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

Abstract

Background-Older adults with type-2 diabetes mellitus (DM) have high incidence of falls. The aim of this study was to compare sensorimotor functions balance, mobility, fear of falling and fall history in older people with DM (with and without neuropathy) and non-diabetic healthy controls.Methods-We enrolled 153 participants aged 50-70years; 51 people with diabetic peripheral neuropathy (D-PN), 52 with diabetes without neuropathy (D-noPN) and 50 healthy controls (HC). Participants completed a fear of falling assessment and detailed test battery comprising sensorimotor functions, lower limb strength, contrast vision, reaction time, balance and mobility from which a composite physiological fall risk score was derived (PFRS). In addition, a fall history of the past three months was recorded.Results-Post-hoc comparisons of ANOVA test revealed the D-PN had significant deficits than the other two groups in tests of lower limb sensation, knee extension strength, reaction time, postural sway, one leg standing, sit-to-stand and the timed up and go test. The D-PN had the highest fear of falling (30.18±6.75) and the highest PFRS (1.68±1.13). PFRS for the D-noPN (0.74±0.80) were intermediate between HC (0.49±0.96) and DP-N groups. Thirty-four D-PN participants (66.7%), 19 D-noPN participants (36.5%) and 7 HC (14.0%) reported one or more falls in the past three months; Chi2 test for trend =28.1,df=2,p<0.001).Conclusions-Older people with diabetic neuropathy have impaired sensorimotor function, balance, mobility, and associated increased fear of falling and fall rates. This population may benefit from fall risk assessments involving the above measures, and subsequent interventions targeted to deficits amenable to correction.

Association of Balance with Somatosensory Loss of Lower Limb in Diabetic Patients

“…The somatosensory system's role extends to conveying information about the position and motion of body segments, using proprioceptive and cutaneous inputs (6). However, in diabetic peripheral neuropathy (DPN), visual and vestibular functions might also contribute to decreased balance and increased fall risk.…”