Intensive glycemic control not associated with more falls or fractures in older patients

June 28, 2011

Older adults with type 2 diabetes who follow intensive glycemic control practices are not at increased risk for falls or fractures compared with patients who follow standard glycemic control, despite a higher incidence of hypoglycemia in the former, reported investigators who analyzed data from the ACCORD BONE study.

Older adults with type 2 diabetes who follow intensive glycemic control practices are not at increased risk for falls or fractures compared with patients who follow standard glycemic control, despite a higher incidence of hypoglycemia in the former, reported investigators who analyzed data from the ACCORD BONE study.
     “We didn't see a net effect of intensive therapy on either fractures or falls,” said Ann V Schwartz, PhD, Associate Professor of Epidemiology at the University of California, San Francisco, in an interview.
     She and her colleagues looked at data on patients followed in the ACCORD trial who reported falls or fractures in the previous year during at least 1 follow-up visit.
     The ACCORD trial was a double 2 x 2 factorial, parallel treatment trial in which participants were randomly assigned to either intensive or standard glycemic control. Two additional subtrials looked at the effects of intensive versus standard therapy to control lipids and blood pressure.
     ACCORD BONE was an ancillary study involving 7287 participants in the fracture substudy and 6782 in the falls substudy.
     The frequency of falls did not differ between the groups­­­, and there was no increase in fall risk among participants aged 65 years or older using intensive control. There were also no differences by sex.
     In the fractures analysis, the authors compared first nonpathologic fractures excluding fractures of the lumbar or thoracic spine.
     The investigators found that there was no effect of intensive glycemic control on fracture risk (hazard ratio 1.04, 95% confidence interval 0.85–1.27) and no differences when specific fracture sites (ie, hip, humerus, distal forearm, ankle or foot) were examined separately. There was also no difference in fracture risk among patients aged 65 years or older.
     Although intensive control was associated in ACCORD with an increased frequency of hypoglycemic episodes requiring assistance, this was not reflected in either the falls or the fractures substudies.
     “The intensive glycemia group also experienced a lower risk of specific microvascular complications, including progression to albuminuria, poor visual acuity, and lack of light touch discrimination. These complications are associated with fracture in broader populations, but we did not observe a lower risk of fracture in the intensive group,” the authors wrote.
     Schwartz noted that the participants in the ACCORD BONE cohorts had a median age of about 62 years; results might be different among adults age 75 or older, she said.