Intensive glycemic control is not associated with fractures or falls in the ACCORD randomized trial.
OBJECTIVE
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.


METHODS
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.


RESULTS
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]).


CONCLUSIONS
Compared with standard glycemia, intensive glycemia did not increase or decrease fracture or fall risk in ACCORD.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA. aschwartz@psg.ucsf.edu
Ann V
AV
Schwartz
Karen L
KL
Margolis
Deborah E
DE
Sellmeyer
Eric
E
Vittinghoff
Walter T
WT
Ambrosius
Denise E
DE
Bonds
Robert G
RG
Josse
Adrian M
AM
Schnall
Debra L
DL
Simmons
Trisha F
TF
Hue
Lisa
L
Palermo
Bruce P
BP
Hamilton
Jennifer B
JB
Green
Hal H
HH
Atkinson
Patrick J
PJ
O'Connor
Rex W
RW
Force
Douglas C
DC
Bauer
D000058:Accidental Falls / Q000706:statistics & numerical data; D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D015519:Bone Density; D002318:Cardiovascular Diseases / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D050723:Fractures, Bone / Q000517:prevention & control*; D006442:Glycated Hemoglobin; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents