A multi-domain fall risk model in diabetes: From screening to prevention

Falls are a common and serious complication among individuals with diabetes mellitus (DM), particularly those with diabetic peripheral neuropathy (D-PN). Multiple impairments in neuromuscular, sensory, and cognitive systems may contribute to increased fall risk in this population. The study aimed to identify key risk factors for falls among older adults with diabetes and to develop a multi-domain fall risk model that integrates screening and explanatory variables for clinical application.
A prospective cohort study was conducted among community-dwelling adults aged 50-70 years with DM for over 5 years, and participants were followed for 6 months to record fall incidence. Group comparisons and multivariate analyses were carried out to identify significant screening and explanatory predictors.
Participants with D-PN demonstrated significantly poorer muscle strength, reaction time, balance, and sensory function compared with non-neuropathic and control groups. Female gender and a history of previous falls were the strongest predictors for screening. Quadriceps strength and tandem balance emerged as key explanatory factors. The final model, comprising five risk variables: diagnosed neuropathy, poor contrast vision, reduced knee strength, impaired balance, and slow walking speed, showed a graded increase in fall incidence from 0% (1 factor) to 83% (five factors).
A simple, multi-domain fall risk model can effectively identify individuals with diabetes at high risk of falling, supporting targeted screening and preventive interventions in clinical practice.