Intensive glycemic control is not associated with fractures or falls in the ACCORD randomized trial

Ann V. Schwartz, Karen L. Margolis, Deborah E. Sellmeyer, Eric Vittinghoff, Walter T. Ambrosius, Denise E. Bonds, Robert G. Josse, Adrian M. Schnall, Debra L. Simmons, Trisha F. Hue, Lisa Palermo, Bruce P. Hamilton, Jennifer B. Green, Hal H. Atkinson, Patrick J. O'Connor, Rex W. Force, Douglas C. Bauer

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1525-1531
Number of pages7
JournalDiabetes Care
Volume35
Issue number7
DOIs
StatePublished - Jul 2012

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Type 2 Diabetes Mellitus
Research Design
Therapeutics

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Schwartz, A. V., Margolis, K. L., Sellmeyer, D. E., Vittinghoff, E., Ambrosius, W. T., Bonds, D. E., ... Bauer, D. C. (2012). Intensive glycemic control is not associated with fractures or falls in the ACCORD randomized trial. Diabetes Care, 35(7), 1525-1531. https://doi.org/10.2337/dc11-2184

Intensive glycemic control is not associated with fractures or falls in the ACCORD randomized trial. / Schwartz, Ann V.; Margolis, Karen L.; Sellmeyer, Deborah E.; Vittinghoff, Eric; Ambrosius, Walter T.; Bonds, Denise E.; Josse, Robert G.; Schnall, Adrian M.; Simmons, Debra L.; Hue, Trisha F.; Palermo, Lisa; Hamilton, Bruce P.; Green, Jennifer B.; Atkinson, Hal H.; O'Connor, Patrick J.; Force, Rex W.; Bauer, Douglas C.

In: Diabetes Care, Vol. 35, No. 7, 07.2012, p. 1525-1531.

Research output: Contribution to journalArticle

Schwartz, AV, Margolis, KL, Sellmeyer, DE, Vittinghoff, E, Ambrosius, WT, Bonds, DE, Josse, RG, Schnall, AM, Simmons, DL, Hue, TF, Palermo, L, Hamilton, BP, Green, JB, Atkinson, HH, O'Connor, PJ, Force, RW & Bauer, DC 2012, 'Intensive glycemic control is not associated with fractures or falls in the ACCORD randomized trial', Diabetes Care, vol. 35, no. 7, pp. 1525-1531. https://doi.org/10.2337/dc11-2184
Schwartz AV, Margolis KL, Sellmeyer DE, Vittinghoff E, Ambrosius WT, Bonds DE et al. Intensive glycemic control is not associated with fractures or falls in the ACCORD randomized trial. Diabetes Care. 2012 Jul;35(7):1525-1531. https://doi.org/10.2337/dc11-2184
Schwartz, Ann V. ; Margolis, Karen L. ; Sellmeyer, Deborah E. ; Vittinghoff, Eric ; Ambrosius, Walter T. ; Bonds, Denise E. ; Josse, Robert G. ; Schnall, Adrian M. ; Simmons, Debra L. ; Hue, Trisha F. ; Palermo, Lisa ; Hamilton, Bruce P. ; Green, Jennifer B. ; Atkinson, Hal H. ; O'Connor, Patrick J. ; Force, Rex W. ; Bauer, Douglas C. / Intensive glycemic control is not associated with fractures or falls in the ACCORD randomized trial. In: Diabetes Care. 2012 ; Vol. 35, No. 7. pp. 1525-1531.
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abstract = "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.",
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T1 - Intensive glycemic control is not associated with fractures or falls in the ACCORD randomized trial

AU - Schwartz, Ann V.

AU - Margolis, Karen L.

AU - Sellmeyer, Deborah E.

AU - Vittinghoff, Eric

AU - Ambrosius, Walter T.

AU - Bonds, Denise E.

AU - Josse, Robert G.

AU - Schnall, Adrian M.

AU - Simmons, Debra L.

AU - Hue, Trisha F.

AU - Palermo, Lisa

AU - Hamilton, Bruce P.

AU - Green, Jennifer B.

AU - Atkinson, Hal H.

AU - O'Connor, Patrick J.

AU - Force, Rex W.

AU - Bauer, Douglas C.

PY - 2012/7

Y1 - 2012/7

N2 - 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.

AB - 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.

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