DIABETES, PRE-DIABETES, AND FALLS IN OLDER ADULTS

描述（由申请人提供）：在老年人中，糖尿病可能增加跌倒和跌倒损伤的风险，特别是骨折。糖尿病还与下肢功能下降有关，这可能会增加跌倒的风险和独立生活的困难。跌倒和下肢功能不佳对老年人的健康和生活质量构成严重威胁，但对老年糖尿病患者这些结果的危险因素的研究很少。最终，需要进行试验，以确定如何预防或减轻这些后果。然而，关于糖尿病与跌倒和下肢功能下降的危险因素之间的关系，还需要更完整和结论性的数据。在糖代谢受损的老年人（糖尿病前期）中采取措施预防这些结果也可能是谨慎的。需要进行研究来确定老年糖尿病前期成年人是否有更高的跌倒和下肢功能下降的风险，以及哪些风险因素可能导致风险增加。这一群体可能是预防性干预措施的特别重要目标。健康、衰老和身体组成动态（HABC）是一项对3075名老年人（基线年龄为70-79岁）进行的纵向研究，为评估糖尿病和糖尿病前期对跌倒和下肢表现的影响提供了独特的资源。HABC包括681名糖尿病患者和945名糖尿病前期患者，男性和女性，非裔美国人和白人参与者人数大致相等。在五年的年度门诊访问中收集跌倒和下肢表现的测量数据。关于这些结果与糖尿病相关的潜在预测因素，包括空腹血糖、HbA[lc]、体位性低血压、身体成分、周围神经病变、视力和药物，已有大量信息可供参考。此外，入院数据可用于调查与糖尿病相关的严重跌倒损伤。我们建议使用HABC数据进行二次分析，以调查糖尿病或糖尿病前期患者跌倒和下肢功能下降的危险因素，强调可能成为干预目标的危险因素。这些分析将为今后设计试验提供信息，以防止老年糖尿病或糖尿病前期患者跌倒并保持力量和平衡。

DESCRIPTION (provided by applicant): In older adults, diabetes may increase the risk of falls and fall injuries, particularly fractures. Diabetes is also associated with lower extremity performance decline, which may contribute to fall risk and difficulty with independent living. Falls and poor lower extremity performance represent serious threats to the health and quality of life for this population, yet there has been little study of the risk factors for these outcomes among older adults with diabetes. Ultimately, trials will be needed to ascertain how these consequences can be prevented or relieved. However, more complete and conclusive data about the relationship between diabetes and risk factors for falls and declining lower extremity performance are needed. Taking measures to prevent these outcomes among older adults with impaired glucose metabolism (pre-diabetes) may also prove prudent. Studies are needed to determine if older pre-diabetic adults have a higher risk of falls and decline in lower extremity performance and what risk factors might account for any increased risk. This group might be especially important to target for preventive interventions. The Dynamics of Health, Aging and Body Composition (HABC), a longitudinal study among 3,075 older adults (70-79 years old at baseline), provides an exceptional resource to assess the influence of diabetes and pre-diabetes on falls and lower extremity performance. HABC includes 681 participants with diabetes and 945 participants with pre-diabetes, approximately equal numbers of men and women, and African-American and white participants. Measurements of falls and lower extremity performance are being collected over five years at annual clinic visits. A wealth of information is available on potential predictors of these outcomes that are related to diabetes, including fasting glucose, HbA[lc], postural hypotension, body composition, peripheral neuropathy, vision, and medications. In addition, data from hospital admissions are available to investigate serious fall injuries associated with diabetes. We propose performing secondary analyses using HABC data to investigate the risk factors for falls and lower extremity performance decline among those with diabetes or pre-diabetes, emphasizing risk factors that might be a target of intervention. These analyses will inform future efforts to design trials to prevent falls and maintain strength and balance in older adults with diabetes or pre-diabetes.