Severe hypoglycemia and hip fracture in patients with type 2 diabetes: a nationwide population-based cohort study

Abstract

Severe hypoglycemia was associated with a higher risk to develop hip fracture. The more the visits of severe hypoglycemia per year indicated the higher associated risk in patients with T2DM. Fall is likely an important reason for severe hypoglycemia in relation to increased risk of hip fracture.

Efficacy and safety of linagliptin to improve glucose control in older people with type 2 diabetes on stable insulin therapy: A randomized trial

“…Patients in this age group probably experience episodes of hypoglycaemia and are probably less able to recognize the symptoms promptly and take the appropriate corrective action . Moreover, recurrent hypoglycaemic episodes have been associated with altered mental status, cognition decline, fractures and cardiac arrhythmias, which could contribute to reduced treatment compliance …”

“…While the exact prevalence of hypoglycaemia in older people with diabetes is not known, recent reports estimate it at 20%‐40% . Notable deleterious effects caused by hypoglycaemia are cardiac arrhythmias, and altered mental status and cognition, which can, in turn, lead to falls and fractures . Furthermore, hospitalization as a result of hypoglycaemia in older people is associated with a substantial increase in morbidity and mortality .…”

Glucagon‐like peptide‐1 receptor agonists and risk of bone fracture in patients with type 2 diabetes: A meta‐analysis of randomized controlled trials

“…Although similar in glycemic control, a lower incidence of hypoglycemia was also observed with lixisenatide than with exenatide . Hypoglycemia and poor glycemic control were associated with an increased risk of fractures, which might be due to the increased risk of fall and the adverse effects on bone metabolism . Therefore, liraglutide and lixisenatide might have more beneficial effects in preventing bone fracture than exenatide.…”

Management of fracture risk in patients with diabetes—Chinese Expert Consensus

“…Although strict glycemic control does not necessarily reduce the risk of fractures, several studies have indicated that poor glycemic control (HbA1c ≥8%–9%) increases fracture risk compared with standard control in T1D and T2D, and that bone accrual following the diagnosis of T1D was impaired in individuals with poor glycemic control . Thus, for patients with diabetes, glycemic control remains a top priority, and the decrease in blood glucose level should be smooth to prevent hypoglycemia and its consequences, including fracture …”

“…Although Chinese patients with diabetes have somewhat different pathophysiological features, such as not being so obese or less insulin resistant than Caucasians, the role of insulin resistance in determining fracture risk is still under debate . Both the epidemiological and cohort studies performed in Asian populations including Chinese suggested a similar general skeleton profile as their Western counterparts: a higher risk of fracture and higher BMDs in those with diabetes than in those without diabetes, an increased fracture risk with a decreased BMD T‐score; and the same risk factors for fracture as Caucasians, such as hypoglycemia and inadequate glycemic control . However, it remains unclear to what extent the BMD T‐score and/or FRAX score underestimate the fracture risk in Asian patients with diabetes.…”