Diabet Med. 2021 Sep;38(9):e14470. doi: 10.1111/dme.14470. Epub 2020 Dec 12.

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

Diabetic medicine : a journal of the British Diabetic Association

Karolina S Khan, Rodica Pop-Busui, Louise Devantier, Alexander G Kristensen, Hatice Tankisi, Ulrik Dalgas, Kristian Overgaard, Henning Andersen

PMID: 33259675 DOI: 10.1111/dme.14470

Abstract

AIM: To estimate the incidence of falls in individuals with type 2 diabetes compared to healthy controls and to describe the characteristics of fallers with type 2 diabetes in relation to motor dysfunction, postural instability and diabetic polyneuropathy (DPN).

METHODS: This is a cross-sectional study of individuals with type 2 diabetes with DPN (n = 54), without DPN (n = 38) and healthy controls (n = 39). Falls were recorded within the preceding year. DPN was defined by clinical scores and nerve conduction studies. Motor function was assessed by a 6-min walk test (6 MWT), five-time sit-to-stand test (FTSST) and isokinetic dynamometry at the non-dominant ankle and knee. An instability index (ST) was measured using static posturography. Univariate and bivariate descriptive statistics were used for group comparisons.

RESULTS: Compared with healthy controls, individuals with diabetes had a higher incidence of falls 36%, (n = 33) versus 15%, (n = 6), p = 0.02. There were no differences in falls when comparing individuals with and without DPN. Fallers had an impaired 6 MWT versus non-fallers (450 ± 153 m vs. 523 ± 97 m respectively), a slower FTSST (11.9 ± 4.2 s vs. 10.3 ± 2.9 s respectively) and a higher ST (53 ± 29 vs. 41 ± 17 respectively), p < 0.02 for all.

CONCLUSION: Individuals with type 2 diabetes reported a higher number of falls within the preceding year compared to healthy controls, irrespective of the presence of DPN. The main factors associated with falls were increased postural instability, lower walking capacity and slower sit-to-stand movements. The 6 MWT, FTSST and posturography should be considered in future screening programs in identification of individuals at risk for falls.

© 2020 Diabetes UK.

Keywords: diabetic polyneuropathy; falls; motor dysfunction; postural instability; type 2 diabetes

References

1. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing. 2006;35(Suppl.2):37-41. - PubMed
2. Hewston P, Deshpande N. Falls and balance impairments in older adults with type 2 diabetes: thinking beyond diabetic peripheral neuropathy. Can J Diabetes. 2016;40(1):6-9. - PubMed
3. Dingwell JB, Ulbrecht JS, Boch J, et al. Neuropathic gait shows only trends towards increased variability of sagittal plane kinematics during treadmill locomotion. Gait Posture. 1999;10(1):21-29. - PubMed
4. Hewston P, Deshpande N. Fear of falling and balance confidence in older adults with type 2 diabetes mellitus: a scoping review. Can J Diabetes. 2018;42(6):664-670. - PubMed
5. Vaz MM, Costa GC, Reis JG, Junior WM, Albuquerque de Paula FJ, Abreu DC. Postural control and functional strength in patients with type 2 diabetes mellitus with and without peripheral neuropathy. Arch Phys Med Rehabil. 2013;94(12):2465-2470. - PubMed
6. Emam AA, Gad AM, Ahmed MM, Assal HSMS. Quantitative assessment of posture stability using computerised dynamic posturography in type 2 diabetic patients with neuropathy and its relation to glycaemic control. Singapore Med J. 2009;50(6):614-618. - PubMed
7. Allet L, Kim H, Ashton-Miller J, De Mott T, Richardson JK. Step length after discrete perturbation predicts accidental falls and fall-related injury in elderly people with a range of peripheral neuropathy. J Diabetes Complications. 2014;28(1 CC-Injuries):79-84. - PubMed
8. Brown SJ, Handsaker JC, Bowling FL, Boulton AJM, Reeves ND. Diabetic peripheral neuropathy compromises balance during daily activities. Diabetes Care. 2015;38(6):1116-1122. - PubMed
9. Pop-Busui R, Boulton AJM, Feldman EL, et al. Diabetic neuropathy: a position statement by the American diabetes association. Diabetes Care. 2017;40(1):136-154. - PubMed
10. Andreassen CS, Jakobsen J, Andersen H. Muscle weakness: a progressive late complication in diabetic distal symmetric polyneuropathy. Diabetes. 2006;55(3):806-812. - PubMed
11. Menz HB, Lord SR, St George R, et al. Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy. Arch Phys Med Rehabil. 2004;85:2. - PubMed
12. Pijnappels M, Reeves ND, Maganaris CN, van Dieën JH. Tripping without falling; lower limb strength, a limitation for balance recovery and a target for training in the elderly. J Electromyogr Kinesiol. 2008;18(2):188-196. - PubMed
13. Christensen DH, Nicolaisen SK, Berencsi K, et al. Danish centre for strategic research in type 2 diabetes (DD2) project cohort of newly diagnosed patients with type 2 diabetes: a cohort profile. BMJ Open. 2018;8(4):1-11. - PubMed
14. American Diabetes Association AD. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2011;34(Suppl 1):S62-S69. - PubMed
15. Tesfaye S, Boulton AJM, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285-2293. - PubMed
16. Bril V, Perkins BA. Validation of the Toronto clinical scoring system for diabetic polyneuropathy. Diabetes Care. 2002;25(11):2048-2052. - PubMed
17. Herman WH, Pop-Busui R, Braffett BH, et al. Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. Diabet Med. 2012;29(7):937-944. - PubMed
18. Tankisi H, Pugdahl KBS, Andersen H, Fuglsang-Frederiksen A. Evidence-based recommendations for examination and diagnostic strategies of polyneuropathy electrodiagnosis. Clin Neurophysiol Pract. 2019;4. - PubMed
19. Dyck PJ, Carter RE, Litchy WJ. Modeling nerve conduction criteria for diagnosis of diabetic polyneuropathy. Muscle Nerve. 2011;44:340-345. - PubMed
20. Harbo T, Brincks J, Andersen H. Maximal isokinetic and isometric muscle strength of major muscle groups related to age, body mass, height, and sex in 178 healthy subjects. Eur J Appl Physiol. 2012;112(1):267-275. - PubMed
21. Christensen IK, Deilami SSJ, Amiri S, Nissen MH, Devantier L, Ovesen T. Validation of posturographic measurements in adolescents. Otol Neurotol. 2018;39(7):e568-e574. - PubMed
22. Gorski LP, da Silva AM, Cusin FS, Cesaroni S, Ganança MM, Caovilla HH. Body balance at static posturography in vestibular migraine. Braz J Otorhinolaryngol. 2019;85(2):183-192. - PubMed
23. Rikli RE, Jones CJ. The reliability and validity of a 6-minute walk test as a measure of physical endurance in older adults. J Aging Phys Act. 1998;6(4):363-375. - PubMed
24. United Nations Department Of Economic and Social Affairs. WHO global report on falls prevention in older age. Community Health (Bristol). 2007;53. - PubMed
25. Delbaere K, Close JCTT, Mikolaizak AS, Sachdev PS, Brodaty H, Lord SR. The falls efficacy scale international (FES-I). A comprehensive longitudinal validation study. Age Ageing. 2010;39(2):210-216. - PubMed
26. Richardson JK, Hurvitz EA. Peripheral neuropathy: a true risk factor for falls. J Gerontol A Biol Sci Med Sci. 1995;50(4):M211-M215. - PubMed
27. Yang Y, Hu X, Zhang Q, Zou R. Diabetes mellitus and risk of falls in older adults: a systematic review and meta-analysis. Age Ageing. 2016;45(6):761-767. - PubMed
28. MacGilchrist C, Paul L, Ellis BM, Howe TE, Kennon B, Godwin J. Lower-limb risk factors for falls in people with diabetes mellitus. Diabet Med. 2010;27(2):162-168. - PubMed
29. Handsaker JC, Brown SJ, Bowling FL, et al. Contributory factors to unsteadiness during walking up and down stairs in patients with diabetic peripheral neuropathy. Diabetes Care. 2014;37(11):3047-3053. - PubMed
30. Oppenheim U, Kohen-Raz R, Alex D, Kohen-Raz A, Azarya M. Postural characteristics of diabetic neuropathy. Diabetes Care. 1999;22(2):328-332. - PubMed

Publication Types

• Journal Article

Grant support

• Aarhus Universitet
• NNF14OC0011633/Novo Nordisk Fonden