Some diabetes medications, such as sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1RAs), may lead to weight loss that contributes to loss of muscle mass and consequently, a higher risk of falls, suggests a study published in Scientific Reports.¹ Older patients, patients with a history of fall at admission, and those taking SGLT2 inhibitors at discharge were at a significantly higher risk.

This study evaluated the relationship between SGLT2 inhibitors and GLP-1RAs and the risk of falls in patients with type 2 diabetes. A total of 471 patients, median age 64 years, who had been hospitalized in the Department of Endocrinology, Diabetes, and Metabolism at the University of Tsukuba Hospital in Japan were followed for up to five years after discharge through annual fall surveys. Falls occurred at a rate of 17.1 per 100 person-years in the study group.

During the median follow-up period of two years, the study identified a past history of fall at the time of hospitalization, increasing age, and SGLT2 inhibitor use at discharge as independent predictors of falls. The odds ratios (ORs) for fall risk were 1.80 for SGLT2 inhibitor use alone, 1.61 for use of GLP-1RAs alone, and 2.89 for the combined use of both medications. While the use of SGLT2 inhibitors emerged as an independent risk factor for falls, GLP-1RAs alone did not significantly influence fall risk. This association remained significant even after adjusting for known risk factors for falls, such as history of falls, skeletal muscle mass, muscle strength, and retinopathy. 

Notably, the concurrent use of both SGLT2 inhibitors and GLP-1RAs was associated with a significantly higher risk of falls compared with SGLT2 inhibitors monotherapy.

Therefore, clinicians treating patients with type 2 diabetes should be aware of the potential fall risk associated with SGLT2 inhibitors and GLP-1 receptor agonists. Patients prescribed SGLT2 inhibitors, especially those using GLP-1 receptor agonists simultaneously, should be carefully monitored for fall risk. Persons prone to falls should be advised appropriate dietary and exercise interventions to minimize loss of skeletal muscle mass.

Reference

1.   Yasuhiro Suzuki, et al. Longitudinal association of SGLT2 inhibitors and GLP-1RAs on falls in persons with type 2 diabetes. Sci Rep. 2025 Mar 17;15(1):9178. doi: 10.1038/s41598-025-91101-0.