These Diabetes Meds INCREASE Fall Risk!

Popular diabetes medications increase fall risk, with the danger nearly tripling when certain drug combinations are used, according to a recent Japanese study that raises concerns for older adults managing type 2 diabetes.

At a Glance

  • SGLT2 inhibitors nearly double the risk of falls in type 2 diabetes patients
  • Combined use of SGLT2 inhibitors with GLP-1 receptor agonists nearly triples fall risk
  • Fall predictors include previous fall history, SGLT2 inhibitor use, and advanced age
  • Medication-induced weight loss and muscle mass reduction may contribute to increased fall risk
  • Healthcare providers should consider fall risk when prescribing these medications to older adults

Understanding the Increased Fall Risk with Diabetes Medications

A study published in Scientific Reports has identified that sodium-glucose cotransporter-2 (SGLT2) inhibitors, commonly prescribed medications for type 2 diabetes, significantly increase the risk of falls in patients. The research, conducted by Yasuhiro Suzuki and colleagues from the University of Tsukuba in Japan, followed 471 participants with a median age of 64 over a five-year period. The findings reveal that patients taking SGLT2 inhibitors had nearly double the odds of falling compared to those not taking these medications, with an odds ratio of 1.80.

The researchers defined a fall as “coming in contact with the ground (or floor) from a standing or sitting position with a body part other than the foot in contact with the ground (floor surface) against the patient’s intention.” The study found a fall incidence rate of 17.1 per 100 person-years among participants, highlighting the significance of this safety concern for diabetes patients, particularly older adults who already face elevated fall risks due to age-related factors.

Combined Medication Use Significantly Increases Risk

While SGLT2 inhibitors alone substantially increase fall risk, the study revealed an even more alarming finding regarding combination therapy. When patients took both SGLT2 inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs), the odds of falling nearly tripled, with an odds ratio of 2.89. This dramatic increase suggests that the mechanisms through which these medications affect the body may have compounding effects on stability and fall risk.

Interestingly, GLP-1RAs alone, particularly those with lower weight-reducing effects, were not found to be significant independent predictors of falls. This suggests that the mechanism behind the increased fall risk may be related specifically to how SGLT2 inhibitors affect the body, and that these effects become amplified when combined with GLP-1RAs.

Understanding the Mechanisms Behind Increased Fall Risk

Several physiological factors may explain why SGLT2 inhibitors increase fall risk. These medications cause weight loss primarily through calorie loss in urine, but they can also lead to reduction in muscle mass. Additionally, they increase urinary frequency, which may result in more trips to the bathroom, especially at night. For older adults or those with mobility issues, this increased bathroom activity represents more opportunities for falls.

The study identified several key predictors of falls, including a previous history of falls, use of SGLT2 inhibitors, and advanced age. Patients with sarcopenia—age-related loss of skeletal muscle mass and function—appear to be particularly vulnerable. This suggests healthcare providers should exercise caution when prescribing SGLT2 inhibitors to older patients with diabetes who already have reduced muscle mass or other risk factors for falls.

Clinical Implications and Recommendations

The findings have important implications for clinical practice, particularly for healthcare providers treating older adults with type 2 diabetes. The researchers recommend careful consideration of fall risk when prescribing SGLT2 inhibitors, especially in combination with GLP-1RAs. For patients receiving these medications, appropriate diet and exercise interventions may help minimize muscle mass loss and reduce fall risk.

While the study has limitations, including a follow-up rate below the ideal 80% and being conducted at a single center, it provides valuable insights into previously underrecognized risks associated with these widely prescribed diabetes medications. For adults over 40 with type 2 diabetes, discussing fall prevention strategies with healthcare providers becomes increasingly important when starting these medications.

Balancing the benefits of improved glucose control with the potential increased risk of falls represents a challenge that requires individualized decision-making between patients and their healthcare providers, with particular attention to those who already have risk factors for falls or fractures.

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