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Diabetes-related complications, glycemic control, and falls in older adults

¹Department of Epidemiology and Biostatistics, University of California, San Francisco
²Division of Endocrinology, Department of Medicine, University of California, San Francisco
³Division of Diabetes Translation, Centers for Disease Control and Prevention
⁴Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh
⁵Division of Geriatrics, Department of Aging & Geriatric Research, University of Florida
⁶Department of Internal Medicine, The Strelitz Diabetes Institutes, Eastern Virginia Medical School
⁷Department of Pathology and Anatomy, Eastern Virginia Medical School
⁸Section of General Internal Medicine, San Francisco VA Medical Center
⁹Department of Internal Medicine, Pochon CHA University

Aschwartz{at}psg.ucsf.edu

ABSTRACT

Background: 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 if diabetes-related complications or treatments are associated with fall risk in older diabetic adults.

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 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, 24% reported falling; 22%, 26%, 31%, and 30% fell in subsequent years. In adjusted models, reduced peroneal nerve response amplitude (OR=1.50; 95% CI 1.07, 2.12, worst quartile vs others), higher cystatin-C, a marker of reduced renal function, (OR=1.38; 95% CI 1.11, 1.71, for 1SD increase), poorer contrast sensitivity (OR=1.41; 95% CI 0.97, 2.04, worst quartile vs others), and low A1C in insulin users (OR = 4.36; 95% CI 1.32, 14.46, A1C6% vs >8%) were associated with fall risk. In those using oral hypoglycemic medications but not insulin, low A1C was not associated with fall risk (OR = 1.29; 95% CI 0.65, 2.54, A1C6% 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 fall risk.

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