Popular Diabetes Drugs Linked to Fall Risk in T2D

TOPLINE: 

In patients with type 2 diabetes (T2D), sodium-glucose cotransporter 2 (SGLT2) inhibitors significantly increase the risk for falls, and combined use with glucagon-like peptide 1 receptor agonists (GLP-1 RAs) further heightened this risk, emphasizing the need for careful management and support for patients receiving these therapies.

METHODOLOGY:

• The increased risk for falls in people with T2D has been linked to medications that induce hypoglycemia, but low lean body mass also increases the risk for falls. Newer diabetes medications, particularly SGLT2 inhibitors and GLP-1 RAs, can lead to muscle and body mass loss, prompting researchers to assess the association with falls in patients with T2D.
• Researchers conducted a prospective follow-up survey for up to 5 years (median, 2 years) in patients with T2D who had been admitted to the University of Tsukuba Hospital in Japan for poor glycemic control between February 2src14 and December 2src21.
• Among the 471 patients (199 women; median age, 63 years), 53 received GLP-1 RAs, 74 received SGLT2 inhibitors, and 17 received a combination of both these treatments.
• Each year after discharge, the participants received a questionnaire regarding the number of falls (never, once, twice, or more) they experienced in the previous year and their current weight.
• A discrete-time survival analysis was done to identify fall risk factors, using four models that included evaluating variables such as fall history, sex, age, height, and body mass index.

TAKEAWAY:

• The fall incidence rate was 17.1 per 1srcsrc person-years, with 173 individuals reporting at least one fall after discharge and 15 experiencing fractures due to falls.
• Independent fall predictors identified were fall history (odds ratio [OR], 2.26; 95% CI, 1.57-3.26), SGLT2 inhibitor use (OR, 1.8src; 95% CI, 1.1src-2.92), and age (OR, 1.src2; 95% CI, 1.src1-1.src4).
• The best-performing model also found women were at higher risk (OR, 1.73; 95% CI, 1.src3-2.89).
• GLP-1 RA use alone showed no significant association with risk for falls (OR, 1.61; 95% CI, src.88-2.84), but its combined use with SGLT2 inhibitors significantly increased the risk for falls (OR, 2.89; 95% CI, 1.27-6.56). 

IN PRACTICE:

“Our findings suggest the need to (i) consider the increased risk of falls in the case of combined therapy and (ii) provide fall-prone persons receiving such therapy with an appropriate diet and exercise,” concluded the authors.

SOURCE:

The study was led by Yasuhiro Suzuki, Department of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan. It was published online in Scientific Reports.

LIMITATIONS:

The study’s follow-up rate of 69% at first year fell below the desired 8src% for cohort studies, potentially introducing selection bias. Because questionnaires were mailed annually after discharge, the possibility of recall bias cannot be ruled out.Also, the participants were hospitalized with poorly controlled blood glucose levels. These results may not apply to individuals with T2D who have stable glycemic control in an outpatient setting nor to more diverse populations. Finally, most participants used GLP-1 RAs with low weight-reducing effects (dulaglutide, liraglutide, exenatide XR, and lixisenatide), and only seven used semaglutide, which has a strong weight-reducing effect.

DISCLOSURES:

The study was supported by a JSPS KAKENHI Grant-in-Aid for Early-Career Scientists and the Grant for Research on Medical Safety from University of Tsukuba Hospital. The authors reported no conflicts of interests.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.