Glycemia linked to fracture risk in type 1 diabetes

A large study suggests that people with type 1 diabetes are more likely to break a bone when their average blood sugar is dangerously high.
Researchers looked at data from over 47,000 people with diabetes, including 3,329 with type 1, the least common form, which typically develops in childhood or early adulthood when the pancreas can not produce insulin. The others had type 2 diabetes, linked to obesity and aging, which occurs when the body can not properly use or produce enough insulin to convert blood sugar into energy.
Diabetes in the United Kingdom was diagnosed in all these patients between 1995 and 2015. During the study period, 672 people with type 1 diabetes and 8,859 with type 2 diabetes underwent a fracture of the bones.
The study found that, in type 1 diabetics, the risk of fracture was 39% higher when their average blood glucose was dangerously high over time than if the blood glucose was low. Moderately high mean glucose levels, however, do not appear to affect the risk of fracture in these patients.
"In patients with type 1 diabetes, it's important to have good glycemic control, for almost everything, and also to prevent fractures," said Dr. Francesc Formiga of the University of Barcelona.
Blood sugar levels did not seem to influence the risk of fracture in patients with type 2 diabetes.
Despite this, patients with two types of diabetes should make every effort to keep their blood glucose levels within a healthy range, said Formiga, who did not participate in the study, by email.
"People with high blood sugar must know that this is not good for their health or their bones and can increase the risk of fractures. Therefore, they should change their treatment, according to the recommendations of their doctors, "said Formiga.
Diabetes has long been badociated with an increased risk of fractures, but research conducted to date on the exact role of blood glucose in this risk is mixed, said Dr. Christian Meier of the University Hospital of Toronto. Basel in Switzerland and colleagues in the Journal of Clinical Endocrinology. Metabolism.
Many complications of diabetes can contribute to an increased risk of falls and fractures, including cognitive impairment; nerve injury (neuropathy) that decreases sensation in the feet and other extremities; and retinopathy, or eye damage that makes it more difficult to detect obstacles that may cause a fall.
Of the type 1 diabetic patients in the study, individuals with vascular complications such as retinopathy were 29% more likely to have fractures than those without these complications. Vascular complications apparently did not affect the risk of fracture in people with type 2 diabetes.
The study found that in the case of type 1 diabetes, kidney failure was also badociated with a risk of fracture more than doubled.
The study was not designed to demonstrate whether or how high blood glucose levels could affect the risk of falls or fractures in people with diabetes.
One of the drawbacks of the study is that the researchers did not determine whether patients had diabetic neuropathy, said Dr. James Richardson, a professor of physical medicine rehabilitation at Michigan Medicine in Ann Arbor, who did not participate in the research.
This factor could explain a lot of accidents leading to bone fractures, he said.
"The risk of falling is significantly increased in people who can not successfully respond to a postural disturbance (such as a trip or a slip, ankle turn) over the approximately 400 milliseconds available to do so" said Richardson by e-mail.
"This requires fast and accurate information that" signals "the disturbance," said Richardson.
"This comes mainly from an accurate sensation in the feet and ankles and excellent visual acuity."