Falls in individuals with type 2 diabetes; a cross-sectional study on the impact of motor dysfunction, postural instability and diabetic polyneuropathy

Psychosocial Care for People With Diabetic Neuropathy: Time for Action

Psychological factors and psychosocial care for individuals with diabetic neuropathy (DN), a common and burdensome complication of diabetes, are important but overlooked areas. In this article we focus on common clinical manifestations of DN, unremitting neuropathic pain, postural instability, and foot complications, and their psychosocial impact, including depression, anxiety, poor sleep quality, and specific problems such as fear of falling and fear of amputation. We also summarize the evidence regarding the negative impact of psychological factors such as depression on DN, self-care tasks, and future health outcomes. The clinical problem of underdetection and undertreatment of psychological problems is described, together with the value of using brief assessments of these in clinical care. We conclude by discussing trial evidence regarding the effectiveness of current pharmacological and nonpharmacological approaches and also future directions for developing and testing new psychological treatments for DN and its clinical manifestations.

The impact of vestibular dysfunction on falls and postural instability in individuals with type 2 diabetes with and without diabetic polyneuropathy

Aim

This study aimed to determine the association between vestibular dysfunction, falls, and postural instability in individuals with type 2 diabetes (T2D) compared to healthy control individuals and to examine the impact of diabetic polyneuropathy (DPN).

Methods

This cross-sectional study included individuals with T2D with DPN (n = 43), without DPN (n = 32), and healthy controls (n = 32). Cervical and ocular vestibular evoked myogenic potentials (VEMP) were recorded, and latencies and amplitudes were determined. DPN was diagnosed based on nerve conduction studies and clinical scores. Postural instability was examined using a static posturographic balance system and calculated as an instability index (ST). Falls were recorded retrospectively during the past year. Group comparisons were conducted by using univariate and bivariate statistics.

Results

Individuals with T2D experienced more falls than healthy controls (T2D with DPN n = 12[38%], T2D without DPN n = 15[35%], controls n = 5[16%], p = 0.04). Individuals with T2D had decreased postural stability, T2D with DPN, ST (median of 52[iqi = 33; 77]), T2D without DPN, ST (median of 31[iqi = 24; 39]), controls ST (median of 26[iqi = 19; 33], p = 0.01), when comparing all three groups. Individuals with T2D had a greater number of no-responses in oVEMP compared to controls (T2D with DPN, n = 15[46.9%] T2D without DPN n = 25[58.1%], controls n = 9[28.1%], p = 0.04). No difference was found in cVEMP and oVEMP amplitudes in any of the groups. Irrespectively of DPN, fallers with T2D had decreased oVEMP and cVEMP latencies on the right ears, when comparing to non-fallers, respectively, n10 (fallers [median of 16, iqi=15;19 ms.] vs. non-fallers [median of 25 iqi=16;35 ms]); p13 (fallers [median of 16, iqi=15;17 ms.] vs. non-fallers [median of 15, iqi=8;16 ms.], p < 0.05).

Conclusion

Falls and postural instability were more frequent in individuals with T2D compared to healthy controls. Fallers with T2D had vestibular end-organ impairments based on the oVEMP and cVEMP latencies on the right but not the left ears, irrespective of DPN. Individuals with T2D had more frequent no-response of the oVEMP, indicating impaired vestibular nerve function.

Influence of age on static postural control in adults with type 2 diabetes mellitus: a cross-sectional study

Aim

It was the aim of this study to assess static postural control characteristics in people with type 2 diabetes mellitus (T2D) of different ages using a force platform. A relationship was also established between static postural control parameters and age in this study.

Methods

A total of 706 participants with T2D were included in this study. The participants were stratified into three age groups: Group 1 (<60 years old), Group 2 (60-70 years old), and Group 3 (>70 years old). Static postural control assessment during two-leg stance was performed on a force platform by all participants. The center of pressure (CoP)-related parameters were measured under two stance conditions (eyes open and closed). Kruskal-Wallis tests were applied to explore the difference among the different age groups. Multivariate regression analysis was performed to determine the relation between age and static postural control parameters.

Results

Group 1 (<60 years old) had significantly less CoP total tracking length (TTL), sway area (SA), and CoP velocity along the Y direction (V-Y) under both eyes-open and eyes-closed conditions compared with Group 2 (60-70 years old) and Group 3 (>70 years old). Group 1 (<60 years old) had significantly less CoP maximum sway length along the X direction (MSL_X) and longer tracking length each area unit (TTL/SA) under the eyes-open condition compared with Group 2 (60-70 years old) and Group 3 (>70 years old). There was a significantly positive correlation between age and the most static postural parameters such as CoP TTL, SA, MSL-X, MSL-Y, and V-Y. There was a significantly negative correlation between age and TTL/SA.

Conclusion

This study suggested that older T2D participants had worse static postural control ability than younger ones. Most static postural parameters presented a significant correlation with age; the higher the age, the worse the static postural control.

Remote Digital Technologies for the Early Detection and Monitoring of Cognitive Decline in Patients With Type 2 Diabetes: Insights From Studies of Neurodegenerative Diseases

Type 2 diabetes (T2D) is a risk factor for cognitive decline. In neurodegenerative disease research, remote digital cognitive assessments and unobtrusive sensors are gaining traction for their potential to improve early detection and monitoring of cognitive impairment. Given the high prevalence of cognitive impairments in T2D, these digital tools are highly relevant. Further research incorporating remote digital biomarkers of cognition, behavior, and motor functioning may enable comprehensive characterizations of patients with T2D and may ultimately improve clinical care and equitable access to research participation. The aim of this commentary article is to review the feasibility, validity, and limitations of using remote digital cognitive tests and unobtrusive detection methods to identify and monitor cognitive decline in neurodegenerative conditions and apply these insights to patients with T2D.

Effects of Motor Rehabilitation on Balance and Functional Activities in Elderly Patients with Peripheral Neuropathy and Recurrent Falls

To date, little is known about the effects of motor rehabilitation in peripheral neuropathy (PN) patients with a history of recurrent falls (RFH). This study aimed to assess balance and the activities of daily living (ADLs) in elderly lower limb PN patients with and without RFH and to verify the effects of motor rehabilitation on balance and ADLs in these patients. We collected data from 64 lower limb PN patients, who underwent a conventional motor rehabilitation program: 35 patients had a history of recurrent falls, and 29 did not. The Berg Balance Scale (BBS) and motor FIM, before and after rehabilitation, were the outcome measures. After rehabilitation, lower limb PN patients with RFH had significantly higher scores in BBS and motor FIM (p < 0.001, for both) than at entry. The final BBS score and effectiveness in the BBS score of lower limb PN patients with RFH were lower than those of patients without RFH (p < 0.05 and p = 0.009, respectively). The study shows that conventional motor rehabilitation improves both balance and ADLs in patients, but balance improvement is lower in those with RFH. Thus, motor rehabilitation can be a therapeutic option for the management of these patients.

Which field test should be used to compare the functional exercise capacities of patients with type 2 diabetes mellitus with and without diabetic peripheral neuropathy? Cross-sectional study

BACKGROUND

The 6-minute step test (6MST) has begun to be used as a simple and effective alternative for assessing functional exercise capacity. There is no study using 6MSTs to evaluate the exercise capacities of patients with type 2 diabetes mellitus (DM) with and without diabetic peripheral neuropathy (DPN).

OBJECTIVE

To compare the cardiorespiratory responses of the 6-minute walk test (MWT) and the 6MST exercise tests and to analyze the usability of the 6MST in Type 2 DM patients with and without neuropathy.

METHODS

32 non-neuropathic Type 2 DM, 32 neuropathic Type 2 DM patients, and 30 healthy volunteers were included in this cross-sectional study. Functional exercise capacity was evaluated with the 6MWT and the 6MST. The 30-second sit-stand test (30s STS) was used to evaluate general lower extremity muscle strength and function.

RESULTS

There was a significant difference in the results of 6MWT (m), 6MST (number of steps), and 30s STS of the three groups (p<0.05). The 6MST results of patients with neuropathic Type 2 DM were significantly lower than those of non-neuropathic diabetics and those who were healthy (number of steps; 114.07±25.57 vs. 133.48±33.57 vs. 160.35±28.52, respectively) (p=0.001). The change in cardiorespiratory response in systolic blood pressure, heart rate, perceived dyspnea, and leg fatigue severity was significantly higher at 6MST than 6MWT in the three groups (p<0.05). 6MST was correlated with 6MWT (r=0.679, p=0.001), and 30s STS (r=0.589, p=0.001) in patients with Type 2 DM.

CONCLUSIONS

Cardiorespiratory responses increased more in 6MST compared to 6MWT. In patients with Type 2DM, 6MWT and 6MST were moderately correlated with each other. 6MST is an effective and safe assessment method that may better reveal the differences in functional exercise capacity between neuropathic and non-neuropathic individuals in clinics.

Association of diabetes mellitus with gait and falls in community-dwelling older adults: Serial mediation of vision and cognition

BACKGROUND/OBJECTIVE

Diabetes mellitus (DM) is associated with walking performance, but potential underlying mechanisms of this association remain unclear. The present study aims to disentangle the pathways linking DM to gait and falls through the serial mediation effect of vision and cognition among the older population.

METHODS

Data were taken from wave 9 (2018-2019) of the English Longitudinal Study of Aging (ELSA), including 5496 participants aged 60 years and older. DM was identified based on medical diagnosis and laboratory tests. Vision and falls were self-reported. Cognition was evaluated using questionnaire. Gait speed was measured by the "timed walking test". Serial mediation analysis was performed using Mplus 8.3.

RESULTS

DM was associated with impaired gait speed (c = 0.085, P < 0.05) and falls (c = 0.061, P < 0.05). The serial mediation model revealed that vision and cognition significantly mediated the association of DM with impaired gait speed, with 17.97% and 23.60% of the total effects explained by vision and cognition respectively, and 3.37% explained by the path through vision and then cognition. Similarly, vision and cognition significantly mediated the association of DM with falls, with 14.99% and 6.67% of the total effects explained by vision and cognition respectively, and 1.67% explained by the path through vision and then cognition.

CONCLUSIONS

These findings contribute to deeper understanding of the mechanism underlying the association of DM with walking performance. Evaluation and intervention targeted at vision and the cognition may be beneficial for improving gait or reducing falls in older adults with DM.

Preoperative Lymphocyte-to-Monocyte Ratio Can Indicate the Outcomes in Repair of I-III Degree Injury of Lateral Ankle Ligament

Background. This study is aimed at exploring the prognostic value of preoperative lymphocyte-to-monocyte ratio (LMR), an index of systemic inflammation before operation, in ankle lateral ligament repair (ALLR). Methods. A total of 213 I-III degrees injuries of lateral ankle ligament patients received ALLR and were followed up for more than 2 years. Univariate and multivariable linear regression analysis was used to determine the relationship between preoperative LMR and postoperative recovery. The evaluations of postoperative recovery include American Orthopaedic Foot and Ankle Society (AOFAS) score, Karlsson-Peter ankle score (KPAS), Cumberland Ankle Instability Tool (CAIT) score, Visual Analog Scale (VAS) score, and range of motion (ROM). The prognostic value of preoperative LMR was measured by receiver operating characteristic (ROC) curve. Results. 178 patients (178 ankles) were followed up successfully, with a follow-up of $2.82\pm 1.54$ years. Overall, the mean AOFAS, KPAS, CAIT and VAS scores, and ankle varus angle were significantly improved at the final follow-up. Univariate and multiple linear regression analysis showed that preoperative LMR was the only independent factor associated with postoperative function, ROM, and pain. The preoperative LMR of patients with poor recovery was significantly lower than that of patients with good recovery. Based on the ROC analysis, the cutoff value of preoperative LMR was 3.824. The clinical outcomes of patients with $\text{preoperative}\text{LMR}<3.824$ were significantly lower than that of patients with $\text{preoperative}\text{LMR}\ge 3.824$ . The corresponding specificity and sensitivity were 84.6% and 71.4%. Conclusion. The clinical outcomes of open or arthroscopic repair for ATFL injury are satisfactory. As a marker of systemic inflammation, preoperative LMR can be used as a prognostic indicator for ALLR.

Impact of Body Mass Index on Static Postural Control in Adults With and Without Diabetes: A Cross-Sectional Study

AIM

The objective of this research was to determine the static postural control differences measured from a force platform in Type 2 diabetes mellitus (T2DM) and healthy control groups with different levels of body mass index (BMI), and detect the static postural control difference between T2DM and healthy control groups stratified by different BMI category. This research also explored the relationship of BMI and static postural performance.

METHODS

We recruited 706 participants with T2DM and 692 healthy controls who were sufficiently matched for age, gender, and BMI in this cross-sectional study. The participants were stratified into three groups by BMI: normal weight, overweight, and obesity. All participants performed two-legged static stance postural control assessment on a firm force platform. The Center of Pressure (CoP) parameters were collected under eyes-open and eyes-closed conditions. Mann-Whitney U test was used to compare the static postural control parameters within each BMI category in both groups. The static postural control parameters among different weight groups were compared by Kruskal-Wallis test, post hoc pair-wise comparison were conducted. Generalized linear model was conducted to examine the association between BMI and static postural control parameters while controlling for confounding factors.

RESULTS

Healthy control group had statistical difference in most CoP parameters compared to T2DM group based on all BMI categories. Normal weight participants presented significant difference compared with overweight and/or obesity for total track length (TTL) and velocity of CoP displacements in Y direction (V-Y) under eyes-open condition, and for most CoP parameters under eyes-closed condition in both groups. There were statistically significant correlations between BMI and most static postural control parameters under only eyes-closed condition according to the result of generalized linear model.

CONCLUSION

T2DM patients had impaired static postural control performance compared to healthy controls at all BMI categories. The findings also indicated the association between BMI and static postural control, where higher BMI individuals showed more static postural instability in both T2DM and healthy controls.