Takeaway
- Type 2 diabetes (T2D) patients with glycated haemoglobin (HbA1c) levels of <8.0% who were currently exposed to metformin monotherapy were at a lower risk of fracture compared with those not currently exposed to an antidiabetic drug.
- In contrast, the risk of fracture in patients receiving intensified treatment was not or only slightly associated with glycaemic control.
Why this matters
- Findings confirm that metformin is safe in terms of skeletal changes and predominantly exerts its beneficial effect on the risk of fracture in an early and well-controlled disease stage.
Study design
- This nested case-control study included 8809 patients with T2D and fracture and 35,219 matched control participants from the UK Clinical Practice Research Datalink database (1995-2017).
- The association between the level of glycaemic control, antidiabetic treatment and risk of low-trauma fractures was evaluated.
- Funding: Swiss National Science Foundation.
Key results
- Patients with current metformin use and HbA1c levels ≤7.0% were at a lower risk of fractures than those not using any antidiabetic medication (adjusted OR [aOR], 0.89; 95% CI, 0.83-0.96).
- Risk reduction was marginally stronger for those with HbA1c levels of 7.0-8.0% (aOR, 0.81; 95% CI, 0.73-0.90).
- Patients receiving metformin with HbA1c levels >8.0% had a risk of fracture similar to patients not using any antidiabetic drugs (aOR, 0.95; 95% CI, 0.81-1.10).
- The level of glycaemic control was not associated with the risk of fracture in patients with current use of first intensification treatment.
- The level of glycaemic control in patients with current use of second intensification treatment showed an association with the risk of fracture.
- HbA1c levels ≤7.0% (aOR, 1.32; 95% CI, 1.18-1.49).
- HbA1c levels >7.0 to ≤8% (aOR, 1.26; 95% CI, 1.13-1.41).
- HbA1c levels >8.0% (aOR, 1.13; 95% CI, 1.02-1.25).
Limitations
- Possibility of missing some unrecorded fracture cases.
- Study did not analyse the cause of the fracture.
This clinical summary originally appeared on Univadis, part of the Medscape Professional Network.