Diabetic peripheral neuropathy increased risk for fall
Recent data presented at the 50th European Association for the Study of Diabetes Annual Meeting suggest that patients with diabetic peripheral neuropathy are more likely to sway during stair climbing, putting them at a greater risk for falls.
Steven Brown, a PhD student at Manchester Metropolitan University in the United Kingdom, and colleagues evaluated 22 patients (mean age, 57 years) with diabetic peripheral neuropathy (DPN), as well as 40 patients (mean age, 57 years) with diabetes without DPN and 32 healthy controls (mean age, 50 years), to determine mechanisms of unsteadiness among patients with DPN when climbing stairs.
A 10-camera 3-D motion analysis system was used to collect data by reflective markers placed at anatomical locations on the body to calculate whole-body center-of-mass (CoM). Center-of-pressure (CoP) was measured by force platforms mounted on the middle four steps of a seven-step staircase. Patients ascended and descended the staircase at least three times during the study period. The separation between CoM and CoP was used to measure balance in the medial-lateral plane.
There was a significantly higher CoM-CoP separation among the DPN group during stair ascent (P<.01), as well as increased variation in CoM-CoP separation (P<.05), compared with the control group. The same was found during stair descent for the DPN group for higher CoM-CoP separation (P<.05) and CoM-CoP separation variation (P<.01) compared with the control group. There was also a significantly wider stance width among the DPN group compared with the control group during stair descent (P<.05).
No differences were found during stair ascent or descent for the diabetes-only group and control group.
“Diabetes patients with peripheral neuropathy display greater extremes in magnitude of medial-lateral sway during stair ascent and descent as well as displaying higher variability during stair ascent and descent,” the researchers concluded. “This indicates that patients with DPM have difficulty regulating control of balance during this challenging task. A large and more variable medial-lateral sway means that patients with DPN are more likely to lose control of balance and experience a fall during what is known to be an activity — using stairs — where the risk of fall is already very high.”
Researchers said they are further investigating different aspects of gait and how diabetes and DPN affects walking on level ground and stairs.
“Many issues that affect balance in patients with DPN stem from deterioration of muscle size and function, so whilst it is not currently possible to positively improve the sensory deterioration, we have been looking at elements that we can positively influence, such as strength training and interventions, to help vision focus and avoidance of obstacles. We are investigating the impact of such interventions and how they might translate to improvements in gait and balance control.”
For more information:
Brown SJ. Abstract #129. Presented at: 50th EASD Annual Meeting; Sept. 16-19, 2014; Vienna.
Disclosure: The study was funded in part by the European Foundation for the Study of Diabetes.