IMPACT OF ANTICONVULSANT USE ON INCIDENCE OF FALLS IN OLDER PATIENTS WITH DIABETIC PERIPHERAL NEUROPATHY. (11th November 2018)

• Record Type: Journal Article
• Authors: Randolph, A; Lin, Y; Volpi, E; Kuo, Y
• Is Part Of: Innovation in aging. Volume 2(2018)Supplement 1
• Page Start: 151
• Page End: 151
• Publication Date: 2018-11-11
• Subjects: Aging -- Periodicals; Gerontology -- Periodicals; 612.67
• DOI: 10.1093/geroni/igy023.547
• Languages: English
• ISSNs: 2399-5300

Abstract

Abstract: Peripheral neuropathy is a common complication of diabetes that can increase fall risk. Regarding fall risk, the impact of pain management using tricyclic antidepressants and GABA-analogs is unclear because these anticonvulsants can also contribute to falls. To determine these medications' effects on fall and fracture incidence in the older diabetic population with peripheral neuropathy, we used a retrospective cohort design with 1-to-1 propensity matching of anticonvulsant users and non-users. The propensity score model included age, sex, ethnicity, previous falls, diabetes status, insulin use, opioid use, and comorbid anxiety or depression. Both patient groups were selected from a 5% Medicare sample between the years 2008 and 2010 and followed until the first event of fall or fracture, for up to 5 years. Individuals with complete parts A, B, and D Medicare enrollment were included, while those with conditions that could alternatively explain anticonvulsant use were excluded. After applying all selection criteria, 5, 550 patients with prescription and 22, 200 patients without prescription of anticonvulsants were identified. Following matching, cases and controls were largely similar. After adjusting for covariates, anticonvulsant use significantly increased fall and fracture risk (HR 1.19, 95% CI 1.07 to 1.32). However, when considered separately, anticonvulsant use increased fall risk (HR 1.34, 95% CI 1.18 to 1.51) but not fracture risk (HR 1.06, 95% CI 0.92 to 1.22). We therefore conclude that anticonvulsant use is a potentially modifiable risk factor for falls in older patients with diabetic peripheral neuropathy. Discontinuation of anticonvulsants may decrease the incidence of falls in this population.