title: Sulfonylureas and risk of falls and fractures among nursing home residents with type 2 diabetes mellitus.
abstract: OBJECTIVE
  Although sulfonylureas increase the risk of hypoglycemia which may lead to fall-associated fractures, studies quantifying the association between sulfonylureas and falls and/or fractures are sparse and existing studies have yielded inconsistent results. Our objective is to evaluate the extent to which sulfonylurea use was associated with fractures and falls among nursing home residents with type 2 diabetes mellitus.
  
  
  METHODS
  We performed a propensity-matched retrospective new user cohort study of 12,327 Medicare Parts A/B/D eligible long-stay NH residents. Medicare Part D data provided information on sulfonylurea and biguanide use initiated as monotherapy (nsulfonylurea=5807 and nbiguanide=6151) after NH entry. Medicare hospitalizations were used to identify hypoglycemic events (ICD-9-CM codes 250.8, 251.1, 251.2) and fall-associated fractures (ICD-9-CM codes 800, 804, 812-817, 820, 823, 824). Minimum Data Set 2.0 (2008-2010) provided information on falls and potential confounders. Cox models conducted on propensity-matched samples provided adjusted hazard ratio (aHR) estimates and 95% confidence intervals (CI).
  
  
  RESULTS
  Falls were common (37.4 per 100 person-years). Fractures were not associated with initiation of sulfonylureas. Sulfonylurea initiation was associated with an excess risk of falls among residents with moderate activities of daily living limitations (aHR: 1.13; 95% CI: 1.00-1.26), but not among those with minimal limitations or dependence in activities of daily living.
  
  
  CONCLUSIONS
  Nursing home residents with moderate limitations in activities of daily living are at increased risk of falls upon initiation of sulfonylureas. Initiating sulfonylurea use in NH residents must be done with caution.
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA. Electronic address: kate.lapane@umassmed.edu.
authors.forename: Kate L
authors.initials: KL
authors.lastname: Lapane
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA.
authors.forename: Bill M
authors.initials: BM
authors.lastname: Jesdale
authors.affiliation: Department of Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA.
authors.forename: Catherine E
authors.initials: CE
authors.lastname: Dubé
authors.affiliation: Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA 01605, USA.
authors.forename: Camilla B
authors.initials: CB
authors.lastname: Pimentel
authors.affiliation: US Outcomes Research, Merck & Co., Inc., 1 Merck Drive, Whitehouse Station, NJ 08889, USA.
authors.forename: Swapnil N
authors.initials: SN
authors.lastname: Rajpathak
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013453:Sulfonylurea Compounds / Q000009:adverse effects*; D014481:United States / Q000453:epidemiology
chemical_list: D007004:Hypoglycemic Agents; D013453:Sulfonylurea Compounds
keywords: Diabetes; Falls; Fractures; Nursing home; Sulfonylurea