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

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International Journal of Diabetes in Developing Countries Aims and scope Submit manuscript

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 50–70 years: 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 (PFRS) was derived. In addition, a fall history of the past 3 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) was 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 3 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.

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Acknowledgments

We wish to thank the management of National Hospital Colombo, Sri Lanka, and Faculty of Medicine, University of Colombo, Sri Lanka, for ethics approval and facilities provided for this study to make this research successful.

Author contributors

All authors contributed equally in conceptualization of the study. Data collection was conducted by AHW under direct guidance and supervision of PK and DWND. AHW was trained for the methods of the study by PK, DWND, and SL. AHW prepared the manuscript under the guidance of DWND and SL. SL and DWND edited the manuscript. LA and PK contributed to the manuscript by editing and reviewing the manuscript. Final manuscript was reviewed and approved by all the authors for submission.

Funding

This work was supported by the Postgraduate research Scholarship (AP/3/2/2016/PG/05), University of Colombo, Sri Lanka.

Author information

Authors and Affiliations

  1. Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, 25 Kynsey Rd, Colombo, 00800, Sri Lanka

    Asha H. Wettasinghe

  2. Department of Physiology, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

    Dilshani W. N. Dissanayake

  3. Department of Community Medicine, University Hospitals and University of Geneva, Geneva, Switzerland

    Lara Allet

  4. Department of Physiotherapy, School for Health Sciences, HES-SO, University of Applied Sciences & Arts of Western Switzerland, Geneva, Switzerland

    Lara Allet

  5. Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

    Prasad Katulanda

  6. Neuroscience Research Australia, UNSW, Randwick, Sydney, Australia

    Stephen R. Lord

Authors
  1. Asha H. Wettasinghe
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Corresponding author

Correspondence to Asha H. Wettasinghe.

Ethics declarations

This study was approved by the Ethical Review Committee of the Faculty of Medicine, University of Colombo (EC-15-166) and the National Hospital of Sri Lanka, Research Ethics Committee (ETH/COM/2016). All participants signed informed consent prior to their participation.

Conflict of interest

The PPA (NeuRA FallScreen) is commercially available through Neuroscience Research Australia.

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Wettasinghe, A.H., Dissanayake, D.W.N., Allet, L. et al. Sensorimotor impairments, postural instability, and risk of falling in older adults with diabetic peripheral neuropathy. Int J Diabetes Dev Ctries 40, 547–554 (2020). https://doi.org/10.1007/s13410-020-00827-2

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  • DOI: https://doi.org/10.1007/s13410-020-00827-2

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