Diabetic Polyneuropathy and Risk of Falls: Fear of Falling and Other Factors

Abstract

The aim of the study was to analyze postural stability, walking speed and fear of falling in patients with diabetic polyneuropathy (DPN) in order to determine the risk factors for falls, as well as the effect of DPN characteristics as additional factors. A sample of 48 patients with type 2 diabetes and DPN were enrolled in this non-randomized observational study. The patients were divided into two groups of fallers and non-fallers. All subjects underwent evaluation with the Functional Reach Test (FRT), Tinetti Falls Efficacy Scale (Tinetti FES) and 10-Meter Walk Test (10MWT). Neuropathy was quantified with the Michigan Neuropathy Screening Instrument (MNSI, Questionnaire part) and 5.07/10-g Semmes Weinstein monofilament examination (SW-ME). The 10MWT and SW-ME were significantly different between the faller and non-faller groups (p<0.05). Duration of DPN correlated positively with SW-ME (p=0.005) in the faller group. FES showed significant positive correlation with MNSI and negative correlation with 10MWT in the non-faller group. Logistic regression analysis revealed that SW-ME was significantly associated with the probability of falling (p=0.0076; OR=1.378). Study results suggested that the loss of protective sensitivity of foot could be a risk factor for falls in people suffering from type 2 diabetes.

Vibration Perception Threshold and Related Factors for Balance Assessment in Patients with Type 2 Diabetes Mellitus

“…The patients with IVS had a greater fear of falling than patients with NVS. This result is consistent with previous studies [ 29 , 57 ]. In Bogdan’s study [ 29 ], the FES-I score was significantly higher in the DPN group compared to the without DPN group based on MNSI.…”

“…In Bogdan’s study [ 29 ], the FES-I score was significantly higher in the DPN group compared to the without DPN group based on MNSI. In Riandini‘s study [ 57 ], a fear of falling measured by FES-I showed a significant positive correlation with DPN severity quantified using MNSI. Our findings indicated that the VPT, age, and lower extremity strength had a statistically significant association with the fear of falling.…”

Fear of Falling, Lower Extremity Strength, and Physical and Balance Performance in Older Adults with Diabetes Mellitus

“…Based on our study, the mCTSIB can sufficiently differentiate the degrees of balance impairment in the ODM. Poor postural control observed in the ODM is the result of sensory and motor deficits associated with microvascular complications of DM as well as FoF [11][12][13]25]. A significant decrease in the mCTSIB-Tol score and the failed performances on the mCTSIB suggest an increase in the degrees of balance impairment.…”

“…Microvascular complications associated with DM result in multiple impairments including sensory deficits and muscle weakness due to peripheral neuropathy [15][16][17][18], loss of visual acuity due to retinopathy [18][19][20], and impaired postural control and falls due to vestibulopathy [21][22][23]. These impairments predispose ODM to an increase in fall risk [17,20,24], falls [12,17,25], and FoF [25].…”

Sensorimotor impairments, postural instability, and risk of falling in older adults with diabetic peripheral neuropathy

“…Risk factors in DM, and particularly for those with neuropathy, extend well beyond sensory loss. Previous studies have found that in addition to sensory loss and advanced disease status [15], muscle weakness [16], increased postural sway [17], gait and mobility impairments [18,19] and fear of falling [15] increase fall risk in people with DM. Further, older people with DM have increased risks of frailty and osteoporosis with subsequent increased morbidity and mortality associated with fall-related fractures [20][21][22][23].…”