Glucose control, sulfonylureas, and insulin treatment in older adults with type 2 diabetes and risk of falls and fractures: an observational study

Objective To estimate the association between glucose control, sulfonylureas, and insulin treatment with the risk of hospitalisation for falls and fractures in older adults with type 2 diabetes (T2D). Research Design and Methods This observational cohort study used UK Clinical Practice Research Datalink GOLD data linked to hospital and death records. Older adults (≥70 years) with T2D, identified between 2000-2017, were considered exposed if they had three consecutive HbA1c measurements <7% (53 mmol/mol) while on insulin or sulfonylureas. Each exposed individual was matched with up to three non-exposed individuals. Outcomes included hospitalisations for falls and fractures. Flexible parametric survival models, adjusted for sociodemographic and clinical factors, estimated relative (hazard ratio, HR) and absolute risks associated. Results Among 21,365 individuals (5,833 [27.3%] in the exposed group), the adjusted relative risks of hospitalisation for falls and fractures were marginally higher vs those non-exposed: HR 1.04 (95% CI: 0.96–1.11) and 1.07 (0.97–1.17), respectively. The 10-year absolute risk of hospitalisation for falls were slightly higher in the exposed (ranging from 15.6%–36.8% in those aged 70–85 years, respectively) than non-exposed (15.1%–36.0%, respectively) individuals. Absolute risk differences remained minimal (0.2%–0.6% at 5 years and 0.5%–0.8% at 10 years, respectively). Conclusions We found no evidence of an association between sustained HbA1c <7% while on insulin or sulfonylurea and clinically meaningful increased risks of falls or fractures in older adults with T2D. Clinicians should continue to balance the benefits of glycaemic control with the risks of complications in older adults.