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A Closer Look at Diabetic Peripheral Neuropathy and Daily Activities

Diabetic peripheral neuropathy can have an effect on balance…

Previous studies show that patients with diabetic peripheral neuropathy (DPN) have an altered gait strategy and a fivefold increased risk of falling. Falling is a major health risk, especially with disease progression and in the elderly. Diabetic patients with peripheral neuropathy have an increased risk of falls that may result in hospitalization.

In a new study, gait analysis during level walking and stair negotiation was performed in 22 patients with iabetic peripheral neuropathy, 39 patients with diabetes without neuropathy, and 28 non-diabetic control subjects who were using a motion analysis system and embedded force plates in a staircase and level walkway. In order to assess balance, researchers measured the separation between the body center of mass and center of pressure during level walking, stair ascent, and stair descent. Participants were invited to a gait laboratory with a bespoke seven-step instrumented staircase for assessing stair ascent and descent and a level 8-m walkway for assessing normal level walking. Participants were provided with standardized footwear with a neutral foot bed to ensure that there was no influence on gait from different styles of shoe while also ensuring that the patients with diabetes walked with appropriate footwear.

In the results, patients with diabetic peripheral neuropathy demonstrated greater maximum and range of separations of their center of mass from their center of pressure in the medial-lateral plane during stair descent, stair ascent, and level walking compared with the control group (p < 0.05), as well as increased mean separation during level walking and stair ascent (p < 0.05). Patients with diabetic peripheral neuropathy also demonstrated greater maximum anterior separations (toward the staircase) during stair ascent (p < 0.05). No differences were observed or recorded in diabetic patients without neuropathy.

The researchers concluded that greater separations of the center of mass from the center of pressure did present a greater challenge when measuring balance in these patients. Therefore, the higher medial-lateral separations that were found in patients with diabetic peripheral neuropathy would require greater muscular demands to control upright posture. They also noted that this may explain why patients with diabetic peripheral neuropathy are more likely to fall, with the higher separations placing them at a higher risk of experiencing a sideways fall than the non-diabetic control subjects.

Practice Pearls:

  • This study demonstrated a greater level of postural sway in patients with DPN during quiet standing both with eyes open and eyes closed.
  • A1c results were only able to be obtained in just over 50% of the patients with diabetic peripheral neuropathy.
  • This study showed marked impairments in dynamic sway during gait activities in patients with DPN, which became more evident with increasing gait task complexity.

Steven J. Brown. Diabetic Peripheral Neuropathy Compromises Balance During Daily Activities. Diabetes Care. Publish Ahead of Print, published online March 12, 2015.