Diabetes is common among older adults and is associated with greater risk of falls, which can be fatal in this population. One hypothesized link between diabetes and falls is hypoglycemia. However, this has not been evaluated in an older, type 2 diabetes population. We included 1186 ARIC participants with diabetes at Visit 4 (1996-1998) followed through 2013 for severe hypoglycemia and falls. We identified severe hypoglycemia with ICD-9 codes in claims for hospitalization, emergency department and ambulance use. Falls were based on E-codes in inpatient and outpatient claims; secondary outcomes were hospitalized falls and falls with fracture. We used adjusted Cox regression models to evaluate the association of severe hypoglycemia as a time-varying exposure with risk of subsequent fall. Participants had a mean age of 64, 54% female, 32% black; 14 had hypoglycemia prior to baseline and 135 had a severe hypoglycemic episode during follow-up. The crude incidence rate of falls without severe hypoglycemia was 2.17 per 100 person-years (PY) (95% CI: 1.93-2.44) and 8.81 per 100PY (6.73-11.53) with severe hypoglycemia. After adjustment, hypoglycemia was associated with an over two-fold greater risk of falls (Table). Fall history and risk should be considered when deciding glycemic goals and medication use, as hypoglycemia may increase fall risk.


A.K. Lee: None. S.P. Juraschek: None. B. Windham: None. C. Lee: Consultant; Self; XOMA Corporation. Research Support; Self; Eiger BioPharmaceuticals. A. Sharrett: None. J. Coresh: None. E. Selvin: None.


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