Researchers recently completed a study to find out how the risk of fracture differed with the type of insulin therapy used by people with type 2 diabetes. While it is known that there is an increased risk of fracture associated with type 2 diabetes, there have been few studies to examine how specific diabetes treatment methods influence that risk. So, German researchers attempted to investigate this risk related to different types of insulin therapies used in primary care practices.
What We Know about Diabetes and Fracture Risk
Increased risk of fracture has recently been a great concern for people with type 2 diabetes. A variable increase in the risk of fracture has been reported, and depending on factors like diabetes duration and skeletal site; this risk can jump from 20% to almost threefold. Other factors have also been reported to increase fracture risk, including risk for falls, glycemic control, long disease duration, and the presence of certain diabetic complications. Recently, some studies have shown that alternation in the properties of bone material is also a defect that can lead to increases in bone fragility.
About the Study
This study examined data from close to 106,000 type 2 diabetes patients at over 1,070 German medical practices. Researchers used a multivariate logistic regression model to compare the fracture risk in three scenarios:
- Incident insulin therapy vs. oral anti-diabetic medications
- Basal-supported oral therapy vs. conventional insulin therapy vs. supplementary insulin therapy
- NPH insulin vs. insulin detemir vs. insulin glargine
The results were then compared adjusting for sex, age, comorbidity, diabetes care, and glycemic control.
Examining the Results
Next, the results were examined to determine exactly how treatments stood up against one another when it came to fracture risk.
Incident Insulin Therapy vs. Oral Anti-Diabetic Medications
The odds of experiencing an incident fracture were lower in the oral anti-diabetic medication group than in the group of incident insulin users. However, the difference was not significant. At a 95% confidence interval, the odds ratio was 0.87. The confidence interval was 0.72-1.06.
Basal-Supported Oral Therapy vs. Conventional Insulin Therapy vs. Supplementary Insulin Therapy
There were increased odds for fracture risk for supplementary insulin therapy (odds ratio: 1.20, confidence interval 0.63-2.27) and conventional insulin therapy (odds ratio: 1.59, confidence interval 0.89-2.84) compared to the basal-supported oral therapy. These results were also shown not to be significant.
NPH Insulin vs. Insulin Detemir vs. Insulin Glargine
There was no significant difference in fracture risk for basal insulin, including NPH insulin, determir, and glargine. After treatment for more than two years, insulin glargine did show lower odds of having greater than one fracture when compared to NPH users.
About the Findings
This study has shown that long-standing diabetic therapy using insulin glargine was associated with some of the lowest odds of fractures. However, the authors of the study have expressed the need for further research to determine if reduced rates of hypoglycemia could be the cause of lower fracture risks.
These findings were published in Diabetes, Metabolic Syndrome, and Obesity: Targets and Therapy on February 19, 2016.