Reason to Exercise in Diabetic Populations: Use of Rapid-Acting Insulin Predicts Falls in At-Risk Patients

Document Type

Conference Presentation

Department

Health, Exercise, and Sport Sciences Department

Conference Title

American College of Sports Medicine - Medicine & Science in Sports & Exercise conference

Organization

American College of Sports Medicine

Location

Orlando, FL

Date of Presentation

5-30-2019

Journal Publication

Medicine & Science in Sports & Exercise

ISSN

0195-9131

DOI

10.1249/01.mss.0000561771.57685.ee

Volume

51

Issue

6S

First Page

424

Abstract

Diabetes is present in 9.4% of American adults. Insulin is used in Type 1 and Type 2 cases, but without lifestyle change, it can hasten the progression of the disease. Limited data supports an association between diabetes and fall risk in older adults, with greater risk found among insulin-treated patients. Little is known about different insulin classes. PURPOSE: To evaluate the effect of insulin classes on incidence of falls in older adults. METHODS: We conducted retrospective and prospective analyses of 615 hospital patients age ≥65 years who sustained a fall in 2015. Data was extracted from their first fall-related admission that year, including demographic reports, health history, injury characteristics, relevant diagnoses, and home medications. We exported the number of previous falls since 2010 and used logistic and Poisson regressions to test the effect of insulin on the odds of experiencing falls and the total number experienced. We then tracked patients forward until August 2016 and tested the effect of insulin on return visits for new fall-related admissions. RESULTS: Patients were 80.0±9.1 years old, 6.2% used long-acting insulin, 0.5% used intermediate insulin, and 4.2% used rapid-acting insulin. They were admitted 1.9±1.3 times previously and had 0.5±0.9 return visits. There was no relationship with intermediate insulin and the number of previous (P=0.223) or future (P=0.383) falls. Long-acting insulin associated with modest increases in the number of previous (P=0.053) and return (P=0.050) falls. Rapid-acting insulin significantly predicted both. Controlling for weather, age, balance, and cognitive condition, patients using rapid-acting insulin had a 4.2-fold increase in the odds of sustaining multiple previous falls (P=0.002; 95% CI of odds ratio=1.68-10.54), a 37.2% increase in the number of previous visits (P=0.012; 95% CI of IRR: 1.07-1.76), a 2.4-fold increase in the odds of readmission (P=0.033; 95% CI of odds ratio: 1.07-5.50), and a 64.3% increase in the number of return visits (P=0.026; 95% CI of IRR: 1.06-2.54). CONCLUSIONS: Diabetics taking rapid-acting insulin express an elevated risk of falls. Exercise may serve two functions in this population: it can mitigate the acute and chronic effects of diabetes via non-insulin dependent glucose uptake, and it can protect against fall risk.

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