HbA1c variability, in addition to mean HbA1c, predicts incident hip fractures in Chinese people with type 2 diabetes
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ORIGINAL ARTICLE
HbA1c variability, in addition to mean HbA1c, predicts incident hip fractures in Chinese people with type 2 diabetes D.T.W. Lui 1 & C.H. Lee 1,2 & Y.H. Chan 1 & W.S. Chow 1 & C.H.Y. Fong 1 & D.C.W. Siu 1 & H.F. Tse 1 & Y.C. Woo 1 & K.S.L. Lam 1,2 Received: 7 November 2019 / Accepted: 17 March 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary Type 2 diabetes is associated with an increased risk of hip fractures. We hypothesize that long-term glycemic variability predicts incident hip fractures. We demonstrated that HbA1c variability predicted incident hip fractures independent of mean HbA1c, suggesting the potential benefits of minimizing glycemic variability in addition to optimizing mean glycemia for bone health. Introduction Type 2 diabetes is associated with an increased risk of hip fractures, and a linear relationship between HbA1c levels and hip fracture incidence has been observed. We hypothesize that HbA1c variability also predicts incident hip fractures in type 2 diabetes. Methods Chinese individuals with type 2 diabetes aged ≥ 60 years were identified from electronic health records in Hong Kong between 2008 and 2012 and observed for incident hip fractures. Hip fracture was defined by the International Classification of Diseases (Ninth Revision) code 820. HbA1c variability was determined using standard deviation, adjusted standard deviation, and coefficient of variation of HbA1c measurements in the 5 years preceding the entry date. Multivariable Cox regression analysis was used to evaluate associations between HbA1c variability and incident hip fractures. Results A total of 83,282 participants were included. Their mean age was 71.3 ± 7.5 years, duration of diabetes 11.7 ± 7.7 years, baseline HbA1c 56.6 ± 13.5 mmol/mol (7.33 ± 1.23%), and median follow-up 6.8 years. All indices of HbA1c variability were significant independent predictors of incident hip fractures, with an adjusted hazard ratio of up to 1.29 (all p < 0.001), and remained to be independent predictors across groups of different intensity of glycemic control. Mean HbA1c ≥ 64 mmol/mol (8.0%) was associated with a 25% increase in incident hip fractures compared with mean HbA1c < 53 mmol/mol (7.0%). Conclusion HbA1c variability is an independent positive predictor of hip fracture in type 2 diabetes, across the spectrum of varying degree of glycemic control, while a high HbA1c is also not advisable from the perspective of bone health. Keywords Chinese . Diabetes mellitus . Glycated hemoglobin A . Hip fractures . Hypoglycemia . Osteoporosis . Postmenopause . Type 2
Introduction Type 2 diabetes is associated with microvascular and macrovascular complications due to metabolic disturbances
* Y.C. Woo [email protected] * K.S.L. Lam [email protected] 1
Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong SAR, China
2
State Key Laboratory of Pharmaceutical Biotechnology, The University of Hong Kong, Hong Kong SAR, China
from chronic hyperglycemia. Tre
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