title: Glycated Hemoglobin Level and Risk of Hip Fracture in Older People with Type 2 Diabetes: A Competing Risk Analysis of Taiwan Diabetes Cohort Study.
abstract: Hip fracture, which is associated with substantial morbidity and long-term mortality, imposes a major burden on the healthcare system. Diabetes is a risk factor for osteoporosis, which is a crucial risk factor of hip fracture. However, epidemiological studies investigating the risk of hip fracture among patients with type 2 diabetes are limited. This study explored the association between hemoglobin A1c (HbA1c) and the risk of hip fracture in people with type 2 diabetes aged 65 years and older. We conducted a retrospective cohort study of 20,025 older patients with type 2 diabetes who participated in the National Diabetes Case Management Program in Taiwan. The HbA1c level at the baseline and hip fracture incidence over an average of 7.41 years of follow-up were analyzed (maximum and standard deviation were 10.9 and 2.42 years, respectively). A total of 1514 hip fracture cases were recorded. The incidence rates of hip fracture were 9.15, 8.02, 9.58, 10.61, 12.51, and 13.43 per 1000 person-years in patients with baseline HbA1c levels of < 6%, 6-7%, 7%-8%, 8%-9%, 9%-10%, and ≥ 10%, respectively. After multivariate adjustment, the risk of hip fracture increased among patients with HbA1c levels of 9%-10% and ≥ 10.0% compared with patients with HbA1c levels of 6-7% (hazard ratio, 1.24; 95% confidence interval, 1.02-1.49 and 1.32; 1.09-1.58, respectively). Significant linear trends among various HbA1c levels were observed (P  < 0.05). Patients with type 2 diabetes whose HbA1c levels exceeded 9.0% exhibited an increased risk of hip fracture, confirming a linear relationship. Our study's findings demonstrated the importance of glycemic control for fracture prevention in older adults with type 2 diabetes.
authors.affiliation: School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chia-Ing
authors.initials: CI
authors.lastname: Li
authors.affiliation: School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.|Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chiu-Shong
authors.initials: CS
authors.lastname: Liu
authors.affiliation: School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Wen-Yuan
authors.initials: WY
authors.lastname: Lin
authors.affiliation: School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Nai-Hsin
authors.initials: NH
authors.lastname: Meng
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, China Medical University Hospital, Taichung, Taiwan.|School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Ching-Chu
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Graduate Institute of Biostatistics, College of Management, China Medical University, Taichung, Taiwan.
authors.forename: Sing-Yu
authors.initials: SY
authors.lastname: Yang
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Hsuan-Ju
authors.initials: HJ
authors.lastname: Chen
authors.affiliation: School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.|Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Cheng-Chieh
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Graduate Institute of Biostatistics, College of Management, China Medical University, Taichung, Taiwan.|Department of Healthcare Administration, College of Health Science, Asia University, Taichung, Taiwan.
authors.forename: Tsai-Chung
authors.initials: TC
authors.lastname: Li
mesh_terms: D000368:Aged; D015992:Body Mass Index; D015331:Cohort Studies; D003710:Demography; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006620:Hip Fractures / Q000097:blood / Q000453:epidemiology* / Q000209:etiology* / Q000401:mortality; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008019:Life Style; D008297:Male; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin; D007328:Insulin
keywords: glycated hemoglobin; hip fracture; type 2 diabetes