<b>Background</b>: Hypoglycemia has been postulated to
contribute to falls risk in older adults with type 2 diabetes. However, few studies
have prospectively examined the association between severe hypoglycemia and
falls, both important causes of morbidity and mortality.
<div><p><b>Methods</b>: We conducted a prospective cohort analysis
of participants from the Atherosclerosis Risk in Communities (ARIC) Study with
diagnosed diabetes at Visit 4 (1996-1998). Episodes of severe hypoglycemia
requiring medical treatment were identified using ICD-9 codes from
hospitalizations, emergency department visits, and ambulance calls; total falls
were identified from medical claims using E-codes (1996-2013). Secondary
analyses examined hospitalized falls and falls with fracture. We calculated
incidence rates and used Cox regression models to evaluate the independent
associations of severe hypoglycemia with falls occurring after Visit 4 through
2013. </p>
<p><b>Results</b>: Among 1,162 participants with
diabetes, 149 ever had a severe hypoglycemic event, either before baseline or
during the median of 13.1 years of follow-up. The crude incidence rate of falls
among persons without severe hypoglycemia was 2.17 per 100 person-years (PY)
(95%CI: 1.93-2.44), compared to 8.81 per 100PY (6.73-11.53) with severe
hypoglycemia. After adjustment, severe hypoglycemia was associated with over
twofold higher risk of falls (hazard ratio (HR) 2.23, 95%CI 1.61-3.07). Associations
were consistent in subgroups defined by age, sex, race, BMI, duration of
diabetes, or functional difficulty. </p>
<p><b>Conclusions</b>: Severe hypoglycemia was associated with
a substantially higher risk of falls in this community-based population of
adults with diabetes. Fall risk should be considered when individualizing
glycemic treatment in older adults. Assessing hypoglycemia history and future
hypoglycemia risk could also improve multifactorial fall prevention
interventions for older adults with diabetes.</p>
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Serum calcium and incident type 2 diabetes: the Atherosclerosis Risk in Communities (ARIC) study