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Glucose Control Medications

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Medication-Related Falls in Older People

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Abstract

Elderly patients with diabetes are at risk of falls. Various neuropathies, nephropathy, orthostatic hypotension (OH), and retinopathy may contribute to fall risk in this population. The dosage of renally excreted oral hypoglycemic agents needs to be carefully adjusted to avoid hypoglycemia. Long-acting sulfonylureas such as glyburide and glimepiride should be avoided in older individuals. Metformin has a low risk of hypoglycemia, but when used in the situation of decreased renal function, there is an elevated risk of lactic acidosis. New dipeptidyl peptidase-4 (DPP4) inhibitors are excreted renally and their dosage should be adjusted. Patients with type 2 diabetes are 1.6 times more likely to have a fracture and 2.8 times more likely to have a hip fracture than patients without diabetes. The use of thiazolidinediones doubles the risk of fractures in women when compared to other oral hypoglycemia agents. Metformin can cause vitamin B12 deficiency which can be associated with neuropathy and increase the risk of falls. The literature studying the use of antidiabetic medications and the risk of falls is limited. Trials were not originally designed to evaluate the risk of falls or fractures, and some studies were done over short periods of time. Information on the risk of falls with the use of newer antidiabetic medications such as glucagon-like peptide 1 receptor agonists are lacking.

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Abbreviations

CI:

Confidence interval

DM:

Diabetes mellitus

DN:

Diabetic nephropathy

DPP4:

Dipeptidyl peptidase-4

DPN:

Distal polyneuropathy

DR:

Diabetic retinopathy

DSPN:

Distal symmetric polyneuropathy

eGFR:

Estimated glomerular filtration rate

OH:

Orthostatic hypotension

OR:

Odds ratio

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Author information

Authors and Affiliations

  1. Faculty of Pharmacy, University of Montréal, Montréal, QC, Canada

    Louise Mallet BScPharm, PharmD, CGP, FESCP

  2. Department of Pharmacy, McGill University Health Center, Montréal, QC, Canada

    Louise Mallet BScPharm, PharmD, CGP, FESCP

Authors
  1. Louise Mallet BScPharm, PharmD, CGP, FESCP
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Corresponding author

Correspondence to Louise Mallet BScPharm, PharmD, CGP, FESCP .

Editor information

Editors and Affiliations

  1. University of Ottawa and The Ottawa Hospital, Head, Division of Geriatric Medicine University of Ottawa and The Ottawa Hosp, Montréal, Québec, Canada

    Allen R. Huang

  2. Head, Faculty of Pharmacy Université de Montréal, Université de Montréal, Montréal, Québec, Canada

    Louise Mallet

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© 2016 Springer International Publishing Switzerland

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Mallet, L. (2016). Glucose Control Medications. In: Huang, A., Mallet, L. (eds) Medication-Related Falls in Older People. Adis, Cham. https://doi.org/10.1007/978-3-319-32304-6_13

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  • DOI: https://doi.org/10.1007/978-3-319-32304-6_13

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  • Publisher Name: Adis, Cham

  • Print ISBN: 978-3-319-32302-2

  • Online ISBN: 978-3-319-32304-6

  • eBook Packages: MedicineMedicine (R0)

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