Use of glucose-lowering drugs and risk of fracture in patients with type 2 diabetes

Abstract

Background
Diabetes mellitus is associated with an increased risk of hip fracture. The aim of this cohort study was to investigate whether glucose-lowering drugs influence the risk of hip fracture in patients with incident diabetes.

Methods
A study was performed on a cohort of patients with incident type 2 diabetes. Diabetes diagnosis was defined using information from the Danish National Patient Registry and reimbursement information of glucose-lowering drugs from the Register of Medicinal Product Statistics. The period of observation was from 01.01.1996 till 31.12.2011. The primary exposure was glucose-lowering drugs and the primary endpoint was hip fracture. Unadjusted, adjusted, and propensity score adjusted Cox regressions were performed.

Results
5244 patients with type 2 diabetes with a mean follow up of 5.5 years were included in the study. Use of sulphonylureas within the last 90 days was associated with hip fracture in patients with type 2 diabetes, hazard ratio 1.64 (95% confidence interval: 1.54,1.75), whereas ever use of sulohonylyreas was not associated with an increased risk of fractures. Use of sulphonylureas within the last 90 days was also associated with an increased risk of fractures at other sites. Use of glitazones within the last 90 days was associated with an increased risk of hip fracture, hazard ratio 2.07 (95% confidence interval: 1.39,3.07), whereas ever use was not associated with an increased risk.

Conclusions
Current use of sulphonylureas was associated with hip fracture in patients with type 2 diabetes. Speculatively, this may be due to hypoglycemia resulting in falls.

http://www.thebonejournal.com/article/S8756-3282(16)30359-3/abstract

All together now

it's the insulin, stupid!

Well I don't know to be honest but replacing hyperglycemia with hyperinsulinemia is basically just rearranging the deckchairs on the Titanic

Well this goes with the mismanagement of diabetes by the medical profession. First think that should be done for a diabetic is to test to see how his insulin is working. Both will benefit from LCHF but if your are insulin deficient or insulin resistant your treatment should vary depending of the degree of your insulin function. If you are just insulin resistant producing a lot of insulin you should not be trying to increase the insulin in your body. All should not be treated the same. While some with already enough beta cells damage that with LCHF can not control their diabetes could see some benefit with safe medications that will help them balance the insulin to glucagon ratio.

Hi Grahan,
With having uncontrolled RH up to c.16 months ago I had hypos in am and pm when exercising.
So I can understand this problem could be due to hypos. I got an hernia as a result of one fall, when one is on an anticoagulant falls have to avoided at all costs.
regards
Derek

graham64 wrote:Abstract

Background
Diabetes mellitus is associated with an increased risk of hip fracture. The aim of this cohort study was to investigate whether glucose-lowering drugs influence the risk of hip fracture in patients with incident diabetes.

Methods
A study was performed on a cohort of patients with incident type 2 diabetes. Diabetes diagnosis was defined using information from the Danish National Patient Registry and reimbursement information of glucose-lowering drugs from the Register of Medicinal Product Statistics. The period of observation was from 01.01.1996 till 31.12.2011. The primary exposure was glucose-lowering drugs and the primary endpoint was hip fracture. Unadjusted, adjusted, and propensity score adjusted Cox regressions were performed.

Results
5244 patients with type 2 diabetes with a mean follow up of 5.5 years were included in the study. Use of sulphonylureas within the last 90 days was associated with hip fracture in patients with type 2 diabetes, hazard ratio 1.64 (95% confidence interval: 1.54,1.75), whereas ever use of sulohonylyreas was not associated with an increased risk of fractures. Use of sulphonylureas within the last 90 days was also associated with an increased risk of fractures at other sites. Use of glitazones within the last 90 days was associated with an increased risk of hip fracture, hazard ratio 2.07 (95% confidence interval: 1.39,3.07), whereas ever use was not associated with an increased risk.

Conclusions
Current use of sulphonylureas was associated with hip fracture in patients with type 2 diabetes. Speculatively, this may be due to hypoglycemia resulting in falls.

http://www.thebonejournal.com/article/S8756-3282(16)30359-3/abstract

yoly wrote:Well this goes with the mismanagement of diabetes by the medical profession. First think that should be done for a diabetic is to test to see how his insulin is working. Both will benefit from LCHF but if your are insulin deficient or insulin resistant your treatment should vary depending of the degree of your insulin function. If you are just insulin resistant producing a lot of insulin you should not be trying to increase the insulin in your body.  All should not be treated the same. While some with already enough beta cells damage that with LCHF can not control their diabetes could see some benefit with safe medications that will help them balance the insulin to glucagon ratio.

Precisely!

However do you know anyone other than an already diagnosed Type 1 who has been able to get their insulin tested? I even know Type 1/LADAs who were misdiagnosed Type 2 who still couldn't get their insulin tested when it would be an obvious way of differential diagnosis.

The standard answer is "there's no point testing it, the treatment would be the same" ie. high carb low fat and add drugs, and onto insulin when the oral drugs no longer work.

<sigh>

I wonder if the sulphs are sucking calcium out of the bones and plastering it onto the arteries?

Derek wrote:Hi Grahan,
With having uncontrolled RH up to c.16 months ago I had hypos in am and pm when exercising.
So I can understand this problem could be due to hypos. I got an hernia as a result of one fall, when one is on an anticoagulant falls have to avoided at all costs.
regards
Derek

Yes I can understand uncontrolled RH being a problem the same would apply to T1s and insulin dependent T2s, thankfully low carb can go some way to reduce the hypo's

I can think myself lucky that all I need to concern myself with is high BG which is not an issue on low carb, you and Chris have a far more complex type of diabetes to contend with

It only "appears" to be complex. Once you realise that decoupling your metabolism from dependency on glucose is the key, you're on your way.

Have you found the same, Derek? Running on fats/ketones means my glucose has levelled out and even drops when they happen are no longer causing symptoms.

chris c wrote:It only "appears" to be complex. Once you realise that decoupling your metabolism from dependency on glucose is the key, you're on your way.

Have you found the same, Derek? Running on fats/ketones means my glucose has levelled out and even drops when they happen are no longer causing symptoms.

Absolutely Chris, I have not had a hypo since I went very low carb in September 2015. atb D.

You tell them that and they don't believe you!