Charlier Sarah, Vavanikunnel Janina, Becker Claudia, Jick Susan S, Meier Christian, Meier Christoph R
Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.
Hospital Pharmacy, University Hospital Basel, Basel, Switzerland.
J Clin Endocrinol Metab. 2021 Jan 23;106(2):554-566. doi: 10.1210/clinem/dgaa796.
Patients with type 2 diabetes mellitus (T2DM) have an increased risk of low-trauma fractures. However, the effect of antidiabetic medication in relation to glycemic control on the risk of fracture is poorly understood.
This work aimed to evaluate the association between the level of glycemic control, use of antidiabetic medication, and risk of low-trauma fractures in patients with newly diagnosed T2DM.
We conducted a nested case-control analysis among individuals registered in the Clinical Practice Research Datalink. The base population consisted of patients with newly diagnosed T2DM from 1995 to 2017. Cases were patients with a low-trauma fracture after T2DM diagnosis. We matched 4 controls to each case. Exposures of interest were glycemic control (last glycated hemoglobin [HbA1c] level before fracture) and type of diabetes treatment. We conducted conditional logistic regression analyses adjusted for several confounders.
We identified 8809 cases and 35 219 controls. Patients with current metformin use and HbA1c levels of less than 7.0% and between 7.0-8.0% had a reduced risk of fractures (adjusted odds ratio 0.89; 95% CI, 0.83-0.96 and 0.81; 95% CI, 0.73-0.90, respectively) compared with untreated patients. However, in patients receiving metformin plus 1 or 2 other antidiabetic drugs, or insulin (alone or in addition to other antidiabetic medication), the level of glycemic control was not associated with the risk of fracture compared with untreated patients.
While patients with good or medium glycemic control receiving current metformin monotherapy had a lower risk of fracture compared with untreated patients, glycemic control in patients receiving treatment other than metformin was not associated with risk of fracture.
2型糖尿病（T2DM）患者发生低创伤性骨折的风险增加。然而，抗糖尿病药物与血糖控制对骨折风险的影响尚不清楚。
本研究旨在评估新诊断的T2DM患者血糖控制水平、抗糖尿病药物的使用与低创伤性骨折风险之间的关联。
我们在临床实践研究数据链中登记的个体中进行了一项巢式病例对照分析。基础人群包括1995年至2017年新诊断的T2DM患者。病例为T2DM诊断后发生低创伤性骨折的患者。我们为每个病例匹配4名对照。感兴趣的暴露因素为血糖控制（骨折前最后糖化血红蛋白[HbA1c]水平）和糖尿病治疗类型。我们进行了条件逻辑回归分析，并对多个混杂因素进行了调整。
我们确定了8809例病例和35219名对照。与未治疗的患者相比，目前使用二甲双胍且HbA1c水平低于7.0%和在7.0 - 8.0%之间的患者骨折风险降低（调整后的优势比分别为0.89；95%可信区间，0.83 - 0.96和0.81；95%可信区间，0.73 - 0.90）。然而，在接受二甲双胍加1种或2种其他抗糖尿病药物或胰岛素（单独或除其他抗糖尿病药物外）治疗的患者中，与未治疗的患者相比，血糖控制水平与骨折风险无关。
与未治疗的患者相比，可以接受当前二甲双胍单药治疗的血糖控制良好或中等的患者骨折风险较低，而接受二甲双胍以外治疗的患者的血糖控制与骨折风险无关。
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