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MTM for Type 2 Diabetes Can Decrease the Risk of Falls

Older, diabetic adults can reduce their injury risk from falls through preventative programs including medication therapy management, balance exercises, and cognitive training….

Although the risk of falls increases as any patient gets older, those with type 2 diabetes have an even greater risk of falling. Yearly, approximately one in three independently sufficient adults 65 years old or older will suffer from one or more falls. Diabetes is recognized as a risk factor for falls, fall-related injuries, and fractures through a number of studies. Diabetes-related complications such as peripheral neuropathy, poor vision and depth perception, and cerebrovascular accidents are a few reasons why patients may have poor balance and a greater probability for falls. Mettelinge et. al. aimed to identify risk factors, better understand the relationship between diabetes and falls, and help design fall prevention programs tailored to this population.

In the study, one hundred and four patients with diabetes and ninety five healthy control patients underwent medical screening and a twelve month follow-up. Patients were screened, assessed, and scored on their gait (GAITRite®), balance (AccuGait® force plate), grip strength (Jamar®), and cognitive status (Mini-Mental State Examination and Clock Drawing Test). After baseline measurements were taken, falls were monitored for twelve months using a monthly fall calendar. A fall was defined as "an unexpected event in which the person comes to rest on the ground, floor, or lower level." Compared to control patients, diabetic patients scored worse on ALL physical and cognitive measures. Forty-two diabetic patients compared to twenty-two control patients reported at least one fall where they were injured or two falls where they were not injured and they were classified as "fallers". Both diabetes and poor balance were recognized as independent risk factors for falling. Several factors such as taking more medications, walking slower, taking shorter strides, reduced grip strength and poor cognitive performance played the biggest role in a patient’s risk of falls.

Preventative programs including medication therapy management, balance exercises, and cognitive training may be beneficial in older adults suffering from diabetes in order to reduce the risk of falls. The study found that the strongest mediator of the relationship between diabetes and falls was the number of medications that the patient was taking. Patients with diabetes were taking on average a total of nine medications while patients without diabetes were taking around four medications. The preventative programs mentioned could help patients be more controlled on their medications and keep patients from suffering falls in the future.

Mettelinge, Roman D. et. al. "Understanding the Relationship between Type 2 Diabetes Mellitus and Falls in Older Adults: A Prospective Cohort Study." National Center for Biotechnology Information. U.S. National Library of Medicine, 25 June 2013. Web. <http://www.ncbi.nlm.nih.gov/pubmed/23825617