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Impact of type 2 diabetes on postoperative outcome after hip fracture: nationwide population-based study in Taiwan
  1. Tien-Ching Lee1,2,3,
  2. Yu-Li Lee4,
  3. Jian-Chih Chen5,6,
  4. Chung-Hwan Chen1,3,6,
  5. Pei-Shan Ho7
  1. 1Orthopaedic Research Center, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  2. 2Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  3. 3Department of Orthopedics, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  4. 4Division of Endocrinology and Metabolism, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
  5. 5Department of Orthopedics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  6. 6Department of Orthopedics, College of Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
  7. 7Faculty of Dental Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
  1. Correspondence to Professor Pei-Shan Ho; peishan1103{at}gmail.com

Abstract

Summary The impact of diabetes mellitus (DM) on hip fracture (HFx) is still controversial. We used nationwide population-based data in Taiwan to observe postoperative outcomes of HFx in patients with type 2 diabetes mellitus (T2DM) and found that the impact of T2DM may be related to medication of blood glucose control.

Objective Published studies evaluating diabetic patients with HFx have shown controversial outcomes. We assessed the impact of T2DM on postoperative outcomes after HFx in elderly patients using the nationwide population database in Taiwan.

Research design and methods We used data from the National Health Research Institute in Taiwan to recruit patients who had undergone operations for HFx between 2000 and 2009. The recruited patients with T2DM were divided into the oral antidiabetic drug (OAD) cohort and the insulin cohort according to the use or non-use of insulin. Patients without DM were propensity score matched in a 1:1 ratio by four variables. We used the χ2 test, linear regression and Cox proportional hazards model to assess variables, including length of hospital stay, medical cost, complications, early readmission, and 1-year mortality.

Results We identified 5490 subjects in total. The insulin cohort exhibited prolonged hospital stay (11.8 days), higher medical costs, more complications within 30 and 90 after hip surgery, earlier readmission, and higher 1 year mortality rate (25.8%) than the OAD and non-DM cohorts. The OAD cohort had longer hospital stay (10.1 days) and higher readmission rate but fewer complications and mortality rates (14.9%) than the non-DM cohort.

Conclusions After matching confounding factors, the T2DM with OAD control groups were not associated with higher complication or mortality rates but were associated with higher readmission rates. However, diabetic patients with insulin control have poor outcome. The impact of T2DM on the postoperative outcomes of patients with HFx may be related to blood glucose control medication.

  • non-insulin dependent diabetes mellitus
  • insulin
  • oral antihyperglycaemics
  • osteoporosis
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Footnotes

  • Presented at Partial data from this trial were presented at the Orthopaedic Research Society Annual Meeting in March 2018.

  • Contributors T-CL and P-SH had the initial idea, analyzed the data, and wrote the paper. All authors contributed to study design and revisions, and commented on the drafts.

  • Funding This research was supported by grants from MOHW107-TDU-B-212-123006 and from the Kaohsiung Municipal Ta-Tung Hospital (KMTTH_NHIRD-1030903(R) and KMTTH-105-002).

  • Disclaimer The supporters of the study were not involved in the study design, data collection, analysis or interpretation of the results, or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The present study complied with the principles of the Declaration of Helsinki. The data in this study were approved by the institutional review board of the Kaohsiung Medical University Hospital (KMUHIRB-EXEMPT(II)-20170017).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Data are available upon reasonable request.

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