Diabetes Medications Related to an Increased Risk of Falls and Fall-Related Morbidity in the Elderly

Abstract

Special considerations should be made when treating elderly patients with diabetes. At this time, a patient's functional level and risk factors for falls should weigh into decision-making regarding drug selection. The risk of falls and fall-related complications associated with diabetes medications should not be ignored.

Association Between Hypoglycemia and Fall-Related Events in Type 2 Diabetes Mellitus: Analysis of a U.S. Commercial Database

“…A few studies have evaluated the risk for bone fractures associated with exposure to insulin or other oral hypoglycemic agents. [21][22][23] These studies show that a patient's functional level and risk factors for falls should be considered during the drug selection decision-making process, since some of the medications may increase fracture risk and thereby worsen fall-related outcomes. In addition, these studies also show that falls are most likely to occur during hypoglycemic episodes.…”

“…Some studies, however, contradict these findings. 15,21,22 Consequently, focused research evaluation of the impact of diabetes medications on risk of falls is needed. The recently published American Diabetes Association and European Association…”

The effects of canagliflozin, a sodium glucose co-transporter 2 inhibitor, on mineral metabolism and bone in patients with type 2 diabetes mellitus

“…Falls possibly related to volume depletion-related AEs could be a potential explanation for the fracture imbalance, as imbalances in these events were only seen in CANVAS and not in the pooled analysis of non-CANVAS Phase 3 studies. Attempting to elucidate the relationship between falls and fractures would require more systematic collection of fall data as opposed to spontaneous collection of fall AEs, as was done in the canagliflozin program, which almost certainly led to underreporting [72][73][74] . The US Food and Drug Administration (FDA) recently revised the product label of the SGLT2 inhibitor canagliflozin to include a warning related to the increased fracture risk observed with canagliflozin treatment in patients with T2DM…”

Management of Hyperglycemia in Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

“…130,131 Clearly, however, hypoglycemia is more dangerous in the elderly and occurs consistently more often as glycemic targets are lowered. Hypoglycemia may lead to dysrhythmias, but can also lead to accidents and falls (which are more likely to be dangerous in the elderly), 132 dizziness (leading to falls), confusion (so other therapies may not be taken or taken incorrectly), or infection (such as aspiration during sleep, leading to pneumonia). Hypoglycemia may be systematically underreported as a cause of death, so the true incidence may not be fully appreciated.…”