Older diabetics with complications and insulin users with tight blood sugar control have an increased risk of falling, the results of a new study suggest.

The researchers found that among 446 diabetic adults in their 70s, those suffering from diabetes complications, such as nerve damage in the feet and legs, vision problems and kidney impairment, were at heightened risk of having a fall over five years.

The same was true of those who had their blood sugar under tight control with insulin therapy, the researchers report in the journal Diabetes Care.

In general, it’s recommended that older diabetics have A1C levels - a measure of long-term blood sugar control - below 7 percent. In this study, insulin users whose A1C was 6 percent or lower were more than four times as likely to suffer a fall as those with levels at 8 percent or higher. However, the fall risk was not increased in patients with low A1C levels who did not use insulin.

It’s likely that the higher risk stems from episodes of hypoglycemia, a state where blood sugar dips too low, explained lead researcher Dr. Ann V. Schwartz, of the University of California San Francisco.

The findings, she told Reuters Health, illustrate the “trade-off” patients and doctors face in deciding how tightly to rein in blood sugar. Good blood sugar control lowers the risk of complications, which may also reduce fall risk, Schwartz said. But achieving very low A1C levels with insulin may contribute to falls in some cases.

The good news, the researchers found, was that tight blood sugar control with oral medications did not increase the risk of falls.

In general, Schwartz noted, people on oral diabetes medications do not have as many hypoglycemic episodes as those on insulin do. The findings suggest that achieving even very low A1C levels with oral agents is safe where fall risk is concerned.

SOURCE: Diabetes Care, March 2008.