Intensive Glycemic Control Is Not Associated With Fractures or Falls in the ACCORD Randomized Trial
- Ann V. Schwartz, PHD1⇓,
- Karen L. Margolis, MD2,
- Deborah E. Sellmeyer, MD3,
- Eric Vittinghoff, PHD1,
- Walter T. Ambrosius, PHD4,
- Denise E. Bonds, MD5,
- Robert G. Josse, MD6,
- Adrian M. Schnall, MD7,
- Debra L. Simmons, MD8,
- Trisha F. Hue, PHD1,
- Lisa Palermo, MS1,
- Bruce P. Hamilton, MB9,
- Jennifer B. Green, MD10,
- Hal H. Atkinson, MD4,
- Patrick J. O’Connor, MD2,
- Rex W. Force, PHARMD11 and
- Douglas C. Bauer, MD1
- 1Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
- 2HealthPartners Research Foundation, Minneapolis, Minnesota
- 3Division of Endocrinology, Johns Hopkins School of Medicine, Baltimore, Maryland
- 4Department of Biostatistics, Wake Forest School of Medicine, Winston-Salem, North Carolina
- 5Division of Prevention and Population Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
- 6Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- 7Department of Medicine, Case Western Reserve School of Medicine, Cleveland, Ohio
- 8Department of Endocrinology and Metabolism, Central Arkansas Veterans Healthcare System and University of Arkansas for Medical Sciences, Little Rock, Arkansas
- 9Department of Medicine, University of Maryland School of Medicine, Baltimore VA Medical Center, Baltimore, Maryland
- 10Department of Medicine, Endocrinology and Metabolism, Duke University Medical Center, Durham, North Carolina
- 11College of Pharmacy, Idaho State University, Pocatello, Idaho
- Corresponding author: Ann V. Schwartz, .
OBJECTIVE Older adults with type 2 diabetes are at high risk of fractures and falls, but the effect of glycemic control on these outcomes is unknown. To determine the effect of intensive versus standard glycemic control, we assessed fractures and falls as outcomes in the Action to Control Cardiovascular Risk in Diabetes (ACCORD) randomized trial.
RESEARCH DESIGN AND METHODS ACCORD participants were randomized to intensive or standard glycemia strategies, with an achieved median A1C of 6.4 and 7.5%, respectively. In the ACCORD BONE ancillary study, fractures were assessed at 54 of the 77 ACCORD clinical sites that included 7,287 of the 10,251 ACCORD participants. At annual visits, 6,782 participants were asked about falls in the previous year.
RESULTS During an average follow-up of 3.8 (SD 1.3) years, 198 of 3,655 participants in the intensive glycemia and 189 of 3,632 participants in the standard glycemia group experienced at least one nonspine fracture. The average rate of first nonspine fracture was 13.9 and 13.3 per 1,000 person-years in the intensive and standard groups, respectively (hazard ratio 1.04 [95% CI 0.86–1.27]). During an average follow-up of 2.0 years, 1,122 of 3,364 intensive- and 1,133 of 3,418 standard-therapy participants reported at least one fall. The average rate of falls was 60.8 and 55.3 per 100 person-years in the intensive and standard glycemia groups, respectively (1.10 [0.84–1.43]).
CONCLUSIONS Compared with standard glycemia, intensive glycemia did not increase or decrease fracture or fall risk in ACCORD.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc11-2184/-/DC1.
The entire list of the ACCORD investigators can be found in an appendix to ref. 12.
- Received November 10, 2011.
- Accepted March 7, 2012.
- © 2012 by the American Diabetes Association.
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