Impact of type 2 diabetes on postoperative outcome after hip fracture: nationwide population-based study in Taiwan

Abstract

SummaryThe impact of diabetes mellitus (DM) on hip fracture (HFx) is still controversial. We used nationwide population-based data in Taiwan to observe postoperative outcomes of HFx in patients with type 2 diabetes mellitus (T2DM) and found that the impact of T2DM may be related to medication of blood glucose control.ObjectivePublished studies evaluating diabetic patients with HFx have shown controversial outcomes. We assessed the impact of T2DM on postoperative outcomes after HFx in elderly patients using the nationwide population database in Taiwan.Research design and methodsWe used data from the National Health Research Institute in Taiwan to recruit patients who had undergone operations for HFx between 2000 and 2009. The recruited patients with T2DM were divided into the oral antidiabetic drug (OAD) cohort and the insulin cohort according to the use or non-use of insulin. Patients without DM were propensity score matched in a 1:1 ratio by four variables. We used the χ2 test, linear regression and Cox proportional hazards model to assess variables, including length of hospital stay, medical cost, complications, early readmission, and 1-year mortality.ResultsWe identified 5490 subjects in total. The insulin cohort exhibited prolonged hospital stay (11.8 days), higher medical costs, more complications within 30 and 90 after hip surgery, earlier readmission, and higher 1 year mortality rate (25.8%) than the OAD and non-DM cohorts. The OAD cohort had longer hospital stay (10.1 days) and higher readmission rate but fewer complications and mortality rates (14.9%) than the non-DM cohort.ConclusionsAfter matching confounding factors, the T2DM with OAD control groups were not associated with higher complication or mortality rates but were associated with higher readmission rates. However, diabetic patients with insulin control have poor outcome. The impact of T2DM on the postoperative outcomes of patients with HFx may be related to blood glucose control medication.

Raloxifene Ameliorates Glucosamine-Induced Insulin Resistance in Ovariectomized Rats

“…OP increases fracture risk and requires treatment to prevent subsequent comorbidities and mortality after fracture [ 19 , 22 , 25 , 26 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ]. Knee OA leads to an increased risk of fall, which therefore increases fracture risk and required treatment [ 77 , 78 , 79 ].…”

Hemoglobin level and osteoporosis in Chinese elders with type 2 diabetes mellitus

“…A recent review reported that 37.8% of Chinese diabetic subjects suffered from osteoporosis [ 3 ]. In addition, although the bone mineral density (BMD) in patients with type 2 diabetes mellitus (T2DM) is often normal or even elevated [ 4 ], diabetic individuals have an increased risk of fracture than those without T2DM [ 5 , 6 ]. In recent years, osteoporosis associated fracture has been considered an important complication of diabetes [ 7 ].…”

Impact of diabetes mellitus on risk of major complications after hip fracture: a systematic review and meta-analysis

“…In five studies, the number of patients undergoing surgical intervention was not clear [ 12 , 18 , 21 , 24 , 25 ]. All patients were treated surgically in eight studies [ 13 – 15 , 19 , 20 , 22 , 26 , 27 ] while in the remaining studies the number of patients treated surgically was > 78%. In one study [ 14 ] the follow-up was just 30 days.…”

“…These results concur with the generalized higher risk of mortality noted in men after hip fracture [ 33 , 34 ]. Considering the type of drug used for DM control, Behanova et al [ 12 ] and Lee et al [ 22 ] have noted significantly higher mortality in hip fracture patients on insulin as compared to those on oral hypoglycemic drugs. Contrastingly, Golinvaux et al [ 14 ] have noted no such difference in outcomes.…”