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% reported falling; 22, 26, 30, and 31% fell in subsequent years. In adjusted models, reduced peroneal nerve response amplitude (OR 1.50 Ϫ95% 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 Յ6 vs. Ͼ8%) 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 Յ6 vs. Ͼ8%). 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 Յ6% increased risk of falls. Diabetes Care 31:391-396, 2008O lder adults with type 2 diabetes have an increased risk of falls, but little is known about risk factors for falls in this population (1-4). Factors of particular concern include diabetesrelated complications of peripheral neuropathy, reduced vision, and renal function. Insulin therapy is associated with increased falls (3,5), possibly because of more severe disease and/or hypoglycemic episodes. Reduced balance, strength, and gait are likely intermediaries in any association between diabetesrelated complications and risk of falls. Previous studies of falls among older diabetic adults were cross-sectional or had limited data characterizing glycemic control and diabetes-related complications. We used longitudinal data for diabetic participants in the Health, Aging, and Body Composition (Health ABC) Study to determine whether factors associated with diabetes progression or treatment increase risk of falls and whether associations are mediated by poor performance on tests of balance, gait, and strength.RESEARCH DESIGN AND METHODS -Health ABC is a prospective study of 3,075 men and women aged 70 -79 years recruited at

Diabetes in South African older adults: prevalence and impact on quality of life and functional disability – as assessed using SAGE Wave 1 data

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