A recent case-control study has found a strong connection between the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors and increased risk of falls. This situation is especially troubling for people living with type 2 diabetes (T2D). Yasuhiro Suzuki and his colleagues from the Department of Endocrinology and Metabolism, Faculty of Medicine, University of Tsukuba in Japan, carried out this study. Through the process, they identified key determinants that exacerbate fall risks in this vulnerable population.
The discrete-time survival analysis used four models to examine several risk factors. These factors were the number of falls experienced, sex, age, height and body mass index. The findings of our study suggest that women are at a markedly higher risk of falls. They have an OR of 1.73 (OR 95% CI 1.03 to 2.89). This analysis showed important information on the overall fall risk of diabetes medications. In the process, it showcased the dangers that disproportionately affect women and girls.
Findings on SGLT2 Inhibitors
One of the most significant findings from the study is that SGLT2 inhibitors significantly increase fall risks in T2D patients. The rate of falling was estimated at 17.1 falls per 100 person-years. 173 participants reported having at least 1 fall following their discharge. Of those falls, 15 led to fractured bones from the fall. Our analysis showed that even when SGLT2 inhibitors were used, this class of drugs independently predicted falls. It has a particularly high effect size (odds ratio of 1.80, 95% CI [1.10, 2.92]).
Chesney’s groundbreaking research made one big discovery. This was particularly the case when SGLT2 inhibitors were used in combination with glucagon-like peptide 1 receptor agonists (GLP-1 RAs), where the risk of falls was significantly compounded. Cox Regression Analysis This combination therapy demonstrates a remarkable odds ratio of 2.89 (95% CI, 1.27-6.56). Healthcare providers should be very careful about prescribing these medications concurrently.
Independent Predictors of Falls
This study found multiple independent predictors of falls among T2D patients. History of falls was found to be a major player. This result had an odds ratio of 2.26 and a 95% confidence interval of 1.57 to 3.26. In addition, age was identified as a factor contributing to PI development, OR 1.02 (95% CI, 1.01-1.04). Clinicians need to closely monitor older patients. They need to be especially vigilant towards patients with a history of falls when prescribing diabetes medications.
In fact, GLP-1 RAs used alone significantly do not contribute to fall risk with OR of 1.61 (95% CI, 0.88-2.84). When glycosurics were combined with SGLT2 inhibitors, there is a significant heightening in fall risk that should be addressed.
Implications for Patient Care
Given the study’s findings, these implications could be significant for clinical practice surrounding diabetes treatment protocol. The original researchers were disappointed by a low follow-up rate of just 69% in that first year. This was less than the acceptable 80% for cohort studies, thus they acknowledged the need for more research to make robust conclusions about fall risks associated with diabetes medications.
This assertion points to the evidence-based importance of holistic, multidisciplinary approaches to care. They should have medication management and lifestyle interventions to reduce fall risks integrated within the care of patients with T2D.
“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.”
This statement underscores the importance of comprehensive care strategies that encompass not only medication management but also lifestyle modifications aimed at reducing fall risks among patients with T2D.
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