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 Researchers examined data on more than 47,000 people with diabetes,
including 3,329 with type 1, the less common form, which typically
develops in childhood or young adulthood when the pancreas can't
produce insulin. The rest had type 2 diabetes, which is linked to
obesity and aging and happens when the body can't properly use or
make enough insulin to convert blood sugar into energy.
All of these patients were diagnosed with diabetes in the UK between
1995 and 2015. During the study period, 672 people with type 1
diabetes and 8,859 with type 2 diabetes experienced bone fractures.
For type 1 diabetics, the risk of fracture was 39 percent higher
when their average blood sugar levels over time were dangerously
high than it was with lower blood sugar levels, the study found.
Moderately high average blood sugar didn't appear to impact the risk
of fracture for these patients, however.
"In patients with type 1 diabetes, it is important to have good
glycemic control, for almost everything and also to prevent
fractures," said Dr. Francesc Formiga of Barcelona University.
Blood sugar levels didn't appear to influence the risk of fractures
for patients with type 2 diabetes.
Despite this, patients with both types of diabetes should make every
effort to keep their blood sugar in a healthy range, Formiga, who
wasn't involved in the study, said by email.
"People with high levels of sugar should be aware that it is not
good for their global health or for their bones and may increase the
risk of fractures, therefore they should modify their treatment,
according to the recommendations of their doctors," Formiga said.
Diabetes has long been linked to an increased risk of fractures, but
research to date has been mixed regarding exactly what role blood
sugar levels play in this risk, Dr. Christian Meier of University
Hospital Basel in Switzerland and colleagues write in the Journal of
Clinical Endocrinology and Metabolism.
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Several complications of diabetes may contribute to an increased
risk of falls and fractures including cognitive impairment; nerve
damage (neuropathy) that diminishes sensation in the feet and other
extremities; and retinopathy, or eye damage that makes it harder to
detect obstacles that might cause a fall.
Among type 1 diabetes patients in the study, people with vascular
complications like retinopathy were 29 percent more likely to
experience fractures than people who didn't have these
complications. Vascular complications didn't appear to influence
fracture risk for people with type 2 diabetes.
With type 1 diabetes, kidney failure was also associated with more
than doubled odds of a fracture, the study found.
The study wasn't designed to prove whether or how elevated blood
sugar might impact the risk of falls or fractures in people with
diabetes.
One limitation of the study is that researchers didn't account for
whether patients had diabetic neuropathy, said Dr. James Richardson,
a professor in physical medicine in rehabilitation at Michigan
Medicine in Ann Arbor who wasn't involved in the research.
That factor might explain a lot of the accidents leading to bone
fractures, he said.
"Fall risk is markedly increased in people who cannot successfully
respond to a postural perturbation (such as a trip or slip, ankle
turn) in the roughly 400 milliseconds available to do so,"
Richardson said by email.
"This requires rapid and precise information that 'reports' the
perturbation," Richardson said. "This comes, primarily, from precise
sensation in the feet and ankles and excellent visual acuity."
SOURCE: https://bit.ly/2te1Hiw Journal of Clinical Endocrinology and
Metabolism, online January 16, 2019.
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