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Diabetes Care:糖尿病增高骨折相关住院风险

2013-01-06 Diabetes Care CMT

  2012年12月17日在线发表于《糖尿病护理》(Diabetes Care )的一项研究显示,被确诊为糖尿病的成年人,其骨折相关住院风险明显升高。   该研究由美国马里兰州巴尔的摩市约翰斯·霍普金斯大学Bloomberg公共卫生学院流行病学系的Andrea L.C. Schneider极其同事完成,是一项基于社区的大型研究。研究者表示,这一结果支持美国糖尿病学会在合适的患者人群中评估骨折风险

  2012年12月17日在线发表于《糖尿病护理》(Diabetes Care )的一项研究显示,被确诊为糖尿病的成年人,其骨折相关住院风险明显升高。

  该研究由美国马里兰州巴尔的摩市约翰斯·霍普金斯大学Bloomberg公共卫生学院流行病学系的Andrea L.C. Schneider极其同事完成,是一项基于社区的大型研究。研究者表示,这一结果支持美国糖尿病学会在合适的患者人群中评估骨折风险与实施一级和二级预防策略的建议。

  ARIC这项在4个社区进行的大型研究开始于1987~1989年,纳入了15140名45~64岁的参与者中,在20年随访期间,共发生1078次骨折相关住院(ARIC研究只获取导致住院治疗的骨折)。

  基线时,根据自我报告,1195名参与者有已被确诊的糖尿病,605名参与者经血糖水平测定结果有未被确诊的糖尿病。

  与13340名无糖尿病的研究参与者相比,已确诊糖尿病组的骨折相关住院率显著较大(6.6 vs 3.9/随访1000人-年,95%可信区间[CI]分别为5.4~7.9和3.6~4.1)。

  所有年龄组已确诊糖尿病者的骨折相关住院率均高于无糖尿病者。然而,与无糖尿病者相比,那些有未被确诊糖尿病的参与者骨折风险没有升高,作者们指出。

  校正年龄、性别、人种/研究中心、体质指数、饮酒、吸烟、体育运动以及使用糖皮质激素、抗抑郁药和噻嗪类利尿药等协变量后,已确诊糖尿病仍与骨折相关住院风险显著升高相关,风险比(HR)为1.74(95%CI为1.42~2.14)。

  然而,在完全校正的分析中,有未被确诊糖尿病者的骨折风险也和无糖尿病的参与者相似(HR为1.12,95%CI为0.82~1.53)。

  在已确诊糖尿病者中,与不使用糖尿病药物相比,使用口服糖尿病药物不会使骨折风险升高(HR为0.97,95%CI为0.60~1.55)。然而,使用胰岛素、同时使用或不使用口服药物,均与骨折风险升高相关(HR为1.87,95%CI为1.15~3.05)。

  进行校正后,已确诊糖尿病与骨折风险的相关性并未因年龄、人种、性别或女性绝经状态而有差异。

  然而,这种相关性与血糖控制显著有关。在ARIC研究第二次访视(1990~1992年)时接受糖化血红蛋白水平测定的13508名参与者中,随后17年(中位数)发生骨折相关住院976次。

  进行校正后,已确诊糖尿病者中,糖化血红蛋白水平≥8%的骨折相关住院风险显著大于糖化血红蛋白水平<8%者(HR为1.63,95%CI为1.09~2.44)。进一步校正糖尿病药物使用情况后,上述风险轻度减弱(HR为1.50,95%CI为0.97~2.32)。

  除了评估所有糖尿病患者的骨折风险以外,“我们的研究还表明,血糖控制差(定义为糖化血红蛋白水平≥8%或使用胰岛素)的人有可能从积极的预防措施中获益特别大,无论年龄如何。” Schneider博士和同事写道。

  有证据表明,运动项目有可能会降低糖尿病患者的骨折风险,作者们补充说。“需要进一步研究来了解在使低血糖发作最少化的同时采取运动干预或改善血糖控制的策略是否能够预防糖尿病患者发生骨折。”


Diabetes and Risk of Fracture-Related Hospitalization: The Atherosclerosis Risk in Communities Study

OBJECTIVE 

To examine the association between diabetes, glycemic control, and risk of fracture-related hospitalization in the Atherosclerosis Risk in Communities (ARIC) Study.

RESEARCH DESIGN AND METHODS 

Fracture-related hospitalization was defined using International Classification of Diseases, 9th revision, codes (733.1–733.19, 733.93–733.98, or 800–829). We calculated the incidence rate of fracture-related hospitalization by age and used Cox proportional hazards models to investigate the association of diabetes with risk of fracture after adjustment for demographic, lifestyle, and behavioral risk factors.

RESULTS 

There were 1,078 incident fracture-related hospitalizations among 15,140 participants during a median of 20 years of follow-up. The overall incidence rate was 4.0 per 1,000 person-years (95% confidence interval [CI], 3.8–4.3). Diagnosed diabetes was significantly and independently associated with an increased risk of fracture (adjusted hazard ratio [HR], 1.74; 95% CI, 1.42–2.14). There also was a significantly increased risk of fracture among persons with diagnosed diabetes who were treated with insulin (HR, 1.87; 95% CI, 1.15–3.05) and among persons with diagnosed diabetes with HbA1c ≥8% (1.63; 1.09–2.44) compared with those with HbA1c <8%. Undiagnosed diabetes was not significantly associated with risk of fracture (HR, 1.12; 95% CI, 0.82–1.53).

CONCLUSIONS 

This study supports recommendations from the American Diabetes Association for assessment of fracture risk and implementation of prevention strategies in persons with type 2 diabetes, particularly those persons with poor glucose control.



    

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    2013-01-08 liuxiaona
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    2013-01-08 liuxiaona

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