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


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.
Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California 94107-1762, USA. aschwartz@psg.ucsf.edu
Ann V
AV
Schwartz
Eric
E
Vittinghoff
Deborah E
DE
Sellmeyer
Kenneth R
KR
Feingold
Nathalie
N
de Rekeneire
Elsa S
ES
Strotmeyer
Ronald I
RI
Shorr
Aaron I
AI
Vinik
Michelle C
MC
Odden
Seok Won
SW
Park
Kimberly A
KA
Faulkner
Tamara B
TB
Harris
D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D048909:Diabetes Complications / Q000097:blood / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000627:therapeutic use; D007328:Insulin / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D016017:Odds Ratio; D012307:Risk Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin