Association between hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes

Diabetes Obes Metab. 2012 Jul;14(7):634-43. doi: 10.1111/j.1463-1326.2012.01583.x. Epub 2012 Mar 14.


Aims: This retrospective observational study examined the association between International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM)-coded outpatient hypoglycaemic events and fall-related fractures in Medicare-covered patients with type 2 diabetes.

Methods: Data were derived from healthcare claims for individuals with employer-sponsored Medicare supplemental insurance. The study period consisted of two consecutive 1-year periods; the baseline period (1 April 2008 to 31 March 2009) and the evaluation period (1 April 2009 to 31 March 2010). Patients selected for study were at least 65 years of age with evidence of type 2 diabetes during the baseline period, as identified using a Healthcare Effectiveness Data and Information Set algorithm or by at least two prescription claims for oral antidiabetic drugs. The baseline period was used to collect information on the patients' demographics and clinical characteristics. The evaluation period was used to identify the presence of hypoglycaemic events and fall-related fractures. Logistic regression was employed to examine the association between hypoglycaemic events and fall-related fractures occurring during the evaluation period, adjusting for patients' demographics and clinical characteristics.

Results: Of 361 210 included patients, 16 936 had hypoglycaemic events during the evaluation period. Patients with hypoglycaemic events had 70% higher regression-adjusted odds (hypoglycaemic events odds ratio = 1.70; 95% confidence interval = 1.58-1.83) of fall-related fractures than patients without hypoglycaemic events. Multiple sensitivity analyses also yielded results suggesting increased odds of fall-related fractures in patients with hypoglycaemic events.

Conclusions: ICD-9-CM-coded outpatient hypoglycaemic events were independently associated with an increased risk of fall-related fractures. Further studies of the relationship between hypoglycaemia and the risk of fall-related fractures are warranted.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls*
  • Administration, Oral
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Algorithms
  • Cognition Disorders / complications
  • Cognition Disorders / etiology
  • Diabetes Mellitus, Type 2 / drug therapy*
  • Drug Prescriptions / economics
  • Female
  • Fractures, Bone / economics*
  • Fractures, Bone / etiology
  • Humans
  • Hypoglycemia / chemically induced*
  • Hypoglycemia / complications*
  • Hypoglycemic Agents / administration & dosage
  • Hypoglycemic Agents / adverse effects*
  • Insurance Claim Review
  • Logistic Models
  • Male
  • Medicare
  • Outpatients*
  • Retrospective Studies
  • Risk Factors
  • Unconsciousness / complications*
  • Unconsciousness / etiology
  • United States / epidemiology


  • Hypoglycemic Agents