SGLT2 Inhibitors and Fall Risk in Type 2 Diabetes Patients
New study highlights increased fall risk with diabetes drugs, especially when SGLT2 inhibitors are combined with GLP-1 RAs
Topline
In people with type 2 diabetes, the use of SGLT2 inhibitors is independently linked to higher risk of falls and that risk rises further when combined with GLP-1 receptor agonists, according to a prospective study from Japan.
Study Details
Type 2 diabetes (T2D) is known to increase fall risk due to complications like peripheral neuropathy and hypoglycemia. Newer therapies such as SGLT2 inhibitors and GLP-1 receptor agonists (GLP-1 RAs) improve glycemic control but may also reduce lean muscle mass, raising concerns about their impact on physical stability. Researchers from the University of Tsukuba set out to examine this relationship in patients with poorly controlled diabetes.
Methodology
The study followed 471 T2D patients admitted for poor glycemic control between 2014 and 2021. Participants were surveyed annually after discharge, reporting falls and body weight. Fall risk was analyzed using discrete-time survival models that adjusted for age, sex, BMI, and prior fall history. Treatments examined included GLP-1 RAs, SGLT2 inhibitors, and their combination.
Key Findings
Fall Rate: 17.1 falls per 100 person-years
Major Predictors:
Prior fall history (OR 2.26)
SGLT2 inhibitor use (OR 1.80)
Age (OR 1.02 per year)
Female sex (OR 1.73)
Combination Therapy: Using both SGLT2 inhibitors and GLP-1 RAs significantly increased fall risk (OR 2.89)
GLP-1 RAs Alone: Not statistically significant (OR 1.61)
Implications for Practice
This study adds to the growing need for personalized risk management in diabetes care. Clinicians should monitor muscle mass and fall history in patients starting SGLT2 inhibitors, especially if they are also prescribed GLP-1 RAs. Diet and resistance training may help mitigate risks.
For patients
particularly older adults or women, this highlights the importance of discussing potential fall risk with their care team when initiating or combining these therapies.