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Item #14 

Diabetics With Prior Foot Ulcer Prone to Falls

Falls are common among diabetic patients with prior foot ulcers, according to new study. 

While few falls results in fractures, the risk of fall-related fractures is significantly higher in women than in men.

Dr. Carolyn Wallace, of VA Puget Sound Health Care System, Seattle, Washington, and colleagues examined the incidence of falls, the risk factors for falls, and the frequency of fall-related fractures in 400 diabetic patients with a prior foot ulcer. They collected data on foot status, functionality and lower-limb sensory perception at baseline, 1 year, and 2 years, and information about falls at baseline, 4 weeks, and every 17 weeks thereafter.

The patients had an average age of 62 years, and 77% were male. Fixed foot deformities, insensate feet, and comorbid conditions were observed in 32%, 58%, and 76% of patients, respectively.

The team notes that 252 patients (64%) reported at least one fall during the 2-year follow-up. The overall incidence of falls was 1.25 per person-year. One hundred sixty-four patients (41%) reported at least two falls. Risk factors for two or more falls included a body mass index of at least 30 kg/m, at least one comorbid condition, and insensate feet.

There were a total of 15 fall-related fractures during the study. "Fracture risk was significantly higher in women, in individuals who had diabetes for at least 25 years, and in study participants who wore their own footwear rather than special study shoes," Dr. Wallace and colleagues explain.

They suggest that clinicians discuss the risk of falls with diabetic patients and advise on strategies to prevent fall-related injuries.  Diabetes Care 2002;25:1983-1986.