Severe hypoglycemia is associated with high risk for falls in adults with type 1 diabetes

Shah, Viral N.; Wu, Mengdi; Foster, Nicole C.; Dhaliwal, Ruban; Mukaddam, Mona Al

doi:10.1007/s11657-018-0475-z

Cited by 31 publications

(25 citation statements)

References 17 publications

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“…comprehensive geriatric assessment) (https://www.nice.org.uk/guidance/cg161). According to the STEADI initiative and the NICE guidelines, the management of patients at risk of falling starts with the management of conditions that alter gait, balance and mobility such as postural dizziness and postural hypotension, cognitive impairment, metabolic abnormalities such as hypoglycaemia [48] or hyponatraemia [49], sleep disturbances [50], muscle weakness and urinary incontinence [47] and conditions that induce fainting. Insertion of a pacemaker should be considered for older people with frequent falls associated with cardioinhibitory carotid sinus hypersensitivity, or sinus node dysfunction, conditions which cause sudden changes in heart rate and blood pressure [32,51].…”

Section: Multifactorial Falls Risk Assessment and Interventions In Patients With High Risk Of Fallingmentioning

confidence: 99%

How Can We Prevent Falls?

Blain

Miot

Bernard

2020

Practical Issues in Geriatrics

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Falls represent a major health problem in subjects aged 65 or older because of their high prevalence and the severity of their physical, functional, psychological and financial consequences. Indeed, approximately 30% of people living in the community aged over 65 years and 50% of those older than 80 experience at least one fall every year and one-third of fallers are repeated fallers. Falls result in injuries that require medical attention in 30%, fractures in 5%, a hip fracture (HF) in 1% or another major injury in 5-6%. Every year, around 50 million falls occur in Europe amongst community-dwelling older people, 2.3 million persons aged 65 years or older attend emergency departments for a fall-related injury, 1.4 million are admitted to hospital and 36,000 die from falls. Falls induce psychological consequences in patients, including fear of falling and loss of confidence that can result in selfrestricted activity levels, reduction in physical function and social interactions, and put a major strain on the family. With the ageing of the population, fall has become the third leading cause of years living with disability in older subjects and one of the main causes of admission to a nursing home [1].

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Section: Multifactorial Falls Risk Assessment and Interventions In Patients With High Risk Of Fallingmentioning

confidence: 99%

How Can We Prevent Falls?

Blain

Miot

Bernard

2020

Practical Issues in Geriatrics

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“… 3 Exercise can improve glycemic control 17 and sensitivity to exogenous insulin, 18 and was shown to reduce the risk of falls and fractures in the elderly in a Cochrane review, 47 a complication that individuals with type 1 diabetes are highly vulnerable to. 48 Yet exercise rates are lower in those with type 1 diabetes, with reasons including fear of hypoglycemia, uncertainty about how to control blood sugars around exercise, and diabetes complications. 17 Our data show that those with type 1 diabetes still benefit from the acute effects of exercise on bone turnover.…”

Section: Discussionmentioning

confidence: 99%

Bone turnover and metabolite responses to exercise in people with and without long-duration type 1 diabetes: a case–control study

Taylor

Moser

Smith

et al. 2020

BMJ Open Diab Res Care

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IntroductionExercise acutely alters markers of bone resorption and formation. As risk of fracture is increased in patients with type 1 diabetes, understanding if exercise-induced bone turnover is affected within this population is prudent. We assessed bone turnover responses to acute exercise in individuals with long-duration type 1 diabetes and matched controls.Research design and methodsParticipants with type 1 diabetes (n=15; age: 38.7±13.3; glycosylated hemoglobin: 60.5±6.7 mmol/mol; diabetes duration: 19.3±11.4 years) and age-matched, fitness-matched, and body mass index-matched controls (n=15) completed 45 min of incline walking (60% peak oxygen uptake). Blood samples were collected at baseline and immediately, 30 min, and 60 min postexercise. Markers of bone resorption (β-C-terminal cross-linked telopeptide of type 1 collagen, β-CTx) and formation (procollagen type-1 amino-terminal propeptide, P1NP), parathyroid hormone (PTH), phosphate, and calcium (albumin-adjusted and ionized) were measured. Data (mean±SD) were analyzed by a mixed-model analysis of variance.ResultsBaseline concentrations of P1NP and β-CTx were comparable between participants with type 1 diabetes and controls. P1NP did not change with exercise (p=0.20) but β-CTx decreased (p<0.001) in both groups, but less so in participants with type 1 diabetes compared with controls (−9.2±3.7%; p=0.02). PTH and phosphate increased immediately postexercise in both groups; only PTH was raised at 30 min postexercise (p<0.001), with no between-group differences (p>0.39). Participants with type 1 diabetes had reduced albumin and ionized calcium at all sample points (p<0.01).ConclusionsFollowing exercise, participants with type 1 diabetes displayed similar time-course changes in markers of bone formation and associated metabolites, but an attenuated suppression in bone resorption. The reduced albumin and ionized calcium may have implications for future bone health. Further investigation of the interactions between type 1 diabetes, differing modalities and intensities of exercise, and bone health is warranted.

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“…Other studies have reported increased risk of fractures due to hypoglycemic events,69,70 whereas other studies found no association 9,52,53. Although evidence on hypoglycemia and fracture is conflicting, hypoglycemia is associated with falls61 and hypoglycemia may be widely underdiagnosed in studies that mainly use registries and questionnaires. Thus, the true prevalence of fractures due to hypoglycemia is susceptible to be larger than what is presented in the literature.…”

Section: Impact Of Medications On Fracture Riskmentioning

confidence: 99%

“…One study reported increased fracture risk in patients with T1D and no complications 60. Although the association between diabetes complications and fracture risk remains controversial, a study reported that 41% of patients with T1D are fearful of falls, and that the main contributors to falls are neuropathy and hypoglycemia 61. A severe limitation to the studies assessing diabetes complications, falls, and fracture risk is that the data is mainly collected through registries and questionnaires, and therefore patients may be misclassified by both diabetes diagnosis (e.g.…”

Section: Influence Of Complications and Comorbidities On Fracture Riskmentioning

confidence: 99%

<p>Type 1 Diabetes and Bone Fragility: Links and Risks</p>

Starup-Linde

Hygum

Harsløf

et al. 2019

DMSO

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Type 1 diabetes (T1D) is associated with an increased fracture risk, which is present at young and old age. Reductions in bone mineral density do not explain the increased fracture risk. Novel scanning modalities suggest that structural deficits may contribute to the increased fracture risk. Furthermore, T1D may due to insulinopenia be a state of low bone turnover. However, diabetes complications and comorbidities may influence fracture risk. Patients with T1D are fearful of falls. The diabetes related complications, hypoglycemic events, and antihypertensive treatment may all lead to falls. Thus, the increased fracture risk in T1D seems to be multifactorial, and earlier intervention with antiosteoporotic medication and focus on fall prevention is needed. This systematic review addresses the epidemiology of fractures and osteoporosis in patients with T1D and the factors that influence fracture risk.

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Severe hypoglycemia is associated with high risk for falls in adults with type 1 diabetes

Abstract: This is the first study on prevalence and risk factors for falls suggesting that falls are common in T1D and severe hypoglycemia is a unique diabetes-related factor associated with threefold higher risk for falls.

Cited by 31 publications

References 17 publications

How Can We Prevent Falls?

How Can We Prevent Falls?

Bone turnover and metabolite responses to exercise in people with and without long-duration type 1 diabetes: a case–control study

<p>Type 1 Diabetes and Bone Fragility: Links and Risks</p>

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