Type 2: Intense Control May Raise Hip Fracture Risk

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Older type 2s who exercise tight control over their blood sugar may run an increased risk of hip fracture, says a study from Changi General Hospital in Singapore. The researchers studied 558 elderly people with diabetes who had been treated for hip fracture between 2005 and 2010. They found that those patients had a significantly lower median A1C, 6.8%, than the control group median of 7.4%. In 59.2 percent of the hip fracture cases, the patient’s A1C was less than 7%, and slightly more than three-quarters of the patients were taking sulfonylureas.

Overall, the Singapore researchers noted that patients with A1Cs below 6% were three times more likely to experience a hip fracture than patients with A1Cs above 8%. For patients whose A1C ran from 6% to 7%, the odds of hip fracture were double that of patients at 8% or higher. (The current ADA-recommended A1C for older type 2s is 7%.)

The researchers surmised that lower A1Cs, often the result of treatments using insulin or sulfonylureas, increase the risk of hypoglycemia, thus making patients more vulnerable to falls.
As a result, lead researcher Dr. Troy H. Puar and his team recommend that doctors consider switching elderly patients to drugs that are less likely to cause hypoglycemia, such as metformin or acarbose (brand name Precose).  

Dr. Puar said that because elderly people with diabetes are more vulnerable to hypoglycemia and consequent falls, the 8% A1C target recommended by the American Geriatrics Society makes sense. The Singapore team’s findings were published online on August 2 in the Journal of the American Geriatrics Society (JAGS).

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