The Association Between the Number of Prescription Medications and Incident Falls in a Multi-ethnic Population of Adult Type-2 Diabetes Patients: The Diabetes and Aging Study

Abstract

Background Use of four or more prescription medications is considered a risk factor for falls in older people. It is unclear whether this polypharmacy-fall relationship differs for adults with diabetes. Objective We evaluated the association between number of prescription medications and incident falls in a multi-ethnic population of type-2 diabetes patients in order to establish an evidence-based medication threshold for fall risk in diabetes. Design Baseline survey (1994-1997) with 5 years of longitudinal follow-up. Participants Eligible subjects (N = 46,946) had type-2 diabetes, were ≥18 years old, and enrolled in the Kaiser Permanente Northern California Diabetes Registry. Measurements and main results We identified clinically recognized incident falls based on diagnostic codes (ICD-9 codes: E880-E888). Relative to regimens of 0-1 medications, regimens including 4 or more prescription medications were significantly associated with an increased risk of falls [4-5 medications adjusted HR 1.22 (1.04, 1.43), 6-7 medications 1.33 (1.12, 1.58), >7 medications 1.59 (1.34, 1.89)]. None of the individual glucose-lowering medications was found to be significantly associated with a higher risk of falls in predictive models. Conclusions The prescription of four or more medications was associated with an increased risk of falls among adult diabetes patients, while no specific glucose-lowering agent was linked to increased risk. Baseline risk of falls and number of baseline medications are additional factors to consider when deciding whether to intensify diabetes treatments.