Department of Medicine, University of Chicago, Chicago, IL 60637, USA.
J Gen Intern Med. 2010 Feb;25(2):141-6. doi: 10.1007/s11606-009-1179-2. Epub 2009 Dec 5.
Use of four or more prescription medications is considered a risk factor for falls in older people. It is unclear whether this polypharmacy-fall relationship differs for adults with diabetes.
We evaluated the association between number of prescription medications and incident falls in a multi-ethnic population of type-2 diabetes patients in order to establish an evidence-based medication threshold for fall risk in diabetes.
Baseline survey (1994-1997) with 5 years of longitudinal follow-up.
Eligible subjects (N = 46,946) had type-2 diabetes, were >or=18 years old, and enrolled in the Kaiser Permanente Northern California Diabetes Registry.
We identified clinically recognized incident falls based on diagnostic codes (ICD-9 codes: E880-E888). Relative to regimens of 0-1 medications, regimens including 4 or more prescription medications were significantly associated with an increased risk of falls [4-5 medications adjusted HR 1.22 (1.04, 1.43), 6-7 medications 1.33 (1.12, 1.58), >7 medications 1.59 (1.34, 1.89)]. None of the individual glucose-lowering medications was found to be significantly associated with a higher risk of falls in predictive models.
The prescription of four or more medications was associated with an increased risk of falls among adult diabetes patients, while no specific glucose-lowering agent was linked to increased risk. Baseline risk of falls and number of baseline medications are additional factors to consider when deciding whether to intensify diabetes treatments.
使用四种或更多种处方药被认为是老年人跌倒的一个风险因素。目前尚不清楚这种多药治疗-跌倒关系是否因糖尿病患者而有所不同。
我们评估了 2 型糖尿病患者多民族人群中处方药物数量与新发跌倒事件之间的关系，旨在为糖尿病患者的跌倒风险确定一个基于证据的药物阈值。
基线调查（1994-1997 年），随访 5 年。
符合条件的受试者（N=46946）患有 2 型糖尿病，年龄>18 岁，并参加了 Kaiser Permanente 北加州糖尿病登记处。
我们根据诊断代码（ICD-9 代码：E880-E888）确定了临床上公认的新发跌倒事件。与 0-1 种药物治疗方案相比，包含 4 种或更多种处方药的方案与跌倒风险增加显著相关[4-5 种药物调整后的 HR 为 1.22（1.04，1.43），6-7 种药物为 1.33（1.12，1.58），>7 种药物为 1.59（1.34，1.89）]。在预测模型中，没有一种降血糖药物与更高的跌倒风险显著相关。
在成年糖尿病患者中，开具四种或更多种药物与跌倒风险增加相关，而没有特定的降糖药物与增加的风险相关。在决定是否加强糖尿病治疗时，应考虑基线跌倒风险和基线用药数量等额外因素。
