Multiple diabetic complications, as well as impaired physical and mental function, are associated with declining balance function in older persons with diabetes mellitus

Abstract

ObjectiveTo investigate whether there is a difference in balance function between older persons with and without diabetes mellitus (DM), and to identify whether mediating factors, such as diabetic complications, Instrumental Activities of Daily Living (IADL) score, Mini-Mental State Examination (MMSE) score, as well as hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), serum total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL), are associated with balance function in older persons with DM.MethodsIn this cross-sectional study, a total of 208 older persons were divided into a DM group (n=80) and a control group who did not have DM (n=128). Balance function was evaluated with the Tinetti performance-oriented mobility assessment (POMA), which includes balance and gait subscales. Activities of daily living (ADL), IADL, and the MMSE were also measured. Fall incidents in last 12 months, the use of walking aids, fear of falling, comorbidities, and polypharmacy were recorded. Diabetic complications were recorded, and HbA1c, FPG, TC, TG, and LDL were measured in the patients of the DM group.ResultsFall incidents in last 12 months were higher in the DM group than in the control group (P<0.01). POMA score as well as ADL and IADL scores were lower in the diabetic group than the control group (P<0.05). Within the diabetic group, the POMA score was positively related to the ADL score (odds ratio [OR], 11.7; 95% confidence interval [CI], 3.076–44.497; P<0.01), IADL score (OR, 16.286; 95% CI, 4.793–55.333; P<0.01), and MMSE score (OR, 10.524; 95% CI, 2.764–40.074; P<0.01), but was negatively related to age (OR, 7.707; 95% CI, 2.035–29.185; P<0.01) and diabetic complication (OR, 6.667; 95% CI, 2.279–19.504; P<0.01). Also, within the DM group, the decreased POMA score was associated with multiple diabetic complications (OR, 5.977; 95% CI, 1.378–25.926; P<0.05), decreased IADL score (OR, 10.288; 95% CI, 2.410–43.915; P<0.01), and MMSE score (OR, 13.757; 95% CI, 2.556–74.048; P<0.01).ConclusionMultiple diabetic complications, lower MMSE, ADL, and IADL scores were associated with declining balance function in the older persons with DM. These findings can alert physicians to detect and intervene earlier on declining balance in older persons with DM.

Kidney Function and Risk of Physical and Cognitive Impairment in Older Persons with Type 2 Diabetes at an Outpatient Clinic with Geriatric Assessment Implementation

“…Consequently, diabetic complications could cause physical and mental conditions to become even worse, leading to both physical and cognitive disability. 22 Third, in this study, we also found that in addition to abnormalities in blood glucose control, renal dysfunction assessed by eGFR and UACR was associated with physical and cognitive impairment in diabetic patients, which is consistent with previous report. 22,23 It has been proposed that chronic kidney disease (CKD) in older persons with diabetes may often coexist with risk factors for cognitive impairment, including hyperlipidemia, hypertension, and cardiovascular disease, which in turn can contribute to the development of dementia and physical disability.…”

“…22 Third, in this study, we also found that in addition to abnormalities in blood glucose control, renal dysfunction assessed by eGFR and UACR was associated with physical and cognitive impairment in diabetic patients, which is consistent with previous report. 22,23 It has been proposed that chronic kidney disease (CKD) in older persons with diabetes may often coexist with risk factors for cognitive impairment, including hyperlipidemia, hypertension, and cardiovascular disease, which in turn can contribute to the development of dementia and physical disability. 24,25 Pathophysiologically, CKD may result in vascular endothelial injury or renal insufficiency, both of which have been shown to exacerbate neuronal damage, resulting in alteration amyloid homeostasis.…”

The association of glycemic control and fall risk in diabetic elderly: a cross-sectional study in Hong Kong

“…The fall rate was comparable to similar studies conducted in America (23%) and Malaysia (18.8%) [ 7 , 19 ]. But it was much lower than the fall rate in United Kingdom and China, which was 39% and 36% respectively [ 8 , 12 ]. Both fall and recurrent falls rates were higher among the diabetic patients in this study as compared to previous study among local general elderly (23.3% vs 20% and 8.6% vs 5% respectively) [ 1 – 3 , 36 ].…”

“…The prevalence of fall among diabetic patients ranged from 18.8% to 78% [7][8][9][10]. Diabetic patients have higher fall risk (odds ratio [OR] 1.3 -2.89), increased fall related hospitalization and length of stay [4,[11][12][13][14][15][16][17].…”

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

“…Diabetes mellitus (DM) is a significant risk factor for falls in older adults [7][8][9][10] and associated with an increase in FoF [11]. The prevalence of falls and FoF is significantly higher in older adults with DM (ODM) than in older adults without DM (ONDM) [8,[11][12][13][14]. 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].…”