Newly diagnosed type 1 diabetes: higher HbA1c tied to increased risk for fracture

  • Thayakaran R & al.
  • Diabet Med
  • 8 Mar 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • Higher haemoglobin A1c (HbA1c) level is associated with an increased risk for fracture in people with newly diagnosed type 1 diabetes (T1D).
  • Risk increases by 7% for each percentage increase in HbA1c level.

Why this matters

  • Findings may be considered in fracture risk assessment and even in prompting early anti-osteoporotic intervention in patients with T1D, especially in those presenting with other established risk factor.

Study design

  • This retrospective study identified 5368 people with newly diagnosed T1D between January 1995 and May 2016 from The Health Improvement Network database.
  • Longitudinal HbA1c measurements from diagnosis to fracture were collected.
  • Primary outcome: any fracture recorded by general practitioners.
  • Funding: None disclosed.

Key results

  • 525 fractures over 37830 person-years of follow-up with an incidence rate of 14 per 1000 person-years were observed.
  • HbA1c level was significantly associated with increased risk for fracture (adjusted HR [aHR], 1.07%; P=.002) in patients with T1D representing 7% increase with each percentage increase in HbA1c levels.
  • Compared with HbA1c
  • 53-58.5 mmol/mol, 7-7.5% (aHR, 1.02; 95% CI, 0.70-1.49).
  • >74.9 mmol/mol, >9% (aHR, 1.23; 95% CI, 0.91-1.65).

Limitations

  • Measure of bone fragility not included in the analysis.

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