Diabetic retinopathy linked to increased fall risk

Roshini Claire Anthony
30 Nov 2017
Diabetic retinopathy linked to increased fall risk

Individuals with mild-to-moderate non-proliferative diabetic retinopathy appear to have an elevated risk of falls compared with individuals with diabetes but no diabetic retinopathy, according to a Singapore study.

“[While] diabetes per se was not associated with a higher risk of falling … the presence of [diabetic retinopathy] in participants with diabetes was significantly associated with falling … those with mild and moderate [non-proliferative diabetic retinopathy] were independently more likely to have a history of falls than those without [diabetic retinopathy],” said the researchers.

“These results suggest that efforts to prevent falls need to be incorporated into the clinical care of individuals with diabetes and diabetic retinopathy, particularly during the early stage of the disease,” they said.

In this cross-sectional post hoc analysis of 9,481 participants in the SEED* study (mean age 58.7 years, 50.4 percent female), 30.3 percent of participants had diabetes (n=2,869), of whom 29.9 percent (n=857) had diabetic retinopathy in at least one eye. Participants answered a questionnaire, underwent a clinical examination, and had fundus photographs taken to identify presence of diabetic retinopathy.

There were more falls reported by patients with diabetes and diabetic retinopathy than those with diabetes only (20.4 percent vs 16.3 percent).

Compared with patients without diabetes, patients with diabetic retinopathy were more likely to report a fall in the 12 months prior (odds ratio [OR], 1.31, 95 percent confidence interval, 1.07–1.60; p=0.008). [JAMA Ophthalmol 2017;doi:10.1001/jamaophthalmol.2017.4983]

Conversely, patients with diabetes but not diabetic retinopathy had a similar risk of falls as individuals without diabetes (OR, 1.06; p=0.42).

Patients with mild or moderate non-proliferative diabetic retinopathy had a higher risk of falls compared with patients with diabetes but without diabetic retinopathy (OR, 1.81; p=0.003 [mild] and OR, 1.89; p=0.01 [moderate]).

There was no elevated risk of falls among individuals with vision-threatening diabetic retinopathy (VTDR), one of the reasons for which could be reduced mobility leading to movement restriction, seeing as how patients with VTDR were older and had more comorbidities, said the researchers.

The researchers acknowledged that the self-reporting of falls may have led to recall bias. There was also limited information available on comorbidities such as osteoporosis, hypoglycaemia, and hearing impairment, as well as use of certain medications which may have affected the risk of falls.  

“Our findings suggest that strategies to prevent or delay the development of [diabetic retinopathy] are likely to reduce the risk of falls in persons with diabetes, preventing fall-related decline in physical functioning, suboptimal quality of life, and lack of independence in adults with diabetes. Furthermore, our results underscore the importance of safety and mobility training even for people with mild to moderate [diabetic retinopathy] who are not experiencing visual impairment,” they said. 

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