Abstract
Elderly patients with diabetes are at risk of falls. Various neuropathies, nephropathy, orthostatic hypotension (OH), and retinopathy may contribute to fall risk in this population. The dosage of renally excreted oral hypoglycemic agents needs to be carefully adjusted to avoid hypoglycemia. Long-acting sulfonylureas such as glyburide and glimepiride should be avoided in older individuals. Metformin has a low risk of hypoglycemia, but when used in the situation of decreased renal function, there is an elevated risk of lactic acidosis. New dipeptidyl peptidase-4 (DPP4) inhibitors are excreted renally and their dosage should be adjusted. Patients with type 2 diabetes are 1.6 times more likely to have a fracture and 2.8 times more likely to have a hip fracture than patients without diabetes. The use of thiazolidinediones doubles the risk of fractures in women when compared to other oral hypoglycemia agents. Metformin can cause vitamin B12 deficiency which can be associated with neuropathy and increase the risk of falls. The literature studying the use of antidiabetic medications and the risk of falls is limited. Trials were not originally designed to evaluate the risk of falls or fractures, and some studies were done over short periods of time. Information on the risk of falls with the use of newer antidiabetic medications such as glucagon-like peptide 1 receptor agonists are lacking.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Abbreviations
- CI:
-
Confidence interval
- DM:
-
Diabetes mellitus
- DN:
-
Diabetic nephropathy
- DPP4:
-
Dipeptidyl peptidase-4
- DPN:
-
Distal polyneuropathy
- DR:
-
Diabetic retinopathy
- DSPN:
-
Distal symmetric polyneuropathy
- eGFR:
-
Estimated glomerular filtration rate
- OH:
-
Orthostatic hypotension
- OR:
-
Odds ratio
References
Crews RT, Yalla SV, Fleischer AE, Wu SC (2013) A growing troubling triad: diabetes, aging, and falls. J Aging Res 2013:342650
Tilling LM, Darawil K, Britton M (2006) Falls as a complication of diabetes mellitus in older adults. J Diabetes Complicat 28:158–162
Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE et al (2002) Older women with diabetes have a higher risk o falls: a prospective study. Diabetes Care 25:1749–1754
Kasznicki J (2014) Advances in the diagnosis and management of diabetic distal symmetric polyneuropathy. Arch Med Sci 10:345–354
Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA (1989) Low-extremity amputation in people with diabetes. Epidemiology and prevention. Diabetes Care 12:24–31
Vinik AI, Strotmeyer ES, Nakave AA, Patel CV (2008) Diabetic neuropathy in older adults. Clin Geriatr Med 24:407–435
Maty SC, Fried LP, Volpato S, Williamson J, Brancati FL, Blaum CS (2004) Patterns of disability related to diabetes mellitus in older women. J Gerontol A Biol Sci Med Sci 59:148–153
Menz HB, Lord SR, St George R, Fitzpatrick RC (2004) Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy. Arch Phys Med Rehabil 85:245–252
Lanier EF, Mote MB, Clay EC (2011) Evaluation and management of orthostatic hypotension. Am Fam Physician 84:527–536
Low PA, Benrud-Larson LM, Sletten DM, Opfer-Gehrking L, Weigand SD, O’Brian PC et al (2004) Autonomic symptoms and diabetic neuropathy: a population-based study. Diabetes Care 27:2942–2947
Mohamed O, Gillies MC, Wong TY (2007) Management of diabetic retinopathy: a systematic review. JAMA 298:902–916
Hornick T, Aron DC (2008) Preventing and managing diabetic complications in elderly patients. Clev Clin J Med 75:153–158
Antonetti D, Klein R, Gardner TW (2012) Diabetic retinopathy. N Engl J Med 366:1227–1239
Mayne D, Stout NR, Aspray TJ (2010) Diabetes, falls and fractures. Age Aging 39:522–525
Abdel-Rahman EM, Alhamad T, Reeves W, Awad AS (2012) Management of diabetic nephropathy in the elderly: special considerations. J Nephrol Ther 2: pii: 124
Lalau JD, Arnouts P, Sharif A, De Broe ME (2015) Metformin and other antidiabetic agents in renal failure patients. Kidney Int 87:308–322
Shorr RI, Ray WA, Daugherty JR, Griffin MR (1996) Individual sulfonylureas and serious hypoglycemia in older people. J Am Geriatr Soc 44:751–755
American Geriatrics Society 2015 Beers Criteria Update Expert Panel (2015) American Geriatrics Society 2015 updated beers criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 63:2227–2246
van Staa T, Abenhaim L, Monette J (1997) Rates of hypoglycemia in users of sulfonylureas. J Clin Epidemiol 50:735–741
Inzucchi SE, Lipska KJ, Mayo H, Bailey CJ, McGuire DK (2014) Metformin in patients with type 2 diabetes and kidney disease: a systematic review. JAMA 312:2668–2675
Rakel A, Sheehy O, Rahme E, LeLorier J (2008) Osteoporosis among patients with type 1 and type 2 diabetes. Diabetes Metab 34:193–205
Yamagishi S, Nakamura K, Inoue H (2005) Possible participation of advanced glycation end products in the pathogenesis of osteoporosis in diabetic patients. Med Hypotheses 65:1013–1015
Kahn SE, Zinman B, Lachin JM, Haffner SM, Herman WH, Holman RR et al (2008) Thiazolidinedione use and bone loss in type 2 diabetes: an analysis form A Diabetes Outcome Progression Trial (ADOPT). Diabetes Care 21:845–851
Schwartz AV, Sellmeyer DE, Vittinghoff E, Palermo L, Lecka-Czernik B, Feingold KR et al (2006) Thiazolidinedione use and bone loss in older diabetic adults. J Clin Endocrinol Metab 91:3349–3354
Berlie HD, Garwood CL (2010) Diabetes medications related to an increased risk of falls and fall-related morbidity in the elderly. Ann Pharmacother 44:712–717
Lapane KL, Yang S, Brown MJ, Jawahar R, Pagliasotti C, Rajpathak S (2013) Sulfonylureas and risk of falls and fractures: a systematic review. Drugs Aging 30:527–547
Kibirige D, Mwebaze R (2013) Vitamin B12 deficiency among patients with diabetes mellitus: is routine screening and supplementation justified ? J Diabetes Metab Disord 12:12–17
Ting R, Szeto C, Chan M, Ma K, Chow K (2006) Risk factors of vitamin B12 deficiency in patients receiving metformin. Arch Intern Med 166:1975–1979
Shibao C, Gamboa A, Diedrich A, Dossett C, Choi L, Farley G et al (2007) Acarbose, an alpha-glucosidase inhibitor, attenuates postprandial hypotension in autonomic failure. Hypertension 50:54–61
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Mallet, L. (2016). Glucose Control Medications. In: Huang, A., Mallet, L. (eds) Medication-Related Falls in Older People. Adis, Cham. https://doi.org/10.1007/978-3-319-32304-6_13
Download citation
DOI: https://doi.org/10.1007/978-3-319-32304-6_13
Published:
Publisher Name: Adis, Cham
Print ISBN: 978-3-319-32302-2
Online ISBN: 978-3-319-32304-6
eBook Packages: MedicineMedicine (R0)