Aims

To investigate the cross-sectional association between deep and superficial diabetic neuropathy, postural impairment assessed by wearable inertial sensors, and the risk of fall among patients with diabetic foot.

Methods

Diabetic patients attending a University Podiatric Clinic were evaluated for the presence of deep and superficial peripheral neuropathy in sensory tests. Postural impairment was assessed using a wearable inertial sensor, and the evaluation of balance/gait and risk of fall was determined by the Tinetti Scale and Downton Index, respectively. Glycemic control was measured by glycated haemoglobin concentration and fasting glycaemia.

The postural parameters measured were the anteroposterior and medio-lateral sway of the center of mass (CoM) and the sway area (area traveled by the CoM per second). The results were analyzed through a logistic regression model to assess those posture variables mostly significantly associated with neuropathy and risk of fall scales.

Results

A total of 85 patients were evaluated. Spearman's rank correlation coefficients showed a strong and significant relationship (p < 0.05) between deep diabetic neuropathy assessed by Semmes-Weinstein monofilament, diapason and biothensiometer and postural alterations, whereas no significant correlations between superficial (painful sensitivity) neuropathy and the postural parameters. The sway path of the displacement along the anterior-posterior axis recorded during tests performed with eyes open and feet close together were significantly (p < 0.05) correlated with a poor glycemic (glycated haemoglobin concentration) control and each other with all diabetic neuropathy tests, fall risk scales, muscular weakness, ankle joint limitation and history of ulcers.

Conclusions

The results support the existence of a strong association between alterations of the deep somato-sensitive pathway (although depending on the tool used to measure peripheral neuropathy), glycemic control and balance impairments assessed using a wearable sensors. Wearable-based postural analysis might be part of the clinical assessment that enables the detection of balance impairments and the risk of fall in diabetic patients with diabetic peripheral neuropathy.

中文翻译：

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基于可穿戴传感器的糖尿病足神经病变患者的姿势分析和跌倒风险评估

目标

旨在研究深部和浅表糖尿病神经病变、可穿戴惯性传感器评估的姿势障碍以及糖尿病足患者跌倒风险之间的横断面关联。

方法

在大学足病诊所就诊的糖尿病患者在感觉测试中评估是否存在深部和浅表周围神经病变。使用可穿戴惯性传感器评估姿势损伤，并分别通过 Tinetti Scale 和 Downton Index 确定平衡/步态和跌倒风险的评估。通过糖化血红蛋白浓度和空腹血糖来测量血糖控制。

测量的姿势参数是质心（CoM）的前后和中侧摇摆以及摇摆面积（CoM每秒移动的面积）。通过逻辑回归模型对结果进行分析，以评估那些与神经病变和跌倒风险显着相关的姿势变量。

结果

总共对 85 名患者进行了评估。Spearman 等级相关系数显示，通过 Semmes-Weinstein 单丝、音叉和生物血压计评估的深层糖尿病神经病变与姿势改变之间存在很强且显着的相关性 ( p  < 0.05)，而浅表（疼痛敏感性）神经病变与姿势参数之间没有显着相关性。在睁眼、双脚并拢的情况下进行的测试期间记录的沿前后轴的位移的摇摆路径与 不良血糖（糖化血红蛋白浓度）控制显着相关（ p <0.05），并且与所有糖尿病神经病变测试相互关联。跌倒风险量表、肌肉无力、踝关节受限和溃疡病史。

结论

结果支持深部躯体敏感通路的改变（尽管取决于用于测量周围神经病变的工具）、血糖控制和使用可穿戴传感器评估的平衡障碍之间存在很强的关联。基于可穿戴设备的姿势分析可能是临床评估的一部分，能够检测患有糖尿病周围神经病变的糖尿病患者的平衡障碍和跌倒风险。