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Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review

Malabu, Usman H., Vangaveti, Venkat N. and Kennedy, Richard Lee 2014, Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review, Clinical epidemiology, vol. 6, pp. 287-294, doi: 10.2147/CLEP.S66821.

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Title Disease burden evaluation of fall-related events in the elderly due to hypoglycemia and other diabetic complications: a clinical review
Author(s) Malabu, Usman H.
Vangaveti, Venkat N.
Kennedy, Richard Lee
Journal name Clinical epidemiology
Volume number 6
Start page 287
End page 294
Total pages 8
Publisher Dove Medical Press
Place of publication Macclesfield, England
Publication date 2014
ISSN 1179-1349
Keyword(s) diabetes complications
elderly
falls
fractures
hypoglycemia
Summary A hypoglycemia-induced fall is common in older persons with diabetes. The etiology of falls in this population is usually multifactorial, and includes microvascular and macrovascular complications and age-related comorbidities, with hypoglycemia being one of the major precipitating causes. In this review, we systematically searched the literature that was available up to March 31, 2014 from MEDLINE/PubMed, Embase, and Google Scholar using the following terms: hypoglycemia; insulin; diabetic complications; and falls in elderly. Hypoglycemia, defined as blood glucose <4.0 mmol/L (70 mg/dL) requiring external assistance, occurs in one-third of elderly diabetics on glucose-lowering therapies. It represents a major barrier to the treatment of diabetes, particularly in the elderly population. Patients who experience hypoglycemia are at a high risk for adverse outcomes, including falls leading to bone fracture, seizures, cognitive dysfunction, and prolonged hospital stays. An increase in mortality has been observed in patients who experience any one of these events. Paradoxically, rational insulin therapy, dosed according to a patient's clinical status and the results of home blood glucose monitoring, so as to achieve and maintain recommended glycemic goals, can be an effective method for the prevention of hypoglycemia and falls in the elderly. Contingencies, such as clinician-directed hypoglycemia treatment protocols that guide the immediate treatment of hypoglycemia, help to limit both the duration and severity of the event. Older diabetic patients with or without underlying renal insufficiency or other severe illnesses represent groups that are at high risk for hypoglycemia-induced falls and, therefore, require lower insulin dosages. In this review, the risk factors of falls associated with hypoglycemia in elderly diabetics were highlighted and management plans were suggested. A target hemoglobin A1c level between 7% and 8% seems to be more appropriate for this population. In addition, the first-choice drugs should have good safety profiles and have the lowest probability of causing hypoglycemia - such as metformin (in the absence of significant renal impairment) and incretin enhancers - while other therapies that may cause more frequent hypoglycemia should be avoided.
Language eng
DOI 10.2147/CLEP.S66821
Field of Research 110299 Cardiorespiratory Medicine and Haematology not elsewhere classified
Socio Economic Objective 920103 Cardiovascular System and Diseases
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2014, Dove Medical Press
Persistent URL http://hdl.handle.net/10536/DRO/DU:30067401

Document type: Journal Article
Collection: School of Medicine
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Created: Mon, 08 Dec 2014, 13:59:57 EST

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