Context
Patients with type 2 diabetes mellitus (T2DM) have an increased risk of low-trauma fractures. However, the effect of antidiabetic medication in relation to glycemic control on the risk of fracture is poorly understood.
Objective
To evaluate the association between the level of glycemic control, use of antidiabetic medication, and risk of low-trauma fractures in patients with newly diagnosed T2DM.
Methods
We conducted a nested case-control analysis among individuals registered within the Clinical Practice Research Datalink. The base population consisted of patients with newly diagnosed T2DM from 1995-2017. Cases were patients with a low-trauma fracture after T2DM diagnosis. We matched four controls to each case. Exposure of interest was glycemic control (last HbA1c level before fracture) and type of diabetes treatment. We conducted conditional logistic regression analyses adjusted for several confounders.
Results
We identified 8809 cases and 35219 controls. Patients with current metformin use and HbA1 levels of <8.0% had a reduced risk of fractures (aOR 0.89, 95% CI 0.83-0.96 and 0.81, 95% CI 0.73-0.90, respectively) compared with untreated patients. However, in patients receiving metformin plus one or two other antidiabetic drugs, or insulin (alone or in addition to other antidiabetic medication), the level of glycemic control was not associated with the risk of fracture compared with untreated patients.
Conclusions
While patients with good or medium glycemic control receiving current metformin monotherapy had a lower risk of fracture compared with untreated patients, glycemic control in patients receiving other treatment than metformin was not associated with risk of fracture.
Background
Previous studies suggested an elevated risk of venous thromboembolism (VTE) among patients with type 2 diabetes mellitus (T2DM), with a possible sex difference. The impact of glycemic control on the risk of VTE is unclear. Our objective was to analyze the association between glycemic control and the risk of unprovoked (idiopathic) VTE in men and women with T2DM.
Methods
We conducted a nested case–control analysis (1:4 matching) within a cohort of patients with incident T2DM between 1995 and 2019 using data from the CPRD GOLD. We excluded patients with known risk factors for VTE prior to onset of DM. Cases were T2DM patients with an unprovoked treated VTE. The exposure of interest was glycemic control measured as HbA1c levels. We conducted conditional logistic regression analyses adjusted for several confounders.
Results
We identified 2′653 VTE cases and 10′612 controls (53.1% females). We found no association between the HbA1c level and the risk of VTE in our analyses. However, when the most recent HbA1c value was recorded within 90 days before the index date, women with HbA1c levels > 7.0% had a 36–55% increased relative risk of VTE when compared to women with HbA1c > 6.5–7.0%.
Conclusions
Our study raises the possibility that female T2DM patients with HbA1c levels > 7% may have a slightly higher risk for unprovoked VTE compared to women with HbA1c levels > 6.5–7.0%. This increase may not be causal and may reflect differences in life style or other characteristics. We observed no effect of glycemic control on the risk of VTE in men.
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