Association Between the Severity of Diabetic Retinopathy and Falls in an Asian Population With Diabetes

Abstract

IMPORTANCEThe presence and severity of diabetic retinopathy (DR) may contribute to the risk of falling in persons with diabetes, but evidence is currently equivocal.OBJECTIVE To investigate the associations of diabetes and DR severity with the likelihood of falls in a multiethnic Asian population. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional post hoc analysis of the Singapore Epidemiology of Eye Diseases study, a population-based study of participants from 3 ethnic groups (3280 Malay, 3400 Indian, and 3353 Chinese individuals) conducted from 2004 to 2011. Of these participants, 552 had data missing on diabetes, falls history, or other covariates or had ungradable fundus photographs and were excluded, leaving 9481 participants. These 9481 underwent a standardized clinical examination and responded to an intervieweradministered questionnaire that collected clinical and sociodemographic information. Multivariable logistic regression models adjusted for confounding fall risk factors assessed the associations of falls with diabetes, DR, and DR severity. A trend analysis was conducted in participants with diabetes to assess if risk of falling was associated with DR severity. Data were analyzed from January 1 through April 30, 2017.EXPOSURES Diabetes was defined as a random glucose level of at least 200 mg/dL, hemoglobin A 1c concentration of at least 6.5% of total hemoglobin, self-reported use of diabetic medication, or history of physician-diagnosed diabetes. Severity of DR was graded as none, minimal, mild, moderate, and vision threatening (VT). MAIN OUTCOMES AND MEASURESA self-reported fall occurring in the previous 12 months, when the participant fell and landed on the ground. RESULTSOf the 9481 participants with a mean (SD) age of 58.7 (10.3) years (4781 women [50.4%]), 6612 (69.7%) had no diabetes and 2869 (30.3%) had diabetes, of whom 857 (29.9%) had DR in at least 1 eye. A history of falls was reported in 872 (13.2%) without diabetes, 328 (16.3%) with no DR, 44 (14.2%) with minimal DR, 54 (26.2%) with mild DR, 34 (27.2%) with moderate DR, and 43 (19.9%) with VTDR (P for trend < .001). In multivariable models, those with DR were more likely to have fallen (odds ratio [OR], 1.31; 95% CI, 1.07-1.60; P = .008) compared with those with no diabetes; no associations were found for participants without DR compared with those with no diabetes. In addition, compared with participants with diabetes but without DR, those with mild (OR, 1.81; 95% CI, 1.23-2.67; P = .003) and moderate (OR, 1.89; 95% CI, 1.16-3.07; P = .01) nonproliferative DR were more likely to have fallen. Having VTDR was not independently associated with a higher likelihood of falling. CONCLUSIONS AND RELEVANCEThe presence of mild to moderate nonproliferative DR was independently associated with an increased likelihood of falling in persons with diabetes compared with persons with diabetes but without DR. Management strategies for diabetes should incorporate fall education and prevention information, particularly in patients with early-stage DR. Long...

<p>Sarcopenia and type 2 diabetes mellitus: a bidirectional relationship</p>

“…Balance is important for both locomotion and physical performance. Unsurprisingly, impaired vision in T2DM contributes to increased falls risk 74. In a cross-sectional analysis of the Singapore Epidemiology of Eye Diseases Study (n=9,481, aged 40–80 years), adults with T2DM and diabetic retinopathy had higher odds (OR:1.31 [95%CI:1.07–1.60]) of falling compared to individuals without diabetes in a fully adjusted model 74.…”

Postural Imbalance in the Elderly: Main Aspects

“…In a study, Gupta et al found that diabetes per se was not a risk factor for falls. However, the authors found an association between diabetic patients with DR and risk of falling [20], suggesting a relation between DR and postural balance.…”

“…Diabetic retinopathy (DR) is a common and potentially blinding microvascular complication of diabetes [20]. In a study, Gupta et al found that diabetes per se was not a risk factor for falls.…”

Fear of Falling, Lower Extremity Strength, and Physical and Balance Performance in Older Adults with Diabetes Mellitus

“…The prevalence of falls and FoF is significantly higher in older adults with DM (ODM) than in older adults without DM (ONDM) [8,[11][12][13][14]. Microvascular complications associated with DM result in multiple impairments including sensory deficits and muscle weakness due to peripheral neuropathy [15][16][17][18], loss of visual acuity due to retinopathy [18][19][20], and impaired postural control and falls due to vestibulopathy [21][22][23]. These impairments predispose ODM to an increase in fall risk [17,20,24], falls [12,17,25], and FoF [25].…”

“…Since impaired sensation required for maintaining standing balance has been reported to vary largely among the ODM [17,18,20,23,24], it is plausible that ODM's performance on the mCTSIB may also vary among them and contribute to the degree of FoF they experienced. On the other hand, FoF may influence how well the ODM performs on the mCTSIB, particularly when they maintain standing balance on a compliant surface with their eyes closed.…”