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Intensive blood glucose control ‘raises risk of falls’

Tight glycaemic control trebles the risk of hip fracture in older patients with type 2 diabetes, say researchers.

Their study analysed the glycaemic control of more than 900 patients with diabetes admitted to a major Singapore hospital with hip fracture, and matched them with controls with diabetes who were managed in the same hospital clinic.

The patients had an average age of 77 years and the use of insulin and sulfonylureas was similar between cases and controls.

The five-year study found that HbA1c levels of less than 7% (9.6 mmol/L) were significantly associated with a risk of hip fracture three times higher than those with HbA1c of more than 8% (11.6 mmol/L).

The authors concluded: ‘Some guidelines suggest that physicians should consider aiming for less-stringent HbA1c targets when managing frail older adults.

‘Even when treating to less stringent targets of HbA1c less than 8%, close monitoring is essential to prevent episodes of hypoglycemia.'

Dr Alan Begg, a GP in Montrose and co-editor of the Practical Diabetes journal, agreed that very tight glycaemic control - especially if done quickly - was not a good thing.

He said: ‘HbA1C targets don't need to change but clinicians need to be aware of risks of too tight glycaemic control and assess on an case-by-case basis.'

J Am GeriatrSoc 2012; 60:1493–1497

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