Diabetics, Both Type 1 and Type 2, at Increased Risk of Falls, Fall-Related Injuries

Results from a recent study of patients in a national registry is offering greater insight into the risk of falls and fall-related injuries in patients with diabetes compared to the general population.

The study, which examined risks associated with type 1 and type 2 diabetes separately, found patients with type 1 diabetes were at a 33% greater risk while patients with type 2 diabetes were at a 19% greater risk of falls than the general population.

"While of course we cannot do anything about getting older or our gender, diabetes—especially type 2 diabetes—use of medications and alcohol abuse could be potentially modifiable risk factors for falls,” concluded investigators. “Gaining further information on risk factors for falls could guide the management of diabetes treatment such as the choice of medication, which enables us to improve treatment particularly in people with a high risk of falls and fractures associated with high mortality."

Led by Nicklas Rasmussen, of the Steno Diabetes Center, the study was designed to tackle a pair of pressing questions through analysis of data within the Danish National Patient Register. The specific goals of the study were to estimate risk of falls and identify factors associated with increased falls and also to estimate differences in fall-related injuries and where they occur in those with type 1 and type 2 diabetes versus the general population. The study, which was presented at the European Association for the Study of Diabetes (EASD) 2020 annual meeting, examined all data the within the registry from 1996-2017.

Through their search, investigators identified cohorts of 12,975 type 1 diabetics and 407,099 type 2 diabetes. From these populations, investigators created sex- and age-matched control groups from the general population. Of note, adjusted analyses performed in the study accounted for age, sex, diabetic complications, a history of alcohol abuse, and a history of medication.

Results of the investigators' query revealed the cumulative incidence rate of falls requiring hospitalization was 13.% among patients with type 1 diabetes and 11.9% in patients with type 2 diabetes. Upon analysis, results suggest type 1 diabetes was associate with a 33% greater risk of falls (HR, 1.33; 95% CI, 1.25-1.43) and type 2 diabetes Wass associated with a 19% greater risk of falls (HR, 1.19; 95% CI, 1.16-1.22).

The investigators' analysis also identified multiple other risk factors significantly associated with falls among patients in both groups. Among patients with type 1 diabetes, other risk factors included being female (T1: HR, 1.21; 95% CI, 1.13-1.29; T2: HR, 1.61; 95% CI, 1.58-1.64), older than 65 years of age (T1: HR, 1.52; 95% CI, 1.39-1.61; T2: HR, 1.32; 95% CI, 1.58-1.64), use not SSRI (HR, 1.35; 95% CI, 1.30-1.40; T2: HR, 1.32; 95% CI, 1.27-1.38), use of opioids (T1: HR, 1.15; 95% CI, 1.12-1.19; T2: HR, 1.09; 95% CI, 1.05-1.12), and a history of alcohol abuse (T1: HR, 1.77; 95% CI, 1.17-2.15; T2: HR, 1.88; 95% CI, 1.69-2.15).

Additionally, investigators found the incidence rate ratio(IRR) of fall-related injuries such as hip (IRR, 1.02; 95% CI, 1.01-1.04), radius (IRR, 1.39; 95% CI, 1.18-1.61), humerus (IRR, 1.24; 95% CI, 1.12-1.37), and skull/facial fractures (IRR, 1.15; 95% CI, 1.07-1.24) were greater among patients with type 2 diabetes. Among patients with type 1 diabetes, an increased IRR was only noted with hip fractures (IRR, 1.11; 95% CI, 1.11-1.23).

This study, “Increased risk of falls, fall-related injuries and fractures in people with type 1 and type 2 diabetes compared with the general population: a nationwide cohort study,” was presented at EASD 2020.