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Diabetes-Related Complications, Glycemic Control, and Falls in Older Adults

¹ Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
² Division of Endocrinology, Department of Medicine, University of California, San Francisco, San Francisco, California
³ Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
⁴ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
⁵ Division of Geriatrics, Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida
⁶ Department of Internal Medicine, The Strelitz Diabetes Institutes, and the Department of Pathology and Anatomy, Eastern Virginia Medical School, Norfolk, Virginia
⁷ Section of General Internal Medicine, San Francisco VA Medical Center, San Francisco, California
⁸ Department of Internal Medicine, Pochon CHA University, Gyeonggi-do, Korea

Address correspondence and reprint requests to Ann V. Schwartz, PhD, UCSF, 185 Berry St., San Francisco, CA 94107-1762. E-mail: aschwartz{at}psg.ucsf.edu

OBJECTIVE—Older adults with type 2 diabetes are more likely to fall, but little is known about risk factors for falls in this population. We determined whether diabetes-related complications or treatments are associated with risk of falls in older diabetic adults.

RESEARCH DESIGN AND METHODS—In the Health, Aging, and Body Composition cohort of well-functioning older adults, participants reported falls in the previous year at annual visits. Odds ratios (ORs) for more frequent falls among 446 diabetic participants whose mean age was 73.6 years, with an average follow-up of 4.9 years, were estimated with continuation ratio models.

RESULTS—In the first year, 23% reported falling; 22, 26, 30, and 31% fell in subsequent years. In adjusted models, reduced peroneal nerve response amplitude (OR 1.50 –95% CI 1.07–2.12], worst quartile versus others); higher cystatin-C, a marker of reduced renal function (1.38 [1.11–1.71], for 1 SD increase); poorer contrast sensitivity (1.41 [0.97–2.04], worst quartile versus others); and low A1C in insulin users (4.36 [1.32–14.46], A1C 6 vs. >8%) were associated with risk of falls. In those using oral hypoglycemic medications but not insulin, low A1C was not associated with risk of falls (1.29 [0.65–2.54], A1C 6 vs. >8%). Adjustment for physical performance explained some, but not all, of these associations.

CONCLUSIONS—In older diabetic adults, reducing diabetes-related complications may prevent falls. Achieving lower A1C levels with oral hypoglycemic medications was not associated with more frequent falls, but, among those using insulin, A1C 6% increased risk of falls.

Abbreviations: CMAP, compound muscle action potential • cysC, cystatin-C • DBP, diastolic blood pressure • eGFR, estimated glomerular filtration rate • Health ABC, Health, Aging, and Body Composition • NCV, nerve conduction velocity • OGTT, oral glucose tolerance test • SBP, systolic blood pressure

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