Patients with type 2 diabetes participating in this cross-sectional observational study were recruited from 35 general practices, predominantly located in the north eastern region of the Netherlands. Recruitment and all study procedures took place between January 2009 and May 2010. Eligible patients with diabetes were either selected by practice nurses during the periodical diabetic check-up, or by the authors using the GPs’ patients information systems. All participating nurses were visited and trained by the authors for trial procedures. The initial selection included patients with a diagnosis of type 2 diabetes, aged ≥70 years, and the ability to follow the study protocol. Exclusion criteria were known autonomic dysfunction, neurodegenerative diseases, active malignancy, irregular pulse, and residing in a nursing home. Patients with irregular pulse were excluded because of the difficulty establishing ‘real’ OH in these patients, due to the high variability of blood pressure. Although all practices were asked to participate in recruiting the control group, only a few practices were willing to do so. As a result, participants in the control group, with no history of diabetes, were selected from only seven of the 35 general practices. These participants were either selected during a consultation with the GP, or by the authors using the GPs’ patient information systems. The same selection criteria as in the diabetes group were used. For the participants in the control group selected by using the patients information system, one additional criterion was used: a consultation with the GP in the last 6 months. This criterion was used to select a group that would be comparable to the patients who were selected during a consultation with the GP. Those who were selected using the GPs’ patient information systems, were sent an invitation to participate in the study.
How this fits in
Although orthostatic hypotension (OH) is more prevalent in old age, and in patients with diabetes, the prevalence of OH in older patients with type 2 diabetes is unknown. OH is also considered as an important risk factor for falling, however, the evidence regarding this association is conflicting. This study showed that OH is highly prevalent in home-dwelling older patients with type 2 diabetes. No association was found between falling and OH. Remarkably, orthostatic complaints were associated with previous falling and high fall risk, even after adjustment for OH. Perhaps, actively inquiring for orthostatic complaints, instead of measuring OH, as part of the care for patients with type 2 diabetes and/or cardiovascular disease, may be a useful step.
