Supplementary Material for: Independent and Combined Effects of Type 2 Diabetes Mellitus and Inappropriate Medication Use on Fall Risk Among the Older People

ABSTRACT Introduction: Falls are a major cause of morbidity and mortality in older people, and type 2 diabetes mellitus (T2DM) has been identified as a key contributor. Another factor associated with increased fall risk is inappropriate medication use (IMU), which includes the use of inappropriate drugs or the omission of indicated ones. However, the independent and combined effects of T2DM and IMU on fall risk in older people remain unclear. Methods: This prospective observational study was conducted among inpatients aged 65 years and older in the internal medicine department of a tertiary hospital between November 2022 and February 2023. Sociodemographic data, Turkish Inappropriate Medication Use in the Elderly (TIME-to-START/STOP) Criteria, and the Itaki Fall Risk Scale were collected through face-to-face interviews conducted by the researcher. The study population was divided into two groups: Group 1 (patients without T2DM n=50) and Group 2 (patients with T2DM, n=58). The effects of the independent variables on fall risk were analyzed using a multivariable logistic regression model (backward Wald method, Nagelkerke R Square 62.0%) in IBM SPSS Statistics 26.0. A p-value <0.05 was considered statistically significant. Results: T2DM and age were significant predictors of fall risk [(B = 2.775, p = 0.047, OR = 16.035); (B = 0.137, p = 0.010, OR = 1.147)]. Among participants with T2DM, females had higher risk of falls compared with males (B = 2.573, OR = 13.158, p = 0.043). At least one IMU was present in 75.0% of the cases per TIME-to-START. Fall risk was significantly higher in Group 2 and in male participants who did not meet “2+” TIME-to-START criteria [(B = 2.077, OR = 8.000, p = 0.014); (B = 2.118, OR = 8.316, p = 0.006)]. IMU was not a significant fall risk predictor in either group according to TIME-to-STOP. Both T2DM and IMU identified by TIME-to-START were significant predictors of high fall risk in older people. In addition to T2DM, age and IMU, living arrangement and history of falls were significant predictors. However, the primary focus was on the independent and combined effects of T2DM and IMU. Conclusions: Our study demonstrated that both T2DM and IMU identified by TIME-to-START were significant predictors of increased fall risk in older people. This risk was especially pronounced in patients with T2DM who also had multiple instances of inappropriate medication. These findings suggest that careful medication management is particularly important for fall prevention in older T2DM patients.摘要 引言：跌倒是老年人发病与死亡的主要诱因，2型糖尿病（type 2 diabetes mellitus, T2DM）已被证实为关键危险因素之一。另一项与跌倒风险升高相关的因素为不恰当用药（inappropriate medication use, IMU），其涵盖不恰当药物使用或遗漏应开具的药物。但目前2型糖尿病与不恰当用药对老年人跌倒风险的独立及联合影响仍不明确。 方法：本前瞻性观察性研究于2022年11月至2023年2月期间，在某三级医院内科收治的65岁及以上住院患者中开展。研究人员通过面对面访谈收集社会人口学数据、老年不恰当用药土耳其标准（Turkish Inappropriate Medication Use in the Elderly, TIME-to-START/STOP）以及伊塔基跌倒风险量表（Itaki Fall Risk Scale）相关信息。将研究对象分为两组：组1（无2型糖尿病患者，n=50）与组2（2型糖尿病患者，n=58）。采用IBM SPSS Statistics 26.0软件中的多变量logistic回归模型（反向Wald法，Nagelkerke R²为62.0%）分析自变量对跌倒风险的影响，以p值<0.05为差异具有统计学意义。 结果：2型糖尿病与年龄是跌倒风险的显著预测因子[(B=2.775, p=0.047, OR=16.035); (B=0.137, p=0.010, OR=1.147)]。在2型糖尿病患者中，女性跌倒风险高于男性（B=2.573, OR=13.158, p=0.043）。根据TIME-to-START标准，75.0%的受试者存在至少1项不恰当用药情况。组2及未达到“2项及以上”TIME-to-START标准的男性受试者跌倒风险显著升高[(B=2.077, OR=8.000, p=0.014); (B=2.118, OR=8.316, p=0.006)]。根据TIME-to-STOP标准，不恰当用药在两组中均未成为跌倒风险的显著预测因子。通过TIME-to-START标准识别的2型糖尿病与不恰当用药均为老年人高跌倒风险的显著预测因子。除2型糖尿病、年龄与不恰当用药外，居住安排与跌倒史同样为显著预测因子，但本研究核心聚焦于2型糖尿病与不恰当用药的独立及联合影响。 结论：本研究证实，通过TIME-to-START标准识别的2型糖尿病与不恰当用药均为老年人跌倒风险升高的显著预测因子，该风险在同时存在多次不恰当用药的2型糖尿病患者中尤为突出。上述研究结果提示，对老年2型糖尿病患者实施精细化用药管理，对于跌倒预防具有重要临床意义。