Falls in people with diabetes and peripheral neuropathy and their association with demographic and clinical characteristics

Introduction: Peripheral neuropathy is a risk factor for falls, especially in older people with chronic diseases. Diabetes-related foot disease is a chronic disease that is predominantly prevalent in older people, and peripheral neuropathy is present in most patients. While this increases their risk of falling, surprisingly little is known about falls within this high-risk population. Our aim was to investigate fall incidence in people with diabetes and peripheral neuropathy, and whether demographic and clinical characteristics are associated with falls.

Method: Prospective longitudinal observational cohort study, embedded within the DIASSIST-RCT. We included 121 participants (17% female; mean age 67 (SD:10) years; mean BMI 29 (SD:5) kg/m2), diagnosed with diabetes and peripheral neuropathy, and (as criteria for the RCT) a history of foot ulceration and custom-made footwear. Demographic and clinical characteristics were obtained from questionnaires and clinical testing at baseline. Participants were followed for 12 months. Falls were recorded via questionnaires at 3-monthly follow-ups, subsequently confirmed during in-person study visits. We performed descriptive statistics, and multivariate logistic regression with forward selection to test for associations with falling.

Results: Of the 121 participants, 40% (n=48) reported at least one fall during 12 months follow-up, and 22% (n=27) reported two or more falls. Median [IQR] number of falls within those with >1 fall was 3 [2;6]. Explained variance in multivariate analyses was 19.6% (R2=0.196), with having a job (OR=0.103; 95%CI:0.029-0.365) the only (protective) factor included.

Conclusions: Falls occur frequently in people with diabetes and neuropathy, and more commonly compared to age-related healthy peers. With care in this population focused on preventing foot ulcers and amputations, more emphasis should be included on fall prevention. We found poor associations between falls and demographic and clinical characteristics. Future research is needed to identify predictors of falls within this high-risk population of people with diabetes and neuropathy.