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Shaik AR, Kohli S, Vohora D. Bone effects of metformin monotherapy and its combination with teneligliptin: A 12-week follow-up study in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2024; 213:111744. [PMID: 38878869 DOI: 10.1016/j.diabres.2024.111744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 05/24/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
AIMS The skeletal effects of metformin monotherapy and in combination with teneligliptin are not well illustrated in patients with T2DM. To address this, we conducted an observational study to evaluate the effect of these oral hypoglycemic agents on bone turnover markers. METHODS We recruited patients with T2DM and first-ever prescribed metformin monotherapy or metformin combined with teneligliptin from a tertiary care teaching hospital in New Delhi, North India. Both bone formation and resorption markers, IL-6 and PTD, were estimated along with glycated hemoglobin at baseline and 12 weeks. RESULTS In both groups, hbA1c levels decreased significantly from baseline to 12 weeks. In the metformin-treated group, β-CTX, sRANKL, IL-6, and PTD decreased significantly, and no significant changes were observed in P1NP, OC, BAP, or OPG at 12 weeks from baseline. In the metformin + teneligliptin group, BAP, β-CTX, sRANKL, IL-6, and PTD decreased significantly, and no significant changes were observed in P1NP, OC, or OPG after 12 weeks from baseline. CONCLUSIONS The positive bone outcome of metformin or teneligliptin was linked to bone resorption rather than bone formation and was independent of changes in HbA1c or PTD. However, these results must be confirmed with well-designed RCTs with more extended follow-up periods.
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Affiliation(s)
- Abdul Rahaman Shaik
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, Hamdard Nagar, New Delhi 110062, India
| | - Sunil Kohli
- Department of Medicine, Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, Hamdard Nagar, New Delhi 110062, India
| | - Divya Vohora
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, Hamdard Nagar, New Delhi 110062, India.
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Huang DN, Zeng Y, Ding HR, Zhang ZK, Wang Y, Han DX, Zhang XZ, Song LG. Characteristics of bone metabolism in the male patients with diabetic neuropathy. J Chin Med Assoc 2024; 87:292-298. [PMID: 38289285 DOI: 10.1097/jcma.0000000000001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the characteristics of bone metabolism and fracture risk in the type 2 diabetes mellitus (T2DM) patients with distal symmetric polyneuropathy (DSPN). METHODS A total of 198 T2DM individuals were recruited from January 2017 to December 2020. Patients with DSPN were evaluated by strict clinical and sensory thresholds. Biochemical parameters and bone mineral density (BMD) were measured. The BMD, bone turnover markers, and probability of fracture were compared between two groups, and the factors related to BMD and probability of hip fracture in 10 years were further explored. RESULTS Compared with type 2 diabetes mellitus without distal symmetric polyneuropathy (T2DN-) patients, type 2 diabetes mellitus with distal symmetric polyneuropathy (T2DN+) patients had lower level of cross-linked C-telopeptide (CTX) (0.32 ± 0.19 vs 0.38 ± 0.21 ng/mL, p = 0.038) and higher level of bone-specific alkaline phosphatase (BALP) (15.28 ± 5.56 vs 12.58 ± 4.41 μg/mL, p = 0.003). T2DN+ patients had higher BMD of lumbar L1-L4 (1.05 ± 0.19 vs 0.95 ± 0.37, p = 0.027) and higher probability of hip fracture (0.98 ± 0.88 vs 0.68 ± 0.63, p = 0.009) as compared to T2DN- individuals. Univariate correlation analysis showed that BALP level (coefficient (coef) = -0.054, p = 0.038), CTX level (coef = -2.28, p = 0.001), and hip fracture risk (coef = -1.02, p < 0.001) were negatively related to the BMD of L1-L4. As for the risk of hip fracture evaluated by WHO Fracture Risk Assessment Tool (FRAX), age (coef = 0.035, p < 0.001), use of insulin (coef = 0.31, p =0.015), and levels of BALP (coef = 0.031, p = 0.017) and CTX (coef = 0.7, p = 0.047) were positively related to the risk of hip fracture. Multivariate regression analysis showed that CTX level (coef = -1.41, p = 0.043) was still negatively related to BMD at the lumbar spine. CONCLUSION This study indicates that T2DM patients with DSPN have special bone metabolism represented by higher BALP level and lower CTX level which may increase BMD at the lumbar spine.
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Affiliation(s)
- Dong-Ni Huang
- Department of Endocrinology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Osteoporosis and Metabolic Bone Diseases, School of Medicine, Tongji University, Shanghai, China
| | - Yue Zeng
- Department of Endocrinology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Osteoporosis and Metabolic Bone Diseases, School of Medicine, Tongji University, Shanghai, China
| | - Hui-Ru Ding
- Department of Endocrinology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Osteoporosis and Metabolic Bone Diseases, School of Medicine, Tongji University, Shanghai, China
| | - Zi-Kai Zhang
- Division of Science and Research, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yu Wang
- Department of Endocrinology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Osteoporosis and Metabolic Bone Diseases, School of Medicine, Tongji University, Shanghai, China
| | - Dong-Xu Han
- Department of Endocrinology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Osteoporosis and Metabolic Bone Diseases, School of Medicine, Tongji University, Shanghai, China
| | - Xiu-Zhen Zhang
- Department of Endocrinology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Osteoporosis and Metabolic Bone Diseases, School of Medicine, Tongji University, Shanghai, China
| | - Li-Ge Song
- Department of Endocrinology, Shanghai Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
- Institute of Osteoporosis and Metabolic Bone Diseases, School of Medicine, Tongji University, Shanghai, China
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Vonna A, Salahudeen MS, Peterson GM. Medication-Related Hospital Admissions and Emergency Department Visits in Older People with Diabetes: A Systematic Review. J Clin Med 2024; 13:530. [PMID: 38256662 PMCID: PMC10817070 DOI: 10.3390/jcm13020530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 01/05/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Limited data are available regarding adverse drug reactions (ADRs) and medication-related hospitalisations or emergency department (ED) visits in older adults with diabetes, especially since the emergence of newer antidiabetic agents. This systematic review aimed to explore the nature of hospital admissions and ED visits that are medication-related in older adults with diabetes. The review was conducted according to the PRISMA guidelines. Studies in English that reported on older adults (mean age ≥ 60 years) with diabetes admitted to the hospital or presenting to ED due to medication-related problems and published between January 2000 and October 2023 were identified using Medline, Embase, and International Pharmaceutical Abstracts databases. Thirty-five studies were included. Medication-related hospital admissions and ED visits were all reported as episodes of hypoglycaemia and were most frequently associated with insulins and sulfonylureas. The studies indicated a decline in hypoglycaemia-related hospitalisations or ED presentations in older adults with diabetes since 2015. However, the associated medications remain the same. This finding suggests that older patients on insulin or secretagogue agents should be closely monitored to prevent potential adverse events, and newer agents should be used whenever clinically appropriate.
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Affiliation(s)
- Azizah Vonna
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia; (M.S.S.); (G.M.P.)
- Department of Pharmacy, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh 23111, Aceh, Indonesia
| | - Mohammed S. Salahudeen
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia; (M.S.S.); (G.M.P.)
| | - Gregory M. Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart 7005, Australia; (M.S.S.); (G.M.P.)
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Hu J, Han J, Jin M, Jin J, Zhu J. Effects of metformin on bone mineral density and bone turnover markers: a systematic review and meta-analysis. BMJ Open 2023; 13:e072904. [PMID: 37355276 PMCID: PMC10314630 DOI: 10.1136/bmjopen-2023-072904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 06/08/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVES Metformin is associated with osteoblastogenesis and osteoclastogenesis. This study aims to investigate the impacts of metformin therapy on bone mineral density (BMD) and bone turnover markers. DESIGN Systematic review and meta-analysis of randomised controlled trials. METHODS Searches were carried out in PubMed, EMBASE, Web of science, Cochrane library, ClinicalTrials.gov from database inception to 26 September 2022. Two review authors assessed trial eligibility in accordance with established inclusion criteria. The risk of bias was assessed using the Cochrane Risk of Bias tool (RoB V.2.0). Data analysis was conducted with Stata Statistical Software V.16.0 and Review Manager Software V.5.3. RESULTS A total of 15 studies with 3394 participants were identified for the present meta-analysis. Our pooled results indicated that metformin had no statistically significant effects on BMD at lumbar spine (SMD=-0.05, 95% CI=-0.19 to 0.09, p=0.47, participants=810; studies=7), at femoral (MD=-0.01 g/cm2, 95% CI=-0.04 to 0.01 g/cm2, p=0.25, participants=601; studies=3) and at hip (MD=0.01 g/cm2, 95% CI=-0.02 to 0.03 g/cm2, p=0.56, participants=634; studies=4). Metformin did not lead to significant change in osteocalcin, osteoprotegerin and bone alkaline phosphatase. Metformin induced decreases in N-terminal propeptide of type I procollagen (MD=-6.09 µg/L, 95% CI=-9.38 to -2.81 µg/L, p=0.0003, participants=2316; studies=7) and C-terminal telopeptide of type I collagen (MD=-55.80 ng/L, 95% CI=-97.33 to -14.26 ng/L, p=0.008, participants=2325; studies=7). CONCLUSION This meta-analysis indicated that metformin had no significant effect on BMD. Metformin decreased some bone turnover markers as N-terminal propeptide of type I procollagen and C-terminal telopeptide of type I collagen. But the outcomes should be interpreted with caution due to several limitations.
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Affiliation(s)
- Jinhua Hu
- Department of Pharmacy, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, Shanghai, China
| | - Jingjie Han
- Department of Pharmacy, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, Shanghai, China
| | - Min Jin
- Department of Pharmacy, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai, Shanghai, China
| | - Jing Jin
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, Shanghai, China
| | - Jialei Zhu
- Obstetrics and Gynecology Hospital of Fudan University, Shanghai, Shanghai, China
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Bahardoust M, Yarali M, Donyadideh G, Rahimi E, Naderi D, Tehrani FM, Delpisheh A. The use of metformin, sulfonylurea compounds and insulin and the risk of hip fractures in diabetic patients: a systematic review and meta-analysis of observational studies. BMC Musculoskelet Disord 2023; 24:367. [PMID: 37161384 PMCID: PMC10170842 DOI: 10.1186/s12891-023-06493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 05/04/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Hip fracture is a major health problem that occurs more often in the elderly, especially in diabetic patients. Some studies have been conducted regarding the effect of anti- diabetic drugs on fractures. But so far, no meta-analysis study has been conducted to investigate the effect of diabetic drugs on hip fractures. Therefore, this study investigated the relationship between anti-diabetic drugs (Metformin, Sulfonylurea, and insulin) with hip fractures. METHODS In this systematic review and meta analysis study, PubMed, Scopus, Google Scholar, and Web of Science databases were searched with specific keywords to find relevant studies. Two researchers included related studies after screening based on the title and full text. Cochran's Q and I2 tests were used to assess heterogeneity between studies. Publication bias between studies was evaluated for each drug using Egger's test. A 95% confidence interval was used for effect size significance. Overall, 49 studies, including 6,631,297 participants, were reviewed. RESULTS The results showed that metformin significantly reduced the risk of hip fracture (HR: 0.833, 95% CI: 0.759, 0.914, P:0.001). Consumption of sulfonylurea compounds was significantly associated with an increased risk of hip fracture. (HR: 1.175, 95% CI:1.068,1.293, P:0.001), The risk of hip fracture in patients receiving insulin was significantly higher than in diabetic patients who did not receive insulin. (HR:1.366, 95% CI:1.226,1.522, P:0.001). CONCLUSION The results of this study showed that taking metformin reduces the risk of hip fracture, and insulin and Sulfonylurea increase the risk of hip fracture.
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Affiliation(s)
- Mansour Bahardoust
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Yarali
- School of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Elham Rahimi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Delaram Naderi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | - Ali Delpisheh
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Sinclair AJ, Abdelhafiz AH. Metabolic Impact of Frailty Changes Diabetes Trajectory. Metabolites 2023; 13:metabo13020295. [PMID: 36837914 PMCID: PMC9960364 DOI: 10.3390/metabo13020295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/25/2023] [Accepted: 02/13/2023] [Indexed: 02/19/2023] Open
Abstract
Diabetes mellitus prevalence increases with increasing age. In older people with diabetes, frailty is a newly emerging and significant complication. Frailty induces body composition changes that influence the metabolic state and affect diabetes trajectory. Frailty appears to have a wide metabolic spectrum, which can present with an anorexic malnourished phenotype and a sarcopenic obese phenotype. The sarcopenic obese phenotype individuals have significant loss of muscle mass and increased visceral fat. This phenotype is characterised by increased insulin resistance and a synergistic increase in the cardiovascular risk more than that induced by obesity or sarcopenia alone. Therefore, in this phenotype, the trajectory of diabetes is accelerated, which needs further intensification of hypoglycaemic therapy and a focus on cardiovascular risk reduction. Anorexic malnourished individuals have significant weight loss and reduced insulin resistance. In this phenotype, the trajectory of diabetes is decelerated, which needs deintensification of hypoglycaemic therapy and a focus on symptom control and quality of life. In the sarcopenic obese phenotype, the early use of sodium-glucose transporter-2 inhibitors and glucagon-like peptide-1 receptor agonists is reasonable due to their weight loss and cardio-renal protection properties. In the malnourished anorexic phenotype, the early use of long-acting insulin analogues is reasonable due to their weight gain and anabolic properties, regimen simplicity and the convenience of once-daily administration.
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Affiliation(s)
- Alan J. Sinclair
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
| | - Ahmed H. Abdelhafiz
- Foundation for Diabetes Research in Older People (fDROP), King’s College, London WC2R 2LS, UK
- Department of Geriatric Medicine Rotherham General Hospital, Rotherham S60 2UD, UK
- Correspondence:
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Tamaki J, Ogawa S, Fujimori K, Ishii S, Nakatoh S, Okimoto N, Kamiya K, Iki M. Hip and vertebral fracture risk after initiating antidiabetic drugs in Japanese elderly: a nationwide study. J Bone Miner Metab 2023; 41:29-40. [PMID: 36517653 DOI: 10.1007/s00774-022-01372-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 09/20/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION We aimed to clarify the risks of initiating antidiabetic drugs for fractures using a nationwide health insurance claims database (NDBJ). MATERIALS AND METHODS Patients aged ≥ 65 years initiating antidiabetic drugs at the outpatient department were enrolled after a 180-day period without prescribed antidiabetic drugs and followed with during 2012-2018 using NDBJ. The adjusted hazard risks (HRs) of each antidiabetic drug (thiazolidine, alpha-glucosidase inhibitor, dipeptidyl peptidase-4 [DPP-4] inhibitor, sulfonylurea, glinide, and insulin) for fractures compared with biguanide were obtained adjusting for age, gender, polypharmacy, dementia, and the other antidiabetic drugs. RESULTS The DPP-4 inhibitor was the most often prescribed antidiabetic drug followed by biguanide with prescribed proportions of 71.7% and 12.9%. A total of 4,304 hip fractures and 9,388 vertebral fractures were identified among the 966,700 outpatient participants. Compared with biguanide, insulin, alpha-glucosidase inhibitor, and DPP-4 inhibitor were related to increased hip fracture risks. Vertebral fracture risk was higher in outpatients prescribed with insulin, thiazolidine, and DPP-4 inhibitor compared with biguanide. Patients prescribed insulin for hip and vertebral fractures' adjusted HRs were 2.17 (95% CI 1.77-2.66) and 1.45 (95% CI 1.24-1.70), respectively. Those prescribed DPP-4 inhibitor for hip and vertebral fractures' adjusted HRs were 1.27 (95% CI 1.15-1.40) and 1.20 (95% CI 1.12-1.28), respectively. CONCLUSIONS Initiating insulin increased the risk of not only hip fractures but also vertebral fractures. Patients initiating antidiabetic drugs had increased risks of hip and vertebral fractures compared with those initiating biguanide independently for age, gender, polypharmacy, and dementia in the Japanese elderly.
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Affiliation(s)
- Junko Tamaki
- Department of Hygiene and Public Health, Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan.
- Faculty of Medicine, National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, KindaiUniversity, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Sumito Ogawa
- Department of Geriatric Medicine, GraduateSchoolofMedicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8511, Japan
- Faculty of Medicine, National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, KindaiUniversity, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Kenji Fujimori
- Department of Health Administration and Policy, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan
- Faculty of Medicine, National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, KindaiUniversity, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Shigeyuki Ishii
- Department of Regulatory Science, SchoolofPharmacy, Tokyo University of Pharmacy and Life Sciences, Horinouchi, Hachiouji, Tokyo, Japan
- Faculty of Medicine, National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, KindaiUniversity, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Shinichi Nakatoh
- Department of Orthopedic Surgery, Asahi General Hospital, 477 TomariShimo-Nikawa-gun, Asahimachi, 939-0798, Japan
- Faculty of Medicine, National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, KindaiUniversity, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Nobukazu Okimoto
- Okimoto Clinic, 185-4 Kubi, Yutaka-machi, Kure, Hiroshima, 734-0304, Japan
- Faculty of Medicine, National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, KindaiUniversity, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Kuniyasu Kamiya
- Department of Hygiene and Public Health, Faculty of Medicine, Osaka Medical and Pharmaceutical University, 2-7 Daigaku-Machi, Takatsuki, Osaka, 569-8686, Japan
| | - Masayuki Iki
- Faculty of Medicine, Kindai University, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
- Faculty of Medicine, National Database Japan-Osteoporosis Management (NDBJ-OS) Study Group, KindaiUniversity, 377-2 Oono-higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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Poret F, Nacher M, Pujo J, Cauvin JM, Demar M, Massicard M, Sabbah N. Risk factors for hypoglycaemia in people with diabetes admitted to the Emergency Department of a Hospital in French Guiana. Diabet Med 2022; 39:e14736. [PMID: 34738244 DOI: 10.1111/dme.14736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/19/2021] [Accepted: 11/04/2021] [Indexed: 11/27/2022]
Abstract
AIMS/INTRODUCTION Strict management of glucose levels in elderly people with diabetes or with comorbidities exposes them to the risk of severe hypoglycaemia (capillary or venous glucose ≤3.3 mmol/L) and the associated morbidity and mortality. We aimed to describe the clinical, laboratory, and epidemiological characteristics of people with diabetes admitted to the Emergency Department in Cayenne, French Guiana for severe hypoglycaemia and identify avoidable behaviours in this population. MATERIALS AND METHODS An observational epidemiological study of adults with diabetes who presented to the Emergency Department with severe hypoglycaemia was conducted between 2015 and 2018. Their medical history, clinical and laboratory data were collected. The primary outcome was the association between therapeutic misuse and age ≥65 years. RESULTS Overall, 178 admissions were analysed. The main cause of hypoglycaemia was insulin dosing-error or inappropriate glycaemic targets. Among those ≥65 years, 59% had a glycated haemoglobin ≤48 mmol/mol (6.5%), and the median duration of their diabetes was 20 years. Among them, 60% were treated with sulfonylurea, repaglinide, biphasic insulin, or mixed drugs, and 48% were on non-diabetes related treatments that had a hypoglycaemic effect. Furthermore, 23% of the elderly treated with oral antidiabetics had chronic kidney disease. CONCLUSION Many avoidable risk factors for severe hypoglycaemia have been highlighted, in particular insulin dosing errors or non-compliance with recommendations for participants ≥ 65 years. Primary care physicians and homecare nurses need to provide preventive interventions and undergo training.
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Affiliation(s)
- Fabien Poret
- Department of Emergency, Cayenne Hospital Center, Cayenne, French Guiana
| | - Mathieu Nacher
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
| | - Jean Pujo
- Department of Emergency, Cayenne Hospital Center, Cayenne, French Guiana
| | - Jean-Michel Cauvin
- Department of Medical Information, Cayenne Hospital Center, Cayenne, French Guiana
| | - Magalie Demar
- Laboratory of Parasitology-Mycology (LHUPM), Cayenne Hospital Center, Cayenne, French Guiana
- EA3593, Amazon Ecosystems and Tropical Diseases, University of Guiana, Georgetown, French Guiana
| | - Mickael Massicard
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
| | - Nadia Sabbah
- Clinical Investigation Center Antilles French Guiana (CIC INSERM 1424), Cayenne Hospital Center, Cayenne, French Guiana
- Department of Endocrinology and Metabolic Diseases, Cayenne Hospital Center, Cayenne, French Guiana
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Wang Y, Yu L, Ye Z, Lin R, Sun AR, Liu L, Wei J, Deng F, Zhong X, Cui L, Li L, Liu Y. Association of metformin use with fracture risk in type 2 diabetes: A systematic review and meta-analysis of observational studies. Front Endocrinol (Lausanne) 2022; 13:1038603. [PMID: 36714564 PMCID: PMC9874692 DOI: 10.3389/fendo.2022.1038603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/21/2022] [Indexed: 01/12/2023] Open
Abstract
AIMS Increasing evidence suggests that metformin can affect bone metabolism beyond its hypoglycemic effects in diabetic patients. However, the effects of metformin on fracture risk in type 2 diabetes mellitus (T2DM) patients remain unclear. A systematic review and meta-analysis were performed in this study to evaluate the association between metformin application and fracture risk in T2DM patients based on previous studies published until June 2021. METHODS A systematic search was performed to collect publications on metformin application in T2DM patients based on PubMed, Embase, Cochran, and Web of Science databases. Meta-analysis was performed by using a random-effects model to estimate the summary relative risks (RRs) with 95% confidence intervals (CIs). Subgroup analyses based on cohort/case-control and ethnicity and sensitivity analyses were also performed. RESULTS Eleven studies were included in the meta-analysis. Results demonstrated metformin use was not significantly associated with a decreased risk of fracture (RR, 0.91; 95% CI, 0.81-1.02; I2 = 96.8%). Moreover, metformin use also demonstrated similar results in subgroup analyses of seven cohort studies and four case-control studies, respectively (RR, 0.90; 95% CI, 0.76-1.07; I2 = 98.0%; RR, 0.96; 96% CI, 0.89-1.03; I2 = 53.7%). Sensitivity analysis revealed that there was no publication bias. CONCLUSION There was no significant correlation between fracture risk and metformin application in T2DM patients. Due to a limited number of existing studies, further research is needed to make a definite conclusion for clinical consensus.
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Affiliation(s)
- Yining Wang
- Zhanjiang Key Laboratory of Orthopaedic Technology and Trauma Treatment, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, China
- Guangdong Provincial Key Laboratory for Research and Development of Natural Drug, School of Pharmacy, Guangdong Medical University, Zhanjiang, China
| | - Liming Yu
- Department of Stomatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhiqiang Ye
- Guangdong Provincial Key Laboratory for Research and Development of Natural Drug, School of Pharmacy, Guangdong Medical University, Zhanjiang, China
| | - Rui Lin
- Zhanjiang Key Laboratory of Orthopaedic Technology and Trauma Treatment, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, China
- Guangdong Provincial Key Laboratory for Research and Development of Natural Drug, School of Pharmacy, Guangdong Medical University, Zhanjiang, China
| | - Antonia RuJia Sun
- Centre for Biomedical Technologies, Queensland University of Technology, Brisbane, Queensland, Australia
- Center for Translational Medicine Research and Development, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen, Guangdong, China
| | - Lingna Liu
- Guangdong Provincial Key Laboratory for Research and Development of Natural Drug, School of Pharmacy, Guangdong Medical University, Zhanjiang, China
- Marine Medical Research Institute of Zhanjiang, Zhanjiang, China
| | - Jinsong Wei
- Department of Orthopedics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Feifu Deng
- Department of Orthopedics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiangxin Zhong
- Department of Orthopedics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Liao Cui
- Guangdong Provincial Key Laboratory for Research and Development of Natural Drug, School of Pharmacy, Guangdong Medical University, Zhanjiang, China
- *Correspondence: Yanzhi Liu, ; Li Li, ; Liao Cui,
| | - Li Li
- Guangdong Provincial Key Laboratory for Research and Development of Natural Drug, School of Pharmacy, Guangdong Medical University, Zhanjiang, China
- *Correspondence: Yanzhi Liu, ; Li Li, ; Liao Cui,
| | - Yanzhi Liu
- Zhanjiang Key Laboratory of Orthopaedic Technology and Trauma Treatment, Zhanjiang Central Hospital, Guangdong Medical University, Zhanjiang, China
- Guangdong Provincial Key Laboratory for Research and Development of Natural Drug, School of Pharmacy, Guangdong Medical University, Zhanjiang, China
- Marine Medical Research Institute of Zhanjiang, Zhanjiang, China
- *Correspondence: Yanzhi Liu, ; Li Li, ; Liao Cui,
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10
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Hangaard S, Jensen MH. Effect of Newer Long-Acting Insulins on Hypoglycemia and Fracture Risk Among People with Diabetes: A Systematic Review. Curr Osteoporos Rep 2021; 19:637-643. [PMID: 34741730 DOI: 10.1007/s11914-021-00706-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW To investigate the effect of newer long-acting insulins on the risk of hypoglycemic episodes and fractures in people with diabetes. RECENT FINDINGS Hypoglycemic episodes are the critical limiting factor in glycemic management due to a deteriorating effect on quality of life. Hypoglycemia may in severe cases lead to unconsciousness and thus fractures. Newer long-acting insulins may result in more stable blood glucose levels, less hypoglycemic episodes, and reduced risk of fractures. Use of insulin increases risk of hypoglycemic episodes, and hypoglycemic episodes increase risk of fractures plausible due to falls. Newer ultra-long-acting insulins reduce risk of hypoglycemic episodes compared to older alternatives, and they are thus promising for reducing fracture risk. However, more studies are needed to determine whether these new insulins reduce risk of fractures.
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Affiliation(s)
- Stine Hangaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, 9210, Aalborg, Denmark
| | - Morten Hasselstrøm Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark.
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, 9210, Aalborg, Denmark.
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11
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Abdelhafiz AH, Peters S, Sinclair AJ. Low glycaemic state increases risk of frailty and functional decline in older people with type 2 diabetes mellitus - Evidence from a systematic review. Diabetes Res Clin Pract 2021; 181:109085. [PMID: 34634389 DOI: 10.1016/j.diabres.2021.109085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 09/18/2021] [Accepted: 09/29/2021] [Indexed: 10/20/2022]
Abstract
AIMS To explore risk of frailty and functional decline associated with low glycaemia in older people with type 2 diabetes. METHODS Systematic review. RESULTS 11 studies included. Six studies investigated risk of frailty or physical decline with hypoglycaemia. Hypoglycaemia increased risk of incident frailty (HR 1.60, 95% CI 1.14 to 2.42) in one study and risk of fractures in four studies (2.24, 1.56 to 3.21, 1.24, 1.13 to 1.37, 1.94, 1.67 to 2.24 and 1.71, 1.35 to 2.16 respectively). In sixth study, hypoglycaemia associated with dependency (P < 0.001). Five studies explored association of low blood glucose/HbA1c with frailty. One study showed that mean blood glucose decreased with increasing frailty (p = 0.003). Two studies reported that HbA1c inversely correlated with clinical frailty scale (r = -0.31, p < 0.01) and HbA1c < 6.9% increased risk of frailty (HR, 1.41 95% CI 1.12 to 1.78) respectively. Last two studies showed that HbA1c < 6.5% associated with risk of any fracture (HR 1.08, 95% CI 1.06 to 1.11) and HbA1c < 6.0% associated with increased risk of care need (3.45, 1.02 to 11.6) respectively. CONCLUSIONS Low glycaemia increases risk of frailty and functional decline in older people with type 2 diabetes. Management should minimise incidence of low glycaemia in these patients.
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Affiliation(s)
- A H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, United Kingdom
| | - S Peters
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, United Kingdom
| | - A J Sinclair
- King's College, London, United Kingdom; Foundation for Diabetes Research in Older People (fDROP), Droitwich Spa WR9 0QH, UK.
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12
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Khosla S, Samakkarnthai P, Monroe DG, Farr JN. Update on the pathogenesis and treatment of skeletal fragility in type 2 diabetes mellitus. Nat Rev Endocrinol 2021; 17:685-697. [PMID: 34518671 PMCID: PMC8605611 DOI: 10.1038/s41574-021-00555-5] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2021] [Indexed: 02/08/2023]
Abstract
Fracture risk is increased in patients with type 2 diabetes mellitus (T2DM). In addition, these patients sustain fractures despite having higher levels of areal bone mineral density, as measured by dual-energy X-ray absorptiometry, than individuals without T2DM. Thus, additional factors such as alterations in bone quality could have important roles in mediating skeletal fragility in patients with T2DM. Although the pathogenesis of increased fracture risk in T2DM is multifactorial, impairments in bone material properties and increases in cortical porosity have emerged as two key skeletal abnormalities that contribute to skeletal fragility in patients with T2DM. In addition, indices of bone formation are uniformly reduced in patients with T2DM, with evidence from mouse studies published over the past few years linking this abnormality to accelerated skeletal ageing, specifically cellular senescence. In this Review, we highlight the latest advances in our understanding of the mechanisms of skeletal fragility in patients with T2DM and suggest potential novel therapeutic approaches to address this problem.
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Affiliation(s)
- Sundeep Khosla
- Division of Endocrinology and Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA.
| | - Parinya Samakkarnthai
- Division of Endocrinology and Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
- Division of Endocrinology, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - David G Monroe
- Division of Endocrinology and Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
| | - Joshua N Farr
- Division of Endocrinology and Kogod Center on Aging, Mayo Clinic, Rochester, MN, USA
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13
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Hidayat K, Fang QL, Shi BM, Qin LQ. Influence of glycemic control and hypoglycemia on the risk of fracture in patients with diabetes mellitus: a systematic review and meta-analysis of observational studies. Osteoporos Int 2021; 32:1693-1704. [PMID: 33860816 DOI: 10.1007/s00198-021-05934-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 03/18/2021] [Indexed: 12/20/2022]
Abstract
Individuals with diabetes mellitus (DM) have an increased risk of fracture. Glycemic control is crucial to the management of DM, but there are concerns pertaining to hypoglycemia development in the course of glycemic control target achievement. The extent to which glycemic control may affect the risk of fracture remains less defined. Hypoglycemia-induced falls have been suggested to contribute to an elevated risk of fracture in DM patients. In this meta-analysis of observational studies, we aimed to investigate the relative contribution of glycemic control, as measured by glycated hemoglobin (HbA1c), and hypoglycemia to the risk of fracture in DM. The PubMed and Web of Science databases were searched for relevant studies. A random-effects model was used to generate summary relative risks (RRs) and 95% confidence intervals (CIs). Both increased HbA1c levels (RR per 1% increase 1.08, 95% CI 1.03, 1.14; nstudies = 10) and hypoglycemia (RR 1.52, 95% CI 1.23, 1.88; nstudies = 8) were associated with an increased risk of fracture. The association between HbA1c levels and the risk of fracture was somewhat nonlinear, with a noticeably increased risk observed at an HbA1c level ≥ 8%. The positive associations of HbA1c levels and hypoglycemia with the risk of fracture did not reach statistical significance in the studies that adjusted for insulin use, hypoglycemia, or falls for the former and in those that adjusted for falls for the latter. In summary, both increased HbA1c levels and hypoglycemia may increase the risk of fracture in patients with DM. The positive association between HbA1c levels and the risk of fracture appears to be, in part, explained by hypoglycemia-induced falls, possibly due to insulin use. The avoidance of hypoglycemia in the course of achieving good glycemic control through the careful selection of glucose-lowering medications may contribute to fracture prevention by reducing the risk of falls related to treatment-induced hypoglycemia.
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Affiliation(s)
- K Hidayat
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China.
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, No. 199 Ren'ai Road, Suzhou, 215123, China.
| | - Q-L Fang
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China
| | - B-M Shi
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, No. 188 Shizi Street, Suzhou, 215006, China.
| | - L-Q Qin
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, No. 199 Ren'ai Road, Suzhou, 215123, China.
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14
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Komorita Y, Minami M, Maeda Y, Yoshioka R, Ohkuma T, Kitazono T. Prevalence of bone fracture and its association with severe hypoglycemia in Japanese patients with type 1 diabetes. BMJ Open Diabetes Res Care 2021; 9:e002099. [PMID: 33888545 PMCID: PMC8070870 DOI: 10.1136/bmjdrc-2020-002099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 03/09/2021] [Accepted: 04/05/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Type 1 diabetes (T1D) is associated with higher fracture risk. However, few studies have investigated the relationship between severe hypoglycemia and fracture risk in patients with T1D, and the results are controversial. Besides, none has investigated the risk factors for fracture in Asian patients with T1D. The aim of the present study was to investigate the prevalence of bone fracture and its relationship between severe hypoglycemia and other risk factors in Japanese patients with T1D. RESEARCH DESIGN AND METHODS The single-center cross-sectional study enrolled 388 Japanese patients with T1D (mean age, 45.2 years; women, 60.4%; mean duration of diabetes, 16.6 years) between October 2019 and April 2020. The occurrence and circumstances of any fracture after the diagnosis of T1D were identified using a self-administered questionnaire. The main outcomes were any anatomic site of fracture and fall-related fracture. Severe hypoglycemia was defined as an episode of hypoglycemia that required the assistance of others to achieve recovery. RESULTS A total of 92 fractures occurred in 64 patients, and 59 fractures (64%) were fall-related. Only one participant experienced fracture within the 10 years following their diagnosis of diabetes. In logistic regression analysis, the multivariate-adjusted ORs (95% CIs) of a history of severe hypoglycemia were 2.11 (1.11 to 4.09) for any fracture and 1.91 (0.93 to 4.02) for fall-related fracture. Fourteen of 18 participants with multiple episodes of any type of fracture had a history of severe hypoglycemia (p<0.001 vs no fracture). CONCLUSIONS We have shown that a history of severe hypoglycemia is significantly associated with a higher risk of bone fracture in Japanese patients with T1D.
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Affiliation(s)
- Yuji Komorita
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Minami Diabetes Clinical Research Center, Fukuoka, Japan
| | - Masae Minami
- Minami Diabetes Clinical Research Center, Fukuoka, Japan
- Clinic Masae Minami, Fukuoka, Japan
| | - Yasutaka Maeda
- Minami Diabetes Clinical Research Center, Fukuoka, Japan
- Clinic Masae Minami, Fukuoka, Japan
| | - Rie Yoshioka
- Minami Diabetes Clinical Research Center, Fukuoka, Japan
- Clinic Masae Minami, Fukuoka, Japan
| | - Toshiaki Ohkuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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15
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Mattishent K, Loke YK. Meta-Analysis: Association Between Hypoglycemia and Serious Adverse Events in Older Patients Treated With Glucose-Lowering Agents. Front Endocrinol (Lausanne) 2021; 12:571568. [PMID: 33763024 PMCID: PMC7982741 DOI: 10.3389/fendo.2021.571568] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/11/2021] [Indexed: 12/17/2022] Open
Abstract
AIMS We conducted a meta-analysis of serious adverse events (dementia, macro- and micro-vascular events, falls and fractures, and death) associated with hypoglycemia in older patients treated with glucose lowering drugs. MATERIALS AND METHODS Meta-analysis of studies reporting on hypoglycemia and adverse events. The search included studies from two previously published systematic reviews, and an updated search of MEDLINE and EMBASE from April 2014 to November 2019. We assessed study validity based on ascertainment of hypoglycemia, adverse events and adjustment for confounders, and conducted a random effects meta-analyses, assessing heterogeneity using the I2 statistic. RESULTS We included 44 studies involving 2,507,434 participants. Most of the studies used adjusted analysis for confounders and hypoglycaemic events were typically identified based on healthcare databases (severe events). Hypoglycemia was associated with increased likelihood of death in a meta-analysis of eighteen studies, pooled OR 2.02 (95% Confidence Interval 1.75-2.32). Studies assessing mortality signal a time-response relationship with a higher risk of adverse events occurring within the first 90 days after hypoglycemia. Our meta-analysis of nine studies demonstrated that hypoglycaemic episodes were associated with dementia - pooled OR 1.50 (95% CI 1.29-1.74). Our meta-analysis of nineteen studies demonstrated associations between hypoglycaemia and macrovascular complications, pooled OR 1.81 (95% CI 1.70-1.94), and microvascular complications (two studies) pooled OR 1.77 (95% CI 1.49-2.10). There is also an association between hypoglycemia and cardiovascular death (six studies) - pooled OR 2.11 (95% CI 1.55 to 2.87). Similarly, our meta-analysis of six studies demonstrated an association between hypoglycemia and falls and fractures, pooled OR 1.78 (95% CI 1.44-2.21) and 1.68 (95% CI 1.37-2.07) respectively. CONCLUSION This meta-analysis confirms previously reported concerns of serious harm following hypoglycemia, especially in the immediate time period after a hypoglycaemic event. Avoidance of hypoglycaemic episodes should be a priority in this vulnerable population.
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16
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Mönnig E, Spaepen E, Osumili B, Mitchell BD, Snoek F, Peyrot M, Kern W, Holstein A. Conversations and Reactions Around Severe Hypoglycaemia (CRASH): Results from the German Cohort of a Global Survey of People with Type 1 Diabetes or Insulin-Treated Type 2 Diabetes and Caregivers. Exp Clin Endocrinol Diabetes 2020; 130:145-155. [PMID: 33368091 DOI: 10.1055/a-1310-7963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND A global cross-sectional survey (CRASH) was designed to provide information about the experiences of people with diabetes (PWD) and their caregivers in relation to severe hypoglycaemic events. METHODS Adults with type 1 diabetes or insulin-treated type 2 diabetes who had experienced one or more severe hypoglycaemic events within the past 3 years, and adult caregivers for such people, were recruited from medical research panels using purposive sampling. We present here results from Germany. RESULTS Approximately 100 individuals in each of the four participant groups completed a 30-minute online survey. Survey results indicated that the most recent severe hypoglycaemic event made many participants feel scared (80.4%), unprepared (70.4%), and/or helpless (66.5%). Severe hypoglycaemia was discussed by healthcare professionals at every visit with only 20.2% of participants who had ever had this conversation, and 53.5% of participants indicated that their insulin regimen had not changed following their most recent event. 37.1% of PWD/people with diabetes cared for by caregivers owned a glucagon kit at the time of survey completion. CONCLUSIONS The survey identified areas for improvement in the prevention and management of severe hypoglycaemic events. For healthcare professionals, these include enquiring more frequently about severe hypoglycaemia and adjusting blood glucose-lowering medication after a severe hypoglycaemic event. For individuals with diabetes and their caregivers, potential improvements include ensuring availability of glucagon at all times. Changes in these areas could lead not only to improved patient wellbeing but also to reduced use of emergency services/hospitalisation and, consequently, lower healthcare costs.
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Affiliation(s)
| | | | | | | | - Frank Snoek
- Amsterdam University Medical Centers, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark Peyrot
- Loyola University Maryland, Baltimore, Maryland, USA
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17
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Al-Mashhadi Z, Viggers R, Fuglsang-Nielsen R, de Vries F, van den Bergh JP, Harsløf T, Langdahl B, Gregersen S, Starup-Linde J. Glucose-Lowering Drugs and Fracture Risk-a Systematic Review. Curr Osteoporos Rep 2020; 18:737-758. [PMID: 33165875 DOI: 10.1007/s11914-020-00638-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/24/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Diabetes mellitus (DM) is associated with increased fracture risk. The aim of this systematic review was to examine the effects of different classes of glucose-lowering drugs on fracture risk in patients with type 2 DM. The heterogeneity of the included studies did not allow formal statistical analyses. RECENT FINDINGS Sixty studies were included in the review. Metformin, dipeptidylpeptidase-IV inhibitors, glucagon-like peptide-1 receptor agonists, and sodium-glucose cotransporter 2-inhibitors do not appear to increase fracture risk. Results for insulin and sulphonylureas were more disparate, although there may be an increased fracture risk related to hypoglycemia and falls with these treatments. Glitazones were consistently associated with increased fracture risk in women, although the evidence was sparser in men. New glucose-lowering drugs are continuously being developed and better understanding of these is leading to changes in prescription patterns. Our findings warrant continued research on the effects of glucose-lowering drugs on fracture risk, elucidating the class-specific effects of these drugs.
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Affiliation(s)
- Z Al-Mashhadi
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - R Viggers
- Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - R Fuglsang-Nielsen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Internal Medicine, Regional Hospital Horsens, Horsens, Denmark
| | - F de Vries
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, The Netherlands
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht, The Netherlands
| | - J P van den Bergh
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, The Netherlands
- Faculty of Medicine and Life Sciences, University Hasselt, Hasselt, Belgium
| | - T Harsløf
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark
| | - B Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark
| | - S Gregersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark
| | - Jakob Starup-Linde
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
- Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, 8220, Aarhus N, Denmark.
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18
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Kanazawa I, Inaba M, Inoue D, Uenishi K, Saito M, Shiraki M, Suzuki A, Takeuchi Y, Hagino H, Fujiwara S, Sugimoto T. Executive summary of clinical practice guide on fracture risk in lifestyle diseases. J Bone Miner Metab 2020; 38:746-758. [PMID: 32892240 DOI: 10.1007/s00774-020-01149-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/23/2020] [Indexed: 12/16/2022]
Abstract
Accumulating evidence has shown that patients with lifestyle diseases such as type 2 diabetes mellitus, chronic kidney disease, and chronic obstructive pulmonary disease are at increased risk of osteoporotic fracture. Fractures deteriorate quality of life, activities of daily living, and mortality as well as a lifestyle disease. Therefore, preventing fracture is an important issue for those patients. Although the mechanism of the lifestyle diseases-induced bone fragility is still unclear, not only bone mineral density (BMD) reduction but also bone quality deterioration are involved in it. Because fracture predictive ability of BMD and FRAX® is limited, especially for patients with lifestyle diseases, the optimal management strategy should be established. Thus, when the intervention of the lifestyle diseases-induced bone fragility is initiated, the deterioration of bone quality should be taken into account. We here review the association between lifestyle diseases and fracture risk and proposed an algorism of starting anti-osteoporosis drugs for patients with lifestyle diseases.
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Affiliation(s)
- Ippei Kanazawa
- Kanazawa Diabetes and Osteoporosis Clinic, 990-2-1 Enya-cho, Izumo, Shimane, 693-0021, Japan.
| | - Masaaki Inaba
- Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Inoue
- Third Department of Medicine, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Kazuhiro Uenishi
- Division of Nutritional Physiology, Kagawa Nutrition University, Saitama, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Masataka Shiraki
- Research Institute and Practice for Involutional Diseases, Nagano, Japan
| | - Atsushi Suzuki
- Department of Endocrinology and Metabolism, Fujita Health University, Aichi, Japan
| | - Yasuhiro Takeuchi
- Endocrine Center, Toranomon Hospital and Okinaka Memorial Institute for Medical Research, Tokyo, Japan
| | - Hiroshi Hagino
- School of Health Science Faculty of Medicine, Tottori University, Tottori, Japan
| | - Saeko Fujiwara
- Department of Pharmacy, Yasuda Women's University, Hiroshima, Japan
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19
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Eckert AJ, Mader JK, Altmeier M, Mühldorfer S, Gillessen A, Dallmeier D, Shah VN, Heyer C, Hartmann B, Holl RW. Fracture risk in patients with type 2 diabetes aged ≥50 years related to HbA1c, acute complications, BMI and SGLT2i-use in the DPV registry. J Diabetes Complications 2020; 34:107664. [PMID: 32624333 PMCID: PMC7502496 DOI: 10.1016/j.jdiacomp.2020.107664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/16/2020] [Accepted: 06/21/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Alexander J Eckert
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany; German Centre for Diabetes Research (DZD), Neuherberg, Germany.
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | | | | | | | - Dhayana Dallmeier
- AGAPLESION Bethesda Clinic, Geriatric Center Ulm, Ulm, Germany; Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, USA
| | | | - Bettina Hartmann
- Heilig-Geist Hospital Bensheim, Department of Gastroenterology and Diabetology, Bensheim, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany; German Centre for Diabetes Research (DZD), Neuherberg, Germany
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20
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Lui DTW, Lee CH, Chan YH, Chow WS, Fong CHY, Siu DCW, Tse HF, Woo YC, Lam KSL. HbA1c variability, in addition to mean HbA1c, predicts incident hip fractures in Chinese people with type 2 diabetes. Osteoporos Int 2020; 31:1955-1964. [PMID: 32385660 DOI: 10.1007/s00198-020-05395-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/17/2020] [Indexed: 12/28/2022]
Abstract
UNLABELLED Type 2 diabetes is associated with an increased risk of hip fractures. We hypothesize that long-term glycemic variability predicts incident hip fractures. We demonstrated that HbA1c variability predicted incident hip fractures independent of mean HbA1c, suggesting the potential benefits of minimizing glycemic variability in addition to optimizing mean glycemia for bone health. INTRODUCTION Type 2 diabetes is associated with an increased risk of hip fractures, and a linear relationship between HbA1c levels and hip fracture incidence has been observed. We hypothesize that HbA1c variability also predicts incident hip fractures in type 2 diabetes. METHODS Chinese individuals with type 2 diabetes aged ≥ 60 years were identified from electronic health records in Hong Kong between 2008 and 2012 and observed for incident hip fractures. Hip fracture was defined by the International Classification of Diseases (Ninth Revision) code 820. HbA1c variability was determined using standard deviation, adjusted standard deviation, and coefficient of variation of HbA1c measurements in the 5 years preceding the entry date. Multivariable Cox regression analysis was used to evaluate associations between HbA1c variability and incident hip fractures. RESULTS A total of 83,282 participants were included. Their mean age was 71.3 ± 7.5 years, duration of diabetes 11.7 ± 7.7 years, baseline HbA1c 56.6 ± 13.5 mmol/mol (7.33 ± 1.23%), and median follow-up 6.8 years. All indices of HbA1c variability were significant independent predictors of incident hip fractures, with an adjusted hazard ratio of up to 1.29 (all p < 0.001), and remained to be independent predictors across groups of different intensity of glycemic control. Mean HbA1c ≥ 64 mmol/mol (8.0%) was associated with a 25% increase in incident hip fractures compared with mean HbA1c < 53 mmol/mol (7.0%). CONCLUSION HbA1c variability is an independent positive predictor of hip fracture in type 2 diabetes, across the spectrum of varying degree of glycemic control, while a high HbA1c is also not advisable from the perspective of bone health.
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Affiliation(s)
- D T W Lui
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - C H Lee
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR, China
| | - Y H Chan
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - W S Chow
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - C H Y Fong
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - D C W Siu
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - H F Tse
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
| | - Y C Woo
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
| | - K S L Lam
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China.
- State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR, China.
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Komorita Y, Iwase M, Fujii H, Ohkuma T, Ide H, Yoshinari M, Oku Y, Nakamura U, Kitazono T. Both hypo- and hyperglycaemia are associated with increased fracture risk in Japanese people with type 2 diabetes: the Fukuoka Diabetes Registry. Diabet Med 2020; 37:838-847. [PMID: 31556147 DOI: 10.1111/dme.14142] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/23/2019] [Indexed: 01/02/2023]
Abstract
AIM The impact of glycaemic control on fracture risk is controversial, which may be due to the possible presence of hypoglycaemia. The aim of this study was to separately investigate the impacts of severe hypoglycaemia and poor glycaemic control on fracture risk in people with type 2 diabetes. METHODS Overall, 4706 Japanese participants (2755 men and 1951 postmenopausal women) with type 2 diabetes (mean age 66 years) were followed prospectively (a median of 5.3 years; follow-up rate, 97.6%), and were stratified by severe hypoglycaemia status and glycaemic control. The primary outcome was fractures at any anatomic site. RESULTS Fractures occurred in 662 participants (249 men and 413 women). The age- and sex-adjusted incidence rates (expressed per 1000 person-years) were: 71.2 (multiple episodes of severe hypoglycaemia), 43.1 (one episode), 25.2 [HbA1c < 53 mmol/mol (< 7%) without severe hypoglycaemia], 28.7 [HbA1c 53 to < 64 mmol/mol (7% to < 8%) without severe hypoglycaemia], 27.7 [HbA1c 64 to < 75 mmol/mol (8% to < 9%) without severe hypoglycaemia] and 40.5 [HbA1c ≥ 75 mmol/mol (≥ 9%) without severe hypoglycaemia]. Multivariate-adjusted hazard ratios (95% confidence intervals) for fractures were 2.24 (1.56, 3.21) in those with multiple episodes of severe hypoglycaemia, and 1.42 (1.04, 1.95) in those with HbA1c ≥ 75 mmol/mol (≥ 9%) without severe hypoglycaemia, compared with those with HbA1c < 53 mmol/mol (< 7%) without severe hypoglycaemia. CONCLUSIONS Both severe hypoglycaemia and poor glycaemic control were significantly related to an increased risk of fracture in people with type 2 diabetes, although severe hypoglycaemia conferred a stronger risk.
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Affiliation(s)
- Y Komorita
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of Internal Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - M Iwase
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Diabetes Centre, Hakujyuji Hospital, Fukuoka, Japan
| | - H Fujii
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Ohkuma
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - H Ide
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Division of General Internal Medicine, School of Oral Health Science, Kyushu Dental University, Kitakyushu, Japan
| | - M Yoshinari
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Y Oku
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - U Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - T Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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22
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Chin KY, Wong SK, Ekeuku SO, Pang KL. Relationship Between Metabolic Syndrome and Bone Health - An Evaluation of Epidemiological Studies and Mechanisms Involved. Diabetes Metab Syndr Obes 2020; 13:3667-3690. [PMID: 33116718 PMCID: PMC7569044 DOI: 10.2147/dmso.s275560] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022] Open
Abstract
Metabolic syndrome (MetS) and osteoporosis are two medical problems plaguing the ageing populations worldwide. Though seemingly distinctive to each other, metabolic derangements are shown to influence bone health. This review summarises the relationship between MetS and bone health derived from epidemiological studies and explains the mechanistic basis of this relationship. The discourse focuses on the link between MetS and bone mineral density, quantitative sonometric indices, geometry and fracture risk in humans. The interesting sex-specific trend in the relationship, probably due to factors related to body composition and hormonal status, is discussed. Mechanistically, each component of MetS affects the bone distinctly, forming a complex interacting network influencing the skeleton. Lastly, the effects of MetS management, such as pharmacotherapies, exercise and bariatric surgery, on bone, are presented. This review aims to highlight the significant relationship between MetS and bone, and proper management of MetS with the skeletal system in mind could prevent cardiovascular and bone complications.
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Affiliation(s)
- Kok-Yong Chin
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- State Key Laboratory of Oncogenes and Related Genes, Renji-Med X Clinical Stem Cell Research Center, Department of Urology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
- Correspondence: Kok-Yong Chin Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, MalaysiaTel +60 3-9145 9573 Email
| | - Sok Kuan Wong
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Sophia Ogechi Ekeuku
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Kok-Lun Pang
- Department of Pharmacology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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23
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Liu JM, Zhu DL, Mu YM, Xia WB. Management of fracture risk in patients with diabetes-Chinese Expert Consensus. J Diabetes 2019; 11:906-919. [PMID: 31219236 DOI: 10.1111/1753-0407.12962] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/20/2019] [Accepted: 06/17/2019] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jian-Min Liu
- Department of Endocrine and Metabolic Diseases, Rui-jin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China
| | - Da-Long Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital Affiliated to Nanjing University Medical School, Nanjing, China
| | - Yi-Ming Mu
- Department of Endocrinology, The General Hospital of the Chinese People's Liberation Army, Beijing, China
| | - Wei-Bo Xia
- Department of Endocrinology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
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24
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Ledesma G, Umpierrez GE, Morley JE, Lewis-D'Agostino D, Keller A, Meinicke T, van der Walt S, von Eynatten M. Efficacy and safety of linagliptin to improve glucose control in older people with type 2 diabetes on stable insulin therapy: A randomized trial. Diabetes Obes Metab 2019; 21:2465-2473. [PMID: 31297968 DOI: 10.1111/dom.13829] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 06/25/2019] [Accepted: 07/07/2019] [Indexed: 12/30/2022]
Abstract
AIM To assess the addition of linagliptin as an alternative to insulin uptitration in older people with type 2 diabetes on stable insulin therapy. MATERIALS AND METHODS This phase 4, randomized, multicentre, double-blinded, placebo-controlled, 24-week study recruited individuals on stable insulin, with baseline HbA1c 7.0%-10.0%, aged ≥60 years and body mass index ≤45 kg/m2 . HbA1c and fasting plasma glucose were measured at study visits, and participants assessed glycaemic control with a self-monitoring blood glucose device. Adverse events (AEs) were reported during the study. RESULTS Three hundred and two participants were randomized 1:1 to linagliptin 5 mg qd and placebo, with one third of patients from Japan. Study population age and HbA1c (baseline mean ± SD) were 72.4 ± 5.4 years and 8.2 ± 0.8%, respectively; ~80% of participants were aged ≥70 years; 80% had macrovascular complications, one third had a baseline estimated glomerular filtration rate <60 mL/min/1.73 m2 ; and half had been diagnosed with diabetes for >15 years. Linagliptin significantly improved glucose control at 24 weeks (HbA1c-adjusted mean change vs. placebo: -0.63%; P <0.0001) and the probability of achieving predefined HbA1c targets without hypoglycaemia (HbA1c <8.0%: OR 2.02; P <0.05 and HbA1c <7.0%: OR 2.44; P <0.01). Linagliptin versus placebo was well tolerated, with similar incidences of AEs, including clinically important hypoglycaemia (blood glucose <54 mg/dL) or severe hypoglycaemia. CONCLUSIONS Addition of linagliptin improves glucose control without an excess of hypoglycaemia in older patients with type 2 diabetes on stable insulin therapy.
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Affiliation(s)
| | | | - John E Morley
- Division of Geriatric Medicine, Saint Louis University, St. Louis, Missouri
| | | | - Annett Keller
- Global BDS, Boehringer Ingelheim Pharma GmbH & Co, KG, Ingelheim, Germany
| | - Thomas Meinicke
- TA CardioMetabolism, Boehringer Ingelheim International GmbH, Biberach, Germany
| | - Sandra van der Walt
- International Project Management Cardiometabolic/CNS, Boehringer Ingelheim International GmbH, Ingelheim, Germany
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25
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[Diabetes mellitus and risk of hip fracture. A systematic review]. Rev Esp Geriatr Gerontol 2019; 55:34-41. [PMID: 31668564 DOI: 10.1016/j.regg.2019.08.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/22/2019] [Accepted: 08/25/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES It has been reported that the risk of fracture is increased in patients with diabetes mellitus (DM). The aim of this study was to investigate the possible relationship between DM and hip fracture, as well as any associated risk factors, by means of a systemic review of the literature. METHODS PubMed and SCOPUS databases were used to search for relevant studies published from January 2001 to August 2018. Retrospective and prospective cohort studies were selected in which the estimated risk of hip fracture was demonstrated by comparing groups of diabetic patients with non-diabetics. A search was also made for risk factors independent from the association between DM and hip fracture. RESULTS A total of 27 articles that fulfilled the inclusion criteria were included. A clear association was observed in diabetic patients (women and men) compared to non-diabetics patients. Among the risk factors, the most important ones were the fact that diabetes was type 1, probably associated with greater risk to a longer duration of DM, and being a female. CONCLUSIONS There is an increased risk of hip fracture in patients diagnosed with DM. This association is more significant in diabetes type 1 and women.
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26
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Cheng L, Hu Y, Li YY, Cao X, Bai N, Lu TT, Li GQ, Li N, Wang AN, Mao XM. Glucagon-like peptide-1 receptor agonists and risk of bone fracture in patients with type 2 diabetes: A meta-analysis of randomized controlled trials. Diabetes Metab Res Rev 2019; 35:e3168. [PMID: 30974033 DOI: 10.1002/dmrr.3168] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 03/05/2019] [Accepted: 04/09/2019] [Indexed: 12/22/2022]
Abstract
AIMS To evaluate the association between glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and the risk of bone fracture in patients with type 2 diabetes mellitus (T2DM). MATERIALS AND METHODS We conducted a systematic literature search in PubMed, Embase, the Cochrane Library, and Web of Science from inception to 28 February 2018 and identified eligible randomized controlled trials. The following data were extracted from each study: first author, year of publication, sample size, patient characteristics, study design, intervention drug, control drug, follow-up time, and incident bone fracture events. A meta-analysis was conducted using Review Manager 5.3 software to calculate the odds ratio (OR) and 95% confidence intervals (CI) for dichotomous variables. RESULTS A total of 38 studies with 39 795 patients with T2DM were included. There were 241 incident bone fracture cases (107 in the GLP-1 RAs group and 134 in the control group). Compared with patients who received placebo and other anti-diabetic drugs, those who received GLP-1 RAs treatment showed a pooled OR of 0.71 (95% CI, 0.56-0.91) for bone fracture. Subgroup analysis showed that treatments with liraglutide and lixisenatide were associated with significantly reduced risk of bone fractures (ORs, 0.56; 95% CI, 0.38-0.81 and 0.55; 95% CI, 0.31-0.97, respectively). However, other GLP-1 RAs did not show superiority to placebo or other anti-diabetic drugs. Moreover, these beneficial effects were dependent on the duration of GLP-1 RAs treatment, only a GLP-1 RAs treatment period of more than 52 weeks could significantly lower the risk of bone fracture in patients with T2DM (OR, 0.71; 95% CI, 0.56-0.91). CONCLUSIONS Compared with placebo and other anti-diabetic drugs, liraglutide and lixisenatide were associated with a significant reduction in the risk of bone fractures, and the beneficial effects were dependent on the duration of treatment.
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Affiliation(s)
- Liang Cheng
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
- Department of Endocrinology, Huai'an Second People's Hospital, Huai'an, China
| | - Yun Hu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yun-Yun Li
- Department of Information Statistics Center, Huai'an Second People's Hospital, Huai'an, China
| | - Xin Cao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Ning Bai
- Department of Endocrinology, Affiliated Hospital of Jiangnan University, Wuxi, China
| | - Ting-Ting Lu
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guo-Qing Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Na Li
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - An-Ning Wang
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Ming Mao
- Department of Endocrinology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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Hidayat K, Du X, Wu MJ, Shi BM. The use of metformin, insulin, sulphonylureas, and thiazolidinediones and the risk of fracture: Systematic review and meta-analysis of observational studies. Obes Rev 2019; 20:1494-1503. [PMID: 31250977 DOI: 10.1111/obr.12885] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 04/29/2019] [Accepted: 05/08/2019] [Indexed: 12/12/2022]
Abstract
Certain glucose-lowering medications have been implicated in the risk of fracture. While there is convincing evidence from randomized controlled trials (RCTs) that thiazolidinedione use is associated with a higher risk of fracture, the effects of metformin, insulin, and sulphonylureas on the risk of fracture remain equivocal because these medications are not generally investigated in RCTs. A meta-analysis of observational studies to provide further insights into the association between the use of metformin, insulin, sulphonylureas, or thiazolidinediones and the risk of fracture was performed. PubMed and Web of Science databases were searched to identify relevant observational studies. A random effects model was used to estimate the summary relative risks (RRs) with 95% confidence intervals (CIs). The use of insulin (RR 1.49, 95% CI 1.29, 1.73; n = 23 studies), sulphonylureas (RR 1.30, 95% CI 1.18, 1.43; n = 10), and thiazolidinediones (RR 1.24, 95% CI 1.13, 1.35; n = 14) was associated with an increased risk of fracture, whereas the use of metformin was associated with a reduced risk of fracture (RR 0.86, 95% CI 0.75, 0.99; n = 12). Regarding types of thiazolidinediones, both pioglitazone (RR 1.38, 95% CI 1.23, 1.54; n = 5) and rosiglitazone (RR 1.34, 95% CI 1.14, 1.58; n = 5) were positively associated with the risk of fracture. In summary, there is compelling evidence to discourage the use of thiazolidinediones in individuals with an increased risk of fracture, whereas metformin appears to have a good safety profile for the risk of fracture. The reduced risk of fracture with metformin could possibly be due to the reduced overall risk of fracture among metformin users, as this medication is typically prescribed in the early stages of type 2 diabetes mellitus. The use of insulin or sulphonylureas may increase fracture risk; this risk is most likely attributed to an increased risk of hypoglycaemia-induced falls. Further confirmation by additional RCTs is required to determine whether the observed association between the use of metformin, insulin, or sulphonylureas and the risk of fracture is due to treatment with these medications or confounding factors.
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Affiliation(s)
- Khemayanto Hidayat
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xuan Du
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Meng-Jiao Wu
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Bi-Min Shi
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of Soochow University, Suzhou, China
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28
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Jensen MH, Vestergaard P. Hypoglycaemia and type 1 diabetes are associated with an increased risk of fractures. Osteoporos Int 2019; 30:1663-1670. [PMID: 31129687 DOI: 10.1007/s00198-019-05014-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/13/2019] [Indexed: 10/26/2022]
Abstract
UNLABELLED People with diabetes have an increased risk of fractures, and in this study, the effect of hypoglycaemia and insulin on this risk was investigated. Type 1 diabetes and hypoglycaemia did increase the fracture risk, and prevention of hypoglycaemia is thus an important focus area in the prevention of fractures. INTRODUCTION Studies have shown that type 1 diabetes (T1D) and type 2 diabetes (T2D) are associated with increased risk of fractures. Especially, subjects with T1D have an increased risk of fractures. The purpose of this study was to investigate the association of T1D, hypoglycaemia and insulin on fracture risk. METHODS A cohort study with T1D subjects (n = 19,896) and T2D subjects (n = 312,188) matched with subjects from the general populated (n = 996,252) and a nested case-control study with T1D subjects with fracture (n = 895) as cases and T1D subjects without (n = 2685) as controls were conducted based on subjects from the Danish National Patient Registry (DNPR). RESULTS T1D (HR = 2.47, 95% CI 2.37 to 2.59), age (HR = 1.05, 95% CI 1.05 to 1.05), previous fracture (HR = 1.95, 95% CI 1.92 to 1.99) and being female (HR = 2.06, 95% CI 2.04 to 2.09) increased the risk of fractures. Also, T2D (HR = 1.14, 95% CI 1.11 to 1.18) increased the risk of proximal upper arm and shoulder fractures. T1D (HR = 2.41, 95% CI 2.20 to 2.65) increased the risk of hip and femoral region fractures. Hypoglycaemia (OR = 1.58, 95% CI 1.27 to 1.97) increased the risk of fractures, whereas insulin use did not change the risk. CONCLUSIONS Hypoglycaemic episodes are associated with increased fracture risk, and the frequency of hypoglycaemic episodes leading to hospital admission was above 16% for T1D subjects. Prevention of hypoglycaemia is thus an important focus area in the prevention of fractures.
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Affiliation(s)
- M H Jensen
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark.
- Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, 9220, Aalborg, Denmark.
| | - P Vestergaard
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
- Department of Endocrinology, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark
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29
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Berra C, De Fazio F, Azzolini E, Albini M, Zangrandi F, Mirani M, Garbossa S, Guardado-Mendoza R, Condorelli G, Folli F. Hypoglycemia and hyperglycemia are risk factors for falls in the hospital population. Acta Diabetol 2019; 56:931-938. [PMID: 30929079 DOI: 10.1007/s00592-019-01323-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 03/08/2019] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To determine the role of hypoglycemia, hyperglycemia or the combination of both as independent risk factors for falls in a hospital population. Secondary objectives included evaluation of other risk factors for falling and their relationships with glucose levels. RESEARCH DESIGN AND METHODS Retrospective cohort study over 2 years on hospitalized subjects (N = 57411) analyzing in-hospital-falls and capillary glucose values. Bivariate analysis (χ2 test) and multivariate analysis (logistic regression) were performed to test for correlation of glucose values, age, sex, Charlson index, service of care, diagnosis at discharge and diabetes treatment with risk of in-hospital-falls. RESULTS The comparison of patients who experienced a fall (fall population) with the non-fall population suggested that: glucose determinations were significantly more frequent in the fall population (OR 3.45; CI 2.98-3.99; p < 0.0001); values of glucose below 70 mg/dl and over 200 mg/dl were significantly associated to falls during hospitalization (OR 1.76; CI 1.42-2.19; p < 0.001) as compared to glycemic values between 70 and 200 mg/dl; diabetes treatment was significantly correlated to risk of fall (OR 2.97; CI 2.54-3.49; p < 0.001); the frequency of glycemia measurements below 70 mg/dl and over 200 mg/dl in the same subject was significantly associated to falls during hospitalization (OR 1.01; CI 1.01-1.02; p < 0.001). CONCLUSION Hypoglycemia and hyperglycemia during hospital stays are correlated with an increased risk for falls in the hospitalized population. Presence of diabetes, use of insulin or glucose variability could potentially constitute risk factors for falls inside the hospital as well.
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Affiliation(s)
- Cesare Berra
- Metabolic Disease and Diabetes, Multimedica IRCCS, Milan, Sesto San Giovanni, Italy.
| | - Francesco De Fazio
- Quality Monitoring Office, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Elena Azzolini
- Clinical Quality Department, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Marco Albini
- Quality Monitoring Office, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Federico Zangrandi
- Clinical Quality Department, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Marco Mirani
- Metabolic Disease and Diabetes, Humanitas Clinical and Research Hospital, Milan, Rozzano, Italy
| | - Stefania Garbossa
- Departmental Unit Diabetes and Metabolic Disorders, ASST Santi Paolo e Carlo, Milan, Italy
- Department of Health Science, University of Milan, Milan, Italy
| | - Rodolfo Guardado-Mendoza
- Research Department, Hospital Regional de Alta Especialidad del Bajío, León, Mexico
- Department of Medicine and Nutrition, University of Guanajuato, León, Guanajuato, Mexico
| | - Gianluigi Condorelli
- Department of Cardiovascular Medicine, Humanitas Clinical and Research Center - IRCCS, Milan, Rozzano, Italy
- Humanitas University, Milan, Italy
- Institute of Genetics and Biomedical Research (Milan Unit), National Research Council of Italy, Milan, Rozzano, Italy
| | - Franco Folli
- Departmental Unit Diabetes and Metabolic Disorders, ASST Santi Paolo e Carlo, Milan, Italy.
- Department of Health Science, University of Milan, Milan, Italy.
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30
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Zhang Y, Chen Q, Liang Y, Dong Y, Mo X, Zhang L, Zhang B. Insulin use and fracture risk in patients with type 2 diabetes: A meta-analysis of 138,690 patients. Exp Ther Med 2019; 17:3957-3964. [PMID: 31007738 PMCID: PMC6468519 DOI: 10.3892/etm.2019.7461] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/22/2019] [Indexed: 12/31/2022] Open
Abstract
Patients with type 2 diabetes mellitus (T2DM) have been reported to have an enhanced risk of bone fracture, however the association between insulin treatment and risk of fracture in patients with T2DM remains to be fully elucidated. The aim of the present meta-analysis was to examine the possible association between insulin treatment and risk of fracture in patients with T2DM. Relevant studies published prior to and including April 2018 were identified by literature searches in PubMed, Embase and Cochrane Library databases. A meta-analysis was performed, which included relevant trials of patients with T2DM comparing insulin to oral anti-diabetic drugs. The combined effect was expressed as a pooled risk ratio (RR) with 95% confidence interval (CI), using a random-effects model. Subgroup analysis was performed to consolidate the results. A total of 7 studies comprising 138,690 patients were eligible for inclusion in the present meta-analysis. After exclusion of one study that introduced major heterogeneity, treatment with, insulin was associated with a significantly increased risk of fracture among patients with T2DM (RR=1.24, 95% CI, 1.07–1.44; P=0.004). Subgroup analysis by sex indicated that the RR for men was 1.04 (95% CI, 0.76–1.44, P=0.801) and that for women was 1.22 (95% CI, 0.92–1.62, P=0.175). Subgroup analysis by fracture site indicated that the RR for hip was 1.18 (95% CI, 0.83–1.68, P=0.363), that for vertebrae was 1.28 (95% CI, 0.90–1.81, P=0.169) and that for non-vertebrae was 1.06 (95% CI, 0.80–1.41, P=0.686). Subgroup analysis by study design suggested that the RR for prospective and retrospective studies was 1.35 (95% CI, 1.06–1.71, P=0.014) and 1.16 (95% CI, 0.99–1.35, P=0.059), respectively. Subgroup analysis by region indicated that the RR for Europe was 1.16 (95% CI, 0.91–1.48, P=0.220), that for North America was 1.24 (95% CI, 0.81–1.90, P=0.333) and that for Asia was 1.34 (95% CI, 0.91–1.98, P=0.141). In conclusion, treatment with insulin increased the risk of fractures among patients with T2DM compared with oral anti-diabetic drugs; however, the association was influenced by various factors, including sex, fracture site, study design and geographical region.
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Affiliation(s)
- Yuxian Zhang
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Qiuying Chen
- Department of Radiology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510627, P.R. China.,Department of Imaging and Nuclear Medicine, Graduate College, Jinan University, Guangzhou, Guangdong 510000, P.R. China
| | - Yuying Liang
- Department of Radiology, The First Affiliated Hospital, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510000, P.R. China
| | - Yuhao Dong
- Department of Imaging and Nuclear Medicine, Graduate College, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Xiaokai Mo
- Department of Imaging and Nuclear Medicine, Graduate College, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Lu Zhang
- Department of Imaging and Nuclear Medicine, Graduate College, Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
| | - Bin Zhang
- Department of Radiology, The First Affiliated Hospital, Jinan University, Guangzhou, Guangdong 510627, P.R. China.,Department of Imaging and Nuclear Medicine, Graduate College, Jinan University, Guangzhou, Guangdong 510000, P.R. China
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de Abreu LLF, Holloway-Kew KL, Mohebbi M, Sajjad MA, Kotowicz MA, Pasco JA. Fracture Risk in Women with Dysglycaemia: Assessing Effects of Baseline and Time-Varying Risk Factors. Calcif Tissue Int 2019; 104:262-272. [PMID: 30483848 DOI: 10.1007/s00223-018-0498-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 11/22/2018] [Indexed: 12/13/2022]
Abstract
Although individuals with diabetes appear to have a higher fracture risk compared to those without diabetes, fracture risk in impaired fasting glucose (IFG) has not been thoroughly explored. This study determined associations between glycaemia status and fracture risk. Women (n = 575, aged 50 + years) enrolled in the Geelong Osteoporosis Study, were followed from baseline (1993-1997), to date of first fracture, death or December 31, 2010, whichever occurred first (median 13.7 years, IQR 7.4-14.8). Hazard ratios (HRs) for any fracture (excluding fingers, toes, skull/face), as well as major osteoporotic fracture (MOF, clinical spine, hip, proximal humerus, wrist), in diabetes (n = 69), IFG (n = 250) and normoglycaemia (n = 256), were calculated using a Cox proportional hazards model. Normoglycaemia was set as the reference category. A Cox proportional hazards model with time-varying covariates was also used to assess change in baseline risk factors at the 10-year follow-up visit (2004-2008). During follow-up (6433 person-years), 162 women sustained any fracture and 104 had a MOF. Unadjusted fracture risk was higher in diabetes (HR 1.64; 95% CI 1.02-2.63) compared to normoglycaemia, but IFG and normoglycaemia had similar risk (HR 1.06; 95% CI 0.76-1.47). Age- and BMD-adjusted any-fracture risk in diabetes compared to normoglycaemia was greater (HR 1.59; 95% CI 0.98-2.58); IFG was similar to normoglycaemia (HR 1.01; 95% CI 0.72-1.41). For MOF, unadjusted and age- and BMD-adjusted fracture risk in IFG was similar to normoglycaemia HR 1.02; 95% CI 0.74-1.40 and HR 0.95; 95% CI 0.69-1.32, respectively, but diabetes was higher compared to normoglycaemia (unadjusted HR 1.64; 95% CI 1.04-2.60; adjusted HR 1.57; 95% CI 0.98-2.51). In the time-varying model, there was no difference between IFG in either the unadjusted or adjusted models, for both any fracture and MOF (p > 0.05). For diabetes, there was a significant difference between normoglycaemia in the adjusted model for any fracture (p = 0.046), but not for MOF (p = 0.103). An increased risk of fracture for women with diabetes was observed after accounting for time-varying risk factors. There was no difference in fracture risk detected for women with IFG.
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Affiliation(s)
| | - Kara L Holloway-Kew
- Deakin University, Geelong, VIC, 3220, Australia.
- Epi-Centre for Healthy Ageing (ECHA), IMPACT Strategic Research Centre, Deakin University, Health Education and Research Building, PO Box 281, Geelong, VIC, 3220, Australia.
| | | | | | - Mark A Kotowicz
- Deakin University, Geelong, VIC, 3220, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, 3010, Australia
- Barwon Health, Geelong, VIC, 3220, Australia
| | - Julie A Pasco
- Deakin University, Geelong, VIC, 3220, Australia
- Department of Medicine-Western Health, The University of Melbourne, St Albans, VIC, 3010, Australia
- Barwon Health, Geelong, VIC, 3220, Australia
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Abdelhafiz AH, Sinclair AJ. Cognitive Frailty in Older People with Type 2 Diabetes Mellitus: the Central Role of Hypoglycaemia and the Need for Prevention. Curr Diab Rep 2019; 19:15. [PMID: 30806826 DOI: 10.1007/s11892-019-1135-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW To highlight the central role of hypoglycaemia in the causation of cognitive frailty and explore ways of recognition and prevention of hypoglycaemia. RECENT FINDINGS Cognitive frailty is an emerging new concept defined as the concomitant presence of physical frailty and cognitive impairment. In older people with diabetes, cognitive frailty is associated with an increased risk of mortality greater than from either physical frailty or cognitive impairment alone. Hypoglycaemia is directly associated with increased risk of cognitive impairment and physical frailty which are the two components of cognitive frailty. The incidence of hypoglycaemia in older people with diabetes is rising and hypoglycaemia-related hospitalisation has overtaken that of hyperglycaemia. Recognition of hypoglycaemic episodes in old age remains challenging which leads to misdiagnoses and under-reporting. Therefore, hypoglycaemia prevention strategies are needed. Research is still required to investigate whether prevention of hypoglycaemia would lead to a reduction in the incidence of cognitive frailty.
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Affiliation(s)
- A H Abdelhafiz
- Department of Geriatric Medicine, Rotherham General Hospital, Moorgate Road, Rotherham, S60 2UD, UK.
| | - A J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich Spa, WR9 0QH, UK
- Kings College, London, SE1 9NH, UK
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Abstract
Accumulating evidence has shown that the risk of osteoporotic fractures is increased in patients with diabetes mellitus (DM). Thus, DM-induced bone fragility has been recently recognized as a diabetic complication. Because the fracture risk is independent of the reduction in bone mineral density, deterioration of the bone quality may be the main cause of bone fragility. Although its mechanism remains poorly understood, accumulated collagen cross-links of advanced glycation end-products (AGEs) and dysfunctions of osteoblast and osteocyte may be involved. Previous studies have suggested that various diabetes-related factors, such as chronic hyperglycemia, insulin, insulin-like growth factor-I, AGEs, and homocysteine, are associated with the risk of bone fragility caused by impaired bone formation and bone remodeling. Furthermore, several anti-diabetic drugs are known to affect bone metabolism and fracture risk. We herein review the association between DM and fracture risk as well as the mechanism of DM-induced bone fragility based on recent evidence.
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Affiliation(s)
- Ippei Kanazawa
- Internal Medicine 1, Shimane University Faculty of Medicine, Japan
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Lo C, Sung FC, Mou CH, Lin TC, Tseng CH, Tzeng YL. Population study evaluating fracture risk among patients with chronic osteomyelitis. PLoS One 2017; 12:e0189743. [PMID: 29267371 PMCID: PMC5739410 DOI: 10.1371/journal.pone.0189743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 11/30/2017] [Indexed: 11/18/2022] Open
Abstract
Background Studies investigating the fracture risk in patients with chronic osteomyelitis (COM) limited to case reports. This study evaluated the association between COM and subsequent fracture risk using population-based data. Methods A subset claims data of the Taiwan National Health Insurance was used to identify 7,147 patients with COM newly diagnosed in 1999–2005 without fracture history and 28,588 general population controls, frequency matched by sex, age and diagnosis date. The incident fractures was measured by the end of 2013. Results The incidence density of fracture was 1.94-fold greater in the COM cohort than in controls (21.5 vs. 11.1 per 1000 person-years), with the adjusted hazard ratio (HR) of 1.81 (95% CI: 1.67–1.95) for COM patients compared to controls after controlling for sex, age, and comorbidities of diabetes, osteoporosis, depression and end-stage renal disease in Cox proportional hazards regression. The fracture risk increased with age and women were at greater risk than men. The fracture incidence increased substantially in those with osteoporosis, 40.2 per 1000 person-years in COM patients. Site specific analysis showed a higher portion of incident fractures for lower limbs, 52.7% in COM cohort and 46.3% in controls. Conclusion Findings in this 15-year follow-up observation support our hypothesis that patients with COM are at an elevated risk of subsequent fracture. COM patients and the elderly deserve adequate consultation and awareness for fracture prevention.
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Affiliation(s)
- Chyi Lo
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
| | - Fung-Chang Sung
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Chih-Hsin Mou
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Tzu-Chieh Lin
- Division of Traumatology, Emergency Department, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chun-Huang Tseng
- Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Ya-Ling Tzeng
- School of Nursing, College of Health Care, China Medical University, Taichung, Taiwan
- Department of Nursing, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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