title: Visit-to-visit variation of fasting plasma glucose is a predictor of hip fracture in older persons with type 2 diabetes: the Taiwan Diabetes Study.
abstract: We investigated the association between fasting plasma glucose variability (FPG-CV) and the risk of hip fracture in elderly diabetic patients. Our finding showed a temporal association between FPG-CV and hip fracture as patients categorized as FPG-CV greater than 25.4 % showed an increased risk in hip fractures.
  
  
  
  Hip fracture is a major health burden in the population and is associated with high rates of mortality and morbidity especially in elderly. It is evident that diabetes mellitus is a risk factor of osteoporosis which is a significant risk factor of hip fracture. However, epidemiological studies exploring the risks of hip fracture among type 2 diabetic patients are limited.
  
  
  
  A retrospective study of 26,501 ethnic Chinese older persons enrolled in the National Diabetes Care Management program in Taiwan was conducted; related factors were analyzed with extended Cox proportional hazards regression models to competing risk data on hip fracture incidence.
  
  
  
  The results show a temporal association between FPG-CV and hip fracture as patients categorized as FPG-CV greater than 25.4 % showed an increased risk in hip fractures, confirming a linear relationship between the two. After multivariate adjustment, the risk of hip fracture increased among patients with FPG-CV of 25.4-42.3 % and >42.3 % compared with patients with FPG-CV of ≦ 14.3 % (hazard ratio, 1.35; 95 % confidence interval 1.14-1.60 and 1.27; 1.07-1.52, respectively). Significant linear trends among various FPG-CV were observed.
  
  
  
  Thus, the present study demonstrated the importance of glucose stability for fracture prevention in older persons with type 2 diabetes. Future studies should be conducted to explore whether reduction in glucose oscillation in older adults with diabetes mellitus can reduce the risk of hip fracture.
authors.affiliation: Department of General Practice, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia.
authors.forename: J I-H
authors.initials: JI
authors.lastname: Chiang
authors.affiliation: Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan.|Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan.
authors.forename: T-C
authors.initials: TC
authors.lastname: Li
authors.affiliation: School of Medicine, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40421, Taiwan.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
authors.forename: C-I
authors.initials: CI
authors.lastname: Li
authors.affiliation: School of Medicine, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40421, Taiwan.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.|Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: C-S
authors.initials: CS
authors.lastname: Liu
authors.affiliation: School of Medicine, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40421, Taiwan.|Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.
authors.forename: N-H
authors.initials: NH
authors.lastname: Meng
authors.affiliation: School of Medicine, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40421, Taiwan.|Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: W-Y
authors.initials: WY
authors.lastname: Lin
authors.affiliation: Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: S-Y
authors.initials: SY
authors.lastname: Yang
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors.forename: H-J
authors.initials: HJ
authors.lastname: Chen
authors.affiliation: School of Medicine, College of Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung, 40421, Taiwan. cclin@mail.cmuh.org.tw.|Department of Medical Research, China Medical University Hospital, Taichung, Taiwan. cclin@mail.cmuh.org.tw.|Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan. cclin@mail.cmuh.org.tw.
authors.forename: C-C
authors.identifier: 0000-0002-9625-6216
authors.initials: CC
authors.lastname: Lin
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005215:Fasting; D005260:Female; D006620:Hip Fractures / Q000097:blood* / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan
chemical_list: D001786:Blood Glucose
keywords: Fasting plasma glucose variability; Hip fracture; Type 2 diabetes