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Scientists have presented a new study describing the effects of blood glucose levels in people with type 1 diabetes on the development of fractures.
Diabetes affects millions of people around the world. Type 1 diabetes or juvenile diabetes can occur at an earlier age because the pancreas does not produce insulin. This leads to poor glycemic control, which can lead to several complications in diabetic patients such as kidney disease, eye problems and the risk of fragility fractures.
A study was conducted and published in the journal Endocrine Society. Journal of Clinical Endocrinology & Metabolism to study the relationship between glycemic control in diabetics and the risk of non-vertebral fractures with low trauma.
The researchers selected participants with type 1 and type 2 diabetes newly diagnosed in a UK-based primary care database. The study period was 21 years, ranging from 1995 to 2015. Participants were divided into two groups: cases and controls.
Diabetic patients with a fragility fracture during the study period were placed in the case group and the date of the fracture was referred to as a baseline date. Participants who had no fracture between the onset of the disease and the date of the index were placed in the control group. The researchers measured the duration of diabetes and HbA1c levels, indicators of blood glucose.
Poor glycemic control in type 1 diabetes is badociated with increased risk of fractures
Of this total, 9,531 patients had fractures. Patients with type 1 diabetes with good glycemic control had no risk of fragility fracture. However, patients with low glycemic control and an HbA1c level ≥ 8% had an increased risk of traumatic fractures. Such an badociation has not been observed in people with type 2 diabetes. On average, these fractures have been observed in diabetic patients for 4.5 years.
Elevated blood glucose levels in type 1 diabetes affect the functions of bone-forming cells (osteoblasts), reduce bone mineral content, and alter the metabolism of calcium and vitamin D.
In type 2 diabetes, the body's resistance to insulin causes an increase in insulin levels in the blood, which stimulate the cells that form the bone. However, patients taking rosglitazone and pioglitazone with antidiabetic drugs had a two- to three-fold increased risk of fracture due to accelerated bone loss.
It's a unique study with several strengths. It included a large number of participants, representing the general population. The glycemic status of the patients was monitored regularly with multiple HbA1c blood levels several times during the study. In addition, type 1 and type 2 diabetes were studied separately.
There are also some limitations to this study. It included a large number of type 2 diabetics in good health and well controlled. Some factors, such as medications and other diseases that affect the risk of fracture, have not been excluded. The cause of the fracture has not been studied.
Education and patient motivation can help prevent risks and improve quality of life
One of the researchers, Janina Vavanikunnel, MD, of the University Hospital Basel in Basel, Switzerland, said in a press release: "We have studied the link between the degree of glycemic control and the Fracture risk using a large type 2 diabetic patients. Both types of diabetes are badociated with fragility fractures and we have shown that poor glycemic control is badociated with an increased risk of fractures in type diabetes. 1. "
Type 1 diabetes with poor blood glucose control is badociated with an increased risk of fragility fractures. The education and motivation of the patient can help prevent this risk and improve the quality of life of diabetes.
Written by Dr. Radhika Baitari, MS
References:
- A higher risk of fracture in type 1 diabetes may be related to poor blood glucose control [Internet]. EurekAlert! 2019 [cited 7 March 2019]. Available at the following address: https://www.eurekalert.org/pub_releases/2019-01/tes-hro011519.php
- Vavanikunnel, J., Charlier S., Becker C., Schneider C., Jick S., Meier C. and Meier C. (2019). Association between glycemic control and risk of fracture in diabetic patients: A nested case-control study. The Journal of Clinical Endocrinology and Metabolism, 104(5), 1645-1654. doi: 10.1210 / jc.2018-01879
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