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

Abstract

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[corrected]% reported falling; 22, 26, 30[corrected], and 31[corrected]% 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 <or=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 <or=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 <or=6% increased risk of falls.

Figure

Lowess smooth curve of A1C level and estimated probability of having any fall during a year of followup, stratified by insulin use. This approach rests on the assumption that risk of falling varies smoothly, though not linearly, with A1C level. The ticks on the x-axis represent the visits among those using insulin (upper) and those not using insulin (lower) with particular A1C levels.