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OR01-2 Increased Fracture Risk in Patients Using Insulin Compared to Metformin, Attenuated in Patients Using Combination of Insulin and Metformin: Based on Common Data Models

OBJECTIVE: Despite their normal to high bone mineral density, fracture risk was increased in patients with type 2 diabetes. Antidiabetic medications have been suspected to account for the excess risk partly. However, longitudinal comparative studies on the effects of various antidiabetic medications...

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Autores principales: Kim, Kwangsoo, Kim, Sang Wan, Kimg, Jung Hee, Lee, Seulbi, Lee, Si-Yeon, Shin, Chan Soo, Kong, Sung Hye
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9625066/
http://dx.doi.org/10.1210/jendso/bvac150.389
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author Kim, Kwangsoo
Kim, Sang Wan
Kimg, Jung Hee
Lee, Seulbi
Lee, Si-Yeon
Shin, Chan Soo
Kong, Sung Hye
author_facet Kim, Kwangsoo
Kim, Sang Wan
Kimg, Jung Hee
Lee, Seulbi
Lee, Si-Yeon
Shin, Chan Soo
Kong, Sung Hye
author_sort Kim, Kwangsoo
collection PubMed
description OBJECTIVE: Despite their normal to high bone mineral density, fracture risk was increased in patients with type 2 diabetes. Antidiabetic medications have been suspected to account for the excess risk partly. However, longitudinal comparative studies on the effects of various antidiabetic medications on fractures are limited. We aimed to evaluate the fracture risk of patients using various antidiabetic medications compared to those using metformin. METHODS: We included 6,694 patients aged ≥ 50 years from the common data model (CDM) database between 2008 and 2012, who used the same antidiabetic medications over a year. The patients were grouped as metformin, insulin, sulfonylurea, dipeptidyl-4-inhibitor (DPP4i)+metformin, insulin+metformin, sulfonylurea+insulin, sulfonylurea+metformin, DPP4i+sulfonylurea+insulin, and sulfonylurea+insulin+metformin. The risks of major osteoporotic fractures (MOF) and hip fractures in each group were analyzed using the Cox proportional hazards model compared with the metformin group as a reference. RESULTS: During a median follow-up duration of 6.1 years, the incidence rates of MOF and hip fracture were 8.36 and 1.53 per 1000 person-year. The mean age was 65.8 years, and 47.7% were women. Compared to metformin users, insulin users showed an increased risk of MOF (hazard ratio [HR] 1.96, 95% confidence interval [CI] 1.28-3.02) and hip fracture (HR 3.06, 95% CI 1.21-7.77) after multivariate adjustments, including age, sex, body mass index (BMI), HbA1c, history of fracture, secondary osteoporosis, rheumatoid arthritis, cardiovascular, cerebrovascular disease, dementia, chronic kidney disease, use of steroid, proton pump inhibitor, and warfarin. Besides, the risk became insignificant in patients using a combination of insulin and metformin in both MOF (HR 1.32, 95% CI 0.77-2.27) and hip fracture risks (HR 2.68, 95% CI 0.56-12.80) after covariates adjustments. In subgroup analysis, insulin users harbored a significantly higher risk for MOF than metformin users only in patients withHbA1c < 7%, or BMI < 25 kg/m(2). CONCLUSION: From real-world data, we found that insulin users were at elevated risk of MOF and hip fracture compared to metformin users, which might be attenuated in users with a combination of insulin and metformin. The increased fracture risk in insulin users was exaggerated in non-obese and well-controlled diabetic patients, indicating the need for routine fracture risk assessment in these patients. Presentation: Saturday, June 11, 2022 11:45 a.m. - 12:00 p.m.
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spelling pubmed-96250662022-11-14 OR01-2 Increased Fracture Risk in Patients Using Insulin Compared to Metformin, Attenuated in Patients Using Combination of Insulin and Metformin: Based on Common Data Models Kim, Kwangsoo Kim, Sang Wan Kimg, Jung Hee Lee, Seulbi Lee, Si-Yeon Shin, Chan Soo Kong, Sung Hye J Endocr Soc Bone & Mineral Metabolism OBJECTIVE: Despite their normal to high bone mineral density, fracture risk was increased in patients with type 2 diabetes. Antidiabetic medications have been suspected to account for the excess risk partly. However, longitudinal comparative studies on the effects of various antidiabetic medications on fractures are limited. We aimed to evaluate the fracture risk of patients using various antidiabetic medications compared to those using metformin. METHODS: We included 6,694 patients aged ≥ 50 years from the common data model (CDM) database between 2008 and 2012, who used the same antidiabetic medications over a year. The patients were grouped as metformin, insulin, sulfonylurea, dipeptidyl-4-inhibitor (DPP4i)+metformin, insulin+metformin, sulfonylurea+insulin, sulfonylurea+metformin, DPP4i+sulfonylurea+insulin, and sulfonylurea+insulin+metformin. The risks of major osteoporotic fractures (MOF) and hip fractures in each group were analyzed using the Cox proportional hazards model compared with the metformin group as a reference. RESULTS: During a median follow-up duration of 6.1 years, the incidence rates of MOF and hip fracture were 8.36 and 1.53 per 1000 person-year. The mean age was 65.8 years, and 47.7% were women. Compared to metformin users, insulin users showed an increased risk of MOF (hazard ratio [HR] 1.96, 95% confidence interval [CI] 1.28-3.02) and hip fracture (HR 3.06, 95% CI 1.21-7.77) after multivariate adjustments, including age, sex, body mass index (BMI), HbA1c, history of fracture, secondary osteoporosis, rheumatoid arthritis, cardiovascular, cerebrovascular disease, dementia, chronic kidney disease, use of steroid, proton pump inhibitor, and warfarin. Besides, the risk became insignificant in patients using a combination of insulin and metformin in both MOF (HR 1.32, 95% CI 0.77-2.27) and hip fracture risks (HR 2.68, 95% CI 0.56-12.80) after covariates adjustments. In subgroup analysis, insulin users harbored a significantly higher risk for MOF than metformin users only in patients withHbA1c < 7%, or BMI < 25 kg/m(2). CONCLUSION: From real-world data, we found that insulin users were at elevated risk of MOF and hip fracture compared to metformin users, which might be attenuated in users with a combination of insulin and metformin. The increased fracture risk in insulin users was exaggerated in non-obese and well-controlled diabetic patients, indicating the need for routine fracture risk assessment in these patients. Presentation: Saturday, June 11, 2022 11:45 a.m. - 12:00 p.m. Oxford University Press 2022-11-01 /pmc/articles/PMC9625066/ http://dx.doi.org/10.1210/jendso/bvac150.389 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Bone & Mineral Metabolism
Kim, Kwangsoo
Kim, Sang Wan
Kimg, Jung Hee
Lee, Seulbi
Lee, Si-Yeon
Shin, Chan Soo
Kong, Sung Hye
OR01-2 Increased Fracture Risk in Patients Using Insulin Compared to Metformin, Attenuated in Patients Using Combination of Insulin and Metformin: Based on Common Data Models
title OR01-2 Increased Fracture Risk in Patients Using Insulin Compared to Metformin, Attenuated in Patients Using Combination of Insulin and Metformin: Based on Common Data Models
title_full OR01-2 Increased Fracture Risk in Patients Using Insulin Compared to Metformin, Attenuated in Patients Using Combination of Insulin and Metformin: Based on Common Data Models
title_fullStr OR01-2 Increased Fracture Risk in Patients Using Insulin Compared to Metformin, Attenuated in Patients Using Combination of Insulin and Metformin: Based on Common Data Models
title_full_unstemmed OR01-2 Increased Fracture Risk in Patients Using Insulin Compared to Metformin, Attenuated in Patients Using Combination of Insulin and Metformin: Based on Common Data Models
title_short OR01-2 Increased Fracture Risk in Patients Using Insulin Compared to Metformin, Attenuated in Patients Using Combination of Insulin and Metformin: Based on Common Data Models
title_sort or01-2 increased fracture risk in patients using insulin compared to metformin, attenuated in patients using combination of insulin and metformin: based on common data models
topic Bone & Mineral Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9625066/
http://dx.doi.org/10.1210/jendso/bvac150.389
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