Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, 2, Yuh-Der Road, Taichung, 40447, Taiwan.
Department of Medicine, China Medical University, Taichung, 40402, Taiwan.
Osteoporos Int. 2017 Jul;28(7):2053-2060. doi: 10.1007/s00198-017-4021-4. Epub 2017 Apr 3.
Hypoglycemia is a major concern in glycemic control. Using the Taiwan National Health Insurance Research Database, we found that the risk of hip fracture was associated with emergency or hospitalization visits of severe hypoglycemia in patients with type 2 diabetes; greater visits were associated with higher incidence of hip fracture.
The objective of the study was to assess the risk of hip fracture among patients with type 2 diabetes mellitus (T2DM) and severe hypoglycemia.
Using the National Health Insurance Research database in Taiwan, we identified 2588 patients with T2DM who had developed severe hypoglycemia from 2001 to 2009. A comparison cohort who had never developed severe hypoglycemia was frequency matched at a ratio of approximately 1:2. Multivariate Cox proportional hazard regression analysis was used to evaluate the risk of hip fracture.
During a median follow-up period of 3.9 years, there were 219 hip fracture events in 5173 comparison cohorts and 148 hip fracture events in 2588 hypoglycemia cohorts. The incidence of hip fracture was higher in patients with severe hypoglycemia than without severe hypoglycemia (17.19 vs. 8.83 per 1000 person-years; adjusted HR 1.71, 95% CI = 1.35-2.16). Approximately half of the individuals developed hip fracture within 2 years from the first occurrence of severe hypoglycemia. There was a significant associated trend towards increased hip fracture risk with increasing average visit of severe hypoglycemia per year (p for trend <0.001). Medication analysis showed that patients taking sulfonylurea alone, insulin alone, and insulin secretagogues combined with insulin had a higher associated risk to develop hip fracture.
Severe hypoglycemia was associated with a higher risk to develop hip fracture. The more the visits of severe hypoglycemia per year indicated the higher associated risk in patients with T2DM. Fall is likely an important reason for severe hypoglycemia in relation to increased risk of hip fracture.
评估 2 型糖尿病（T2DM）伴严重低血糖患者发生髋部骨折的风险。
使用台湾全民健康保险研究数据库，我们确定了 2001 年至 2009 年期间发生严重低血糖的 2588 例 T2DM 患者。对从未发生过严重低血糖的患者进行频率匹配，匹配比例约为 1:2。采用多变量 Cox 比例风险回归分析评估髋部骨折的风险。
在中位随访 3.9 年期间，5173 例对照组中有 219 例髋部骨折事件，2588 例低血糖组中有 148 例髋部骨折事件。严重低血糖患者的髋部骨折发生率高于无严重低血糖患者（17.19 比 8.83 每 1000 人年；调整 HR 1.71，95%CI=1.35-2.16）。大约一半的患者在首次发生严重低血糖后 2 年内发生髋部骨折。随着每年严重低血糖就诊次数的增加，髋部骨折风险呈显著相关趋势（趋势检验 P<0.001）。药物分析显示，单独使用磺脲类药物、单独使用胰岛素以及胰岛素促分泌剂联合胰岛素的患者发生髋部骨折的风险更高。
严重低血糖与髋部骨折风险增加相关。每年严重低血糖就诊次数越多，T2DM 患者的相关风险越高。严重低血糖与髋部骨折风险增加可能与跌倒有关。
