Intensive Glycemic Control Is Not Associated With Fractures or Falls in the ACCORD Randomized Trial

• Published in: Diabetes care Vol. 35; no. 7; pp. 1525 - 1531
• Main Authors: Schwartz, Ann V., Margolis, Karen L., Sellmeyer, Deborah E., Vittinghoff, Eric, Ambrosius, Walter T., Bonds, Denise E., Josse, Robert G., Schnall, Adrian M., Simmons, Debra L., Hue, Trisha F., Palermo, Lisa, Hamilton, Bruce P., Green, Jennifer B., Atkinson, Hal H., O’Connor, Patrick J., Force, Rex W., Bauer, Douglas C.
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.07.2012
• Subjects: Accidental Falls - statistics & numerical data; Adult; Aged; Biological and medical sciences; Blood Glucose - drug effects; Blood pressure; Bone Density; Cardiovascular diseases; Cardiovascular Diseases - prevention & control; Care and treatment; Complications and side effects; Diabetes Mellitus, Type 2 - complications; Diabetes therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Fractures; Fractures, Bone - prevention & control; Glycated Hemoglobin; Health aspects; Humans; Hypoglycemic Agents - administration & dosage; Male; Medical sciences; Metabolic diseases; Middle Aged; Miscellaneous; Mortality; Older people; Original Research; Patient outcomes; Prevention; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk assessment; Risk Factors; Type 2 diabetes; United States; Endocrinopathy; Human; Glycemic control; Nutrition; Diseases of the osteoarticular system; Metabolic diseases; Fracture; Trauma; Target tissue resistance; Association; Clinical trial; Insulin resistance; Fall; Endocrinology; Glycemia
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc11-2184

Older adults with type 2 diabetes are at high risk of fractures and falls, but the effect of glycemic control on these outcomes is unknown. To determine the effect of intensive versus standard glycemic control, we assessed fractures and falls as outcomes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) randomized trial. ACCORD participants were randomized to intensive or standard glycemia strategies, with an achieved median A1C of 6.4 and 7.5%, respectively. In the ACCORD BONE ancillary study, fractures were assessed at 54 of the 77 ACCORD clinical sites that included 7,287 of the 10,251 ACCORD participants. At annual visits, 6,782 participants were asked about falls in the previous year. During an average follow-up of 3.8 (SD 1.3) years, 198 of 3,655 participants in the intensive glycemia and 189 of 3,632 participants in the standard glycemia group experienced at least one nonspine fracture. The average rate of first nonspine fracture was 13.9 and 13.3 per 1,000 person-years in the intensive and standard groups, respectively (hazard ratio 1.04 [95% CI 0.86-1.27]). During an average follow-up of 2.0 years, 1,122 of 3,364 intensive- and 1,133 of 3,418 standard-therapy participants reported at least one fall. The average rate of falls was 60.8 and 55.3 per 100 person-years in the intensive and standard glycemia groups, respectively (1.10 [0.84-1.43]). Compared with standard glycemia, intensive glycemia did not increase or decrease fracture or fall risk in ACCORD.