, Volume 25, Issue 2, pp 141-146
Date: 05 Dec 2009

The 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

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Use of four or more prescription medications is considered a risk factor for falls in older people. It is unclear whether this polypharmacy-fall relationship differs for adults with diabetes.


We evaluated the association between number of prescription medications and incident falls in a multi-ethnic population of type-2 diabetes patients in order to establish an evidence-based medication threshold for fall risk in diabetes.


Baseline survey (1994-1997) with 5 years of longitudinal follow-up.


Eligible subjects (N = 46,946) had type-2 diabetes, were ≥18 years old, and enrolled in the Kaiser Permanente Northern California Diabetes Registry.

Measurements and main results

We identified clinically recognized incident falls based on diagnostic codes (ICD-9 codes: E880-E888). Relative to regimens of 0-1 medications, regimens including 4 or more prescription medications were significantly associated with an increased risk of falls [4-5 medications adjusted HR 1.22 (1.04, 1.43), 6-7 medications 1.33 (1.12, 1.58), >7 medications 1.59 (1.34, 1.89)]. None of the individual glucose-lowering medications was found to be significantly associated with a higher risk of falls in predictive models.


The prescription of four or more medications was associated with an increased risk of falls among adult diabetes patients, while no specific glucose-lowering agent was linked to increased risk. Baseline risk of falls and number of baseline medications are additional factors to consider when deciding whether to intensify diabetes treatments.


This research was funded by the National Institute of Diabetes, Digestive and Kidney Diseases [R01 DK 081796 (Dr. Huang, Dr. Karter, Ms. Warton, and Dr. Ahmed), R01 DK65664 (Dr. Karter, Ms. Warton, and Dr. Ahmed), P60 DK20595 (Drs. Huang and Danielson)], the National Institute of Child Health and Human Development [R01 HD046113 (Dr. Ahmed, Dr. Karter, and Ms. Warton)], and the National Institute on Aging [K23 AG021963 (Dr. Huang)].