People with diabetes who had at least two of these risk factors had a 20% or more increased risk for fracture compared with their control counterparts.

Higher glycated hemoglobin and the presence of kidney disease are associated with lower bone mineral density in people with type 1 diabetes, study results show.

Youth with type 2 diabetes have lower areal bone mineral density than those with obesity or who are of normal weight, according to the results of a cross-sectional study.

In a phase 2 trial it significantly slowed C-peptide decline during 12 months of treatment [34] and follow-up of the participants for an additional year showed stable beta-cell function in those who continued to take verapamil versus a marked decline in those who stopped [35].

And in the longer term, he notes that bone health is also a concern, with the potential for an increased risk for fracture.

Kohler S et al. Diabetes Care 2018: dc171525. doi: 10.2337/dc17-1525

For example, patients with type 1 diabetes experience rapid bone loss during the first few years after disease onset, whereas obesity-related insulin resistance during the early stages of type 2 diabetes has a protective effect on bone health.

However, the authors of an editorial on the study, which is published in the Annals of Internal Medicine , note that although the results “may reassure health care providers,” they may not be completely conclusive.

The investigators say that there were no significant between-group differences in the overall proportion of patients who experienced adverse events.

Complication rates were similar in both groups across the 5 years, but the reduction in bone mineral density was significantly greater in the RYGB than sleeve gastrectomy group.

They add: “It now seems safe to conclude that many prior epidemiological associations between vitamin D deficiency and adverse health outcomes were driven by unmeasured residual confounding or reverse causality.”

There were also no consistent effects of canagliflozin on markers of bone metabolism.

By contrast, there was no difference between the two treatments among people who already had CVD.

Ulcer phenotype Deep involvement of bone/joint/tendon Inflammation >2 cm around wound Crepitus Bullae Gangrene Ecchymosis/petechiae Presence of foreign body Ulcer behavior Acute onset Rapidly progressive Refractory to treatment Limb phenotype Arterial insufficiency Venous insufficiency Lymphedema Systemic health Altered dietary intake Acidosis Azotemia Electrolyte disorders Septicemia Microbiological phenotype: Multidrug-resistant organisms Methicillin-resistant Staphylococcus aureus Gram-negative bacteria with extended-spectrum β-lactamases and carbapenamases Vancomycin-resistant Staphylococcus aureus Insulin users Individuals already on insulin will need intensification of therapy if their overall health and metabolic status is poor.