1474 Diabetes Management in Older Adults Who Fall: A Retrospective Cohort Study

Abstract

Introduction Type 2 diabetes mellitus (T2D) is associated with poor health outcomes and tight glycaemic targets are questionable in those aged over 70 years. We examined whether people with T2D admitted to emergency department (ED) with a fall, were more likely to have greater frailty, co-morbidity burden, or risk factors for falls and whether use of insulin or gliclazide was associated with poor clinical outcomes. Methods The Older Persons Assessment Service (OPAS) is a local emergency department service which accepts patients on frailty criteria. The OPAS databank was retrospectively analysed for people with T2D admitted with a fall between June 2020-September 2022. We examined clinical outcomes relating to medication, age, Charlson co-morbidity index (CCI) and clinical frailty score (CFS). Results 1081 patients were included: 294 (27.2%) with T2D and a mean HbA1c of 53.9 (±15.8) mmol/mol [7.1%]. People with T2D had a similar mean CFS and age compared to those without T2D, but higher mean CCI (7.0±2.2 vs 5.9±2.1, p<0.001). Of those people with T2D, 175 (59.5%) and 240 (81.6%) had a HbA1c ≤53 mmol/mol [7.0%] and ≤64 mmol/mol [8.0%], respectively. In total, 48 (16.3%) people with T2D were identified to have a capillary blood glucose below 4.0 mmol/L on admission to the emergency department. People with T2D treated with insulin and/or gliclazide had a greater mortality (36.6% vs 23.6%, p<0.05), greater frequency of hypoglycaemia (35.4% vs 11.8%, p<0.001), and greater HbA1c (65.5±17.2 mmol/mol [8.2] vs 48.9±12.1 mmol/mol [6.6%]) compared to those who used other agents. People with T2D were not more likely to live in deprived areas. Conclusion Falls are a significant burden, and hypoglycaemia-inducing medication may contribute to the greater mortality observed in people with T2D. Clinician awareness can support de-prescribing for patients with frailty and HbA1c <64mmol/mol. There should be increased awareness of the impact of hypoglycaemia, especially in those using insulin or gliclizade.