 骨折的风险增加。为了确定强化血糖控制是否有助于 对于老年糖尿病患者骨折、福尔斯和/或骨质流失的预防措施，我们建议增加 骨折，福尔斯和骨密度的测量最近启动的临床试验， 糖尿病的心血管风险（雅阁）。雅阁将跟踪10，000名中老年成年人 （平均年龄63岁）2型糖尿病平均5.6年，以确定是否心血管疾病 强化血糖控制（A1 C < 6%）与标准血糖控制（A1 C ~ 7.5%）相比，事件减少。我们 假设随机分配到强化对照组患者骨折发生率较低，福尔斯频率较低， 与随机分配到标准对照组的患者相比，骨丢失减少。在7,145辆雅阁中， 受试者，骨折和福尔斯将通过每12个月自我报告确定， 使用医疗记录进行集中裁决。髋关节和股骨近端骨矿物质密度两年的变化 将使用双能吸收测定法（DEXA）在子样本（N=240）中测定腰椎。

Older adults with type 2 diabetes have a higher risk of fractures, adding to the health burden of this disease. More frequentfalls and perhaps reduced bone strength in those with diabetes are thought to be key contributing factors. However, it is not clear whether better control of diabetes is sufficient to reduce fracture risk or whether additional treatment for osteoporosisshould be given. Observational studies suggest that improved glycemic control may reduce fracture risk by preventing falls, decreasing the severity of falls, and reducing bone loss. Previous trials have demonstrated that improved control reduces diabetic complications, particularly peripheral neuropathy and retinopathy, that are risk factors for falls. Intensive glycemic control may preserve bone strength through reduced levels of advanced glycation endproducts in the bone, improved bone cell function, and reduced bone loss. On the other hand, increased hypoglycemic episodes accompanying tight glycemic control could promote falls in the older diabetic population, resulting in an increased risk of fracture. In order to determine whether intensive glycemic control is useful as a prevention measure for fractures, falls and/or bone loss in older diabetic adults, we propose adding measures of fractures, falls and bone mineral density to the recently initiated clinical trial Actionto Control Cardiovascular Risk in Diabetes (ACCORD). ACCORD will follow 10,000 middle-aged and older adults (average age 63 years) with type 2 diabetes for an average of 5.6 years to determine if cardiovascular events are reduced by intensive (A1C < 6%) versus standard (A1C ~ 7.5%) glycemic control. We hypothesize that those randomized to intensive control will have a lower rate of fractures, less frequent falls, and reduced bone loss compared with those randomized to standard control. In 7,145 of the ACCORD participants, fractures and falls will be determined by self-report every 12 months, with reportedfractures adjudicated centrally using medical records. Change in bone mineral density over two years at the hip and lumbar spine will be determined in a subsample (N=240) using dual energy absorptiometry(DEXA).