Glycemic control and 10-year odds of all-cause fractures in elderly veterans with type 2 diabetes

To investigate the relationship of average level of glycemic control and fractures in elderly Veterans.

Retrospective cohort of Veterans (age ≥65) grouped as follows: no diabetes, HbA1c ≤7.0% [≤53 mmol/mol], HbA1c 7.1-8.0% [54-64 mmol/mol], HbA1c 8.1-9.0% [65-75 mmol/mol], and HbA1c >9% [>75 mmol/mol]. Data from January 1, 2010 - January 1, 2017 from the Veteran's Affairs Corporate Data Warehouse was analyzed using Chi-square and Cox regression analysis.

3434 fractures occurred from the 36,744 Veterans included. The fracture incidences were 14.4, 11.7, 7.9, 8.2, and 10.8 events per 1000 patient years and the hazard ratios were 1.233 (1.130-1.345); p < 0.0001, 0.718 (0.626-0.825); p < 0.0001, 0.682 (0.545-0.854); p = 0.0009, and 0.887 (0.633-1.245); p = 0.4915 in the no diabetes, HA1c ≤7% [≤53 mmol/mol], 7.1-8% [54-64 mmol/mol], 8.1-9% [65-75 mmol/mol], and >9% [>75 mmol/mol] groups after accounting for covariates in the final model.

In elderly Veterans with type 2 diabetes the average HbA1c 7.1-8.0% [54-64 mmol/mol], and 8.1-9% [65-75 mmol/mol] have the lowest fracture incidence and those without diabetes showing the highest incidence rate; however, due to the overall low rate of fracture, the absolute difference in incidence of fracture was very small at 2-5 per 1000 patient years. Beyond limiting the risk factors identified these results don't support altering diabetes treatment goals to reduce fracture risk.