Falls more likely in type 2 diabetes, independent of polyneuropathy
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Adults with type 2 diabetes are more likely to report falls and fear of falling than those without diabetes, regardless of the presence of diabetic polyneuropathy, according to a study published in Diabetic Medicine.
“Individuals with type 2 diabetes and one or more falls had lower postural stability and walking speed, and slower transitional movements. Unexpectedly, muscle strength and scores of diabetic polyneuropathy did not differ between fallers and non-fallers,” Karolina S. Khan, MD, PhD student in the department of neurology at Aarhus University Hospital in Denmark, and colleagues wrote.
Researchers recruited adults aged 18 to 80 years with type 2 diabetes for a cross-sectional study conducted at Aarhus University Hospital from June 2017 to November 2018. Those with diabetes were compared with a control group of adults with normal glucose tolerance, blood pressure and lipid profiles. The study was conducted as part of baseline evaluations in a randomized controlled trial investigating the effects of training in people with diabetes. Adults with diabetes were recruited from the neurology and endocrinology departments at the hospital, whereas controls were recruited through local advertising.
All participants were screened by a physician, and medical history was obtained. Those with type 2 diabetes were placed in a diabetic polyneuropathy group if they had a confirmed polyneuropathy based on the presence of an abnormality in nerve conduction studies of at least two nerves plus a symptom, or if they had a sign of diabetic polyneuropathy based on the validated Toronto Clinical Neuropathy Score. Dynamometry was used to measure maximal isokinetic muscle strength and a static posturographic balance system measured balance. Participants also completed a 6-minute walk test to measure walking capacity, gait speed and endurance; and a five-time sit-to-stand test to measure functional mobility and strength in transitional movements.
A total of 131 adults participated in the study: 54 with type 2 diabetes and confirmed diabetic polyneuropathy, 38 with type 2 diabetes and without diabetic polyneuropathy, and 39 healthy controls. Those with type 2 diabetes had more falls than healthy controls (36% vs. 15%; P = .019). Those with diabetes also had more fear of falls, a higher postural instability index in neutral and head tilt/turn positions, lower motor function in the walk and sit-to-stand tests, and lower muscle strength in all joints except the knee.
The diabetic polyneuropathy groups had a greater fear of falling and lower walking capacity compared with the cohort without diabetic polyneuropathy. However, there was no significant difference in the number of falls between the diabetic polyneuropathy and nondiabetic polyneuropathy groups.
Researchers separated participants with type 2 diabetes into those with falls (n = 33) and those without falls (n = 59). The falls groups had lower walking distance, slower sit-to-stand test results, and more postural instability compared with the group without falls.
“Individuals with type 2 diabetes reported more falls within the preceding year compared to healthy controls, irrespective of the presence of diabetic polyneuropathy,” the researchers wrote. “Major risk factors for falls were increased postural instability, shorter walking distance and slower sit-to-stand movements. Therefore, 6-minute walk test, five-time sit-to-stand test and posturography should be considered in future screening programs in identification of individuals at risk for falls.”
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