Background and aims: Falls are important clinical events in elderly with type 2 diabetes (T2D) associated with increased morbidity and mortality. This study aims to investigate risk factors for falls in T2D. Methods: Subjects with T2D, aged between 65-75 years (youngest old), without foot amputations, severe neuropathy or a history of severe hypoglycemia were consecutively enrolled in a prospective observational study. At baseline, clinical (age, disease duration, body mass index–BMI) and biochemical features (HbA1c, blood glucose, lipid, renal function) were collected. Further, NDS (evaluated by vibration and thermal perception, pin-prick sensation and Achilles tendon reflexes) was assessed and a whole-body composition DEXA was performed to evaluate fat and lean mass. Falls were self-registered on a diary for up to 2 years after enrollment. Associations between risk factors and the outcome (≥1 fall) were tested by regression considering gender and variables associated with falls. Results: 144 subjects with T2D were enrolled (72% male, 69[66-72] years, 8.5[4-13] years of T2D duration). At the end of the follow-up, 14(9.7%) subjects reported at least one fall. Fallers were older (71.0[68.5-73.3] years vs 69.0[66.0-72.0] years, p=0.037), had higher HbA1c (7.0[6.3-8.0]% vs 6.4[6.0-7.1]%, p=0.038) and disease duration (11.5[8.0-22.0] years vs 8.0[4.0-12.0] years, p=0.019) compared to non-fallers. Fallers showed an increased fat mass (31.0[26.6-34.6]% vs 25.7[23.1-30.7]%, p=0.046) also after correction for BMI and a trend in a decreased lean mass (68.8[64.3-74.1]% vs 73.8[66.8-76.7]%, p=0.064). In the final multivariate model, only disease duration and age remain significantly associated with risk of falls. After correction for HbA1c and fat mass, no differences in anti-diabetes treatments were found between the two groups. Conclusion: T2D is a major risk factor for falls, suggesting a major role of disease duration, metabolic control and fat mass. Only disease duration remains significantly associated with the risk of falls, hence new studies are needed to investigate additional factors increasing the risk of falls.