Falls in Elderly Patients With Diabetes Mellitus on Insulin Therapy And/ Or Oral Hypoglycemic Drugs

Authors

  • Raaid Kemal Thenoon Syah Mansoor Department of Family Medicine, Azadi Teaching Hospital, Kirkuk, Iraq
  • Hayder Ghali Wadi Algawwam Department of Emergency Medicine, ONG Onlus, Sulaymaniyah, Iraq

Abstract

Objectives Falls are a major cause of disability and a preventable cause of death in older people. Diabetes mellitus prevalence increases with age. A study by the Agency for Healthcare Research and Quality in America found that in 2010, diabetes-related emergency department visit rates were highest for patients aged 65 and older. The complications of diabetes may lead to an increased risk of falls in older diabetic patients. Methods This is a descriptive cross sectional study to describe the prevalence of falls among diabetic elderly and to compare the prevalence between patients on insulin therapy and patients on oral hypoglycemic drugs in Sulaimaniyah, Iraqi kurdistan for one year from 1st of  July  2014 to 31st of June 2015. Results One hundred and fifty elderly diabetic patients with history of fall were included in This study, 88 (59%) were females and 62 (41%) were males. Their ages ranged between 65 – 90 years, mean age was  77.7 ± 7.11 year, and the mean duration of diabetes mellitus was 15.12±7.36 year. The prevalence of falls increased significantly with increasing age, longer duration of diabetes, treatment with insulin therapy and sulfonylurea, patients with poor diabetic control, patients on poly pharmacy, those requiring assistance with mobility : for those mobile with a stick and frame, those who had suffered peripheral neuropathy, osteoarthritis, retinopathy, cardiac problems, previous stroke, patients who live in institution, those living alone, smokers and alcoholics. Conclusion Poorly controlled diabetes, treatment with insulin therapy and to some extend sulfonylurea, and conditions associated with complications of diabetes are associated with an increased risk of falling in older people.

References

1. Gibson M.J, Andres RO, Isaacs B, Radebaugh T, Worm-Petersen J. The prevention of falls in later life. A report of the Kellogg International Work Group on the prevention of falls by the elderly. Dani Med Bullet 1987; 34:1-24.
2. Hoidrup S, Sorensen TI, Gronbaek M, Schroll M. Incidence and characteristics of falls leading to hospital treatment. J Scand Public Health 2003;31:24–30.
3. Cumming RG, Kelsey JL, Nevitt MC. Methodologic issues in the study of frequent and recurrent health problems. Falls in the elderly. Ann Epidemiol 1990;1:49-56.
4. Tilling LM, Darawil K, Britton M. Falls as a complication of diabetes mellitus in older people. J Diab Comp 2006;20: 158-62.
5. Tesfaye S, Stevens LK, Stephenson JM. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: The Europian Diabetes IDDM Complication Study. Diabetolo 1996;39:1377-84.
6. Pijpers E, Ferreira I, Jongh,de RT. Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors: the Longitudinal Ageing Study Amsterdam. Ag Agei 2012;41:358-65.
7. Allet L, Armand S, Bie- de RA. Clinical factors associated with gait alterations in diabetic patients. Diab Med 2009;26:1003-9.
8. Signorovitch JE, Macaulay D, Diener M. Hypoglycaemia and accident risk in people with type 2 diabetes mellitus treated with non-insulin anti diabetes drugs. Diabetes, Obesity and Metabolism 2013;15:335-41.
9. Kruse RL, Lemaster JW, Madsen RW. Fall and balance outcomes after an intervention to promote leg strength, balance, and walking in people with diabetic peripheral neuropathy. Feet first randomized controlled trial. Phys Ther 2010;90:1568-79.
10. Shorr RI, Ray WA, Daugherty JR. Individual sulfonylureas and serious hypoglycemia in older people. J Am Geriatr Soc 1996;44:751-5.
11. Berlie HD, Garwood CL. Diabetes medications related to an increased risk of falls and fall-related morbidity in the elderly. Ann Pharmacoth 2010;44:712.
12. Brown AF, Mangione CM, Saliba D, Sarkisian CA. Guidelines for improving the care of the older person with diabetes mellitus. J Am Geriatr Soc 2003;51:265-80.
13. Hausdorff JM, Rios DA, Edelberg HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Arch Phys Med Reh 2001;82:10506.
14. Gregg EW, Beckles GL, Williamson DF, Leveille SG, Langlois JA. Diabetes and physical disability among older U.S. adults. Diab Car 2000;23:1272-7.
15. Maurer MS, Burcham J, Cheng H. Diabetes mellitus is associated with an increased risk of falls in elderly residents of a long-term care facility. J Gerontol A Biol Sci Med Sci 2005;60:1157-62.
16. Strotmeyer ES, Cauley JA, Schwartz AV, Nevitt MC, Resnick HE. Non traumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: The health, aging, and body composition study. Arch Int Med 2005;165:1612-7.
17. Durán Alonso JC, investigadores del estudio Diagerca. Prevalence of diabetes mellitus in geriatric patients in nursing homes of Cádiz. Diagerca study. Rev Esp Geriatr Gerontol 2012;47:114-8.
18. Robbins AS. Predictors of falls among elderly people. Results of two population-based studies. Arch int med 1989;149:1628-33.
19. Lindsey M. Tilling, Khaled Darawil, Mary Britton Falls as a complication of diabetes mellitus in older people. Department of Elderly Care Medicine, Homerton University Hospital, Hackney 2006;20:158-62.
20. Hope SV, Strain WD. Hypoglycemia in the elderly. Diab Hypog 2013;6:3-10.
21. Berlie HD, Garwood CL. Diabetes medications related to an increased risk of falls and fall-related morbidity in the elderly. Ann Pharmacother 2010;44:712-7.
22. Meier C, Kraenzlin ME, Bodmer M, Jick SS, Jick H, Meier CR. Use ofthiazolidinedion- es and fracture risk. Arch Int Med 2008;168:820-5.
23. Lecka-Czernik B. Bone as a target of type 2 diabetes treatment. Curr Opin Investig Drugs 2009;10:1085-90.
24. Schwartz AV, Hillier TA, Sellmeyer DE. Older women with diabetes have a higher risk of falls: a prospective study. Diab Car 2002;25:1749-54.
25. Huang ES, Karter AJ, Danielson KK, Warton EM, Ahmed AT. Association between the number of prescription medications and incident falls in a multi-ethnic population of adult type-2 diabetes patients: the diabetes and aging study. J Gen Intern Med 2010;25:141-6.
26. Lord SR, Rogers MW, Howland A, Fitzpatrick R. Lateral stability, sensorimotor function and falls in older people. J Am Geriatr Soc 1999;47:1077-81.
27. Tinetti ME. Factors 3associated with serious injury during falls by ambulatory nursing home residents. J Am Geriatr Soc 1987;35:644-8.
28. Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Int Med 1994;121:442-51.
29. Ettinger MP. Aging bone and osteoporosis: strategies for preventing fractures in the elderly. Arch Int Med 2003;163:2237-46.
30. Council on Scientific Affairs. Alcoholism in the elderly. Am Med Assoc JAMA 1996;275:797-801.

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Published

2019-05-05

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1.
Syah Mansoor RKT, Algawwam HGW. Falls in Elderly Patients With Diabetes Mellitus on Insulin Therapy And/ Or Oral Hypoglycemic Drugs. Iraq Med J [Internet]. 2019 May 5 [cited 2024 Nov. 25];3(1). Available from: https://mail.iraqmedj.org/index.php/imj/article/view/585

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