Glucose Control, Sulfonylureas, and Insulin Treatment in Older Adults With Type 2 Diabetes and Risk of Falls and Fractures: An Observational Study

Abstract

OBJECTIVE To estimate the association among glucose control, sulfonylureas, and insulin treatment with the risk of hospitalization for falls and fractures in older adults with type 2 diabetes (T2D). RESEARCH DESIGN AND METHODS This observational cohort study used U.K. Clinical Practice Research Datalink GOLD data linked to hospital and death records. Older adults (≥70 years) with T2D, identified between 2000 and 2017, were considered exposed if they had three consecutive HbA1c measurements <7% (53 mmol/mol) while receiving treatment with insulin or sulfonylureas. Each exposed individual was matched with to three nonexposed individuals. Outcomes included hospitalizations for falls and fractures. Flexible parametric survival models, adjusted for sociodemographic and clinical factors, and associated estimated relative (hazard ratio [HR]) and absolute risks. RESULTS Among 21,365 individuals (n = 5,833 [27.3%] in the exposed group), the adjusted relative risks of hospitalization for falls and fractures were marginally higher compared with those nonexposed (HR 1.04 [95% CI 0.96–1.11] and 1.07 [95% CI 0.97–1.17], respectively). The 10-year absolute risk values of hospitalization for falls were slightly higher in the exposed (range 15.6–36.8% in those aged 70–85 years) than nonexposed (15.1–36.0%) individuals. Absolute risk differences remained minimal (0.2–0.6% at 5 years and 0.5–0.8% at 10 years). CONCLUSIONS We found no evidence of an association between sustained HbA1c <7% while receiving insulin or sulfonylurea therapy and clinically meaningful increased risks of falls or fractures in older adults with T2D. Clinicians should continue to balance the benefits of glycemic control with the risks of complications in older adults.