The Impact of Diabetic Neuropathy on Balance and on the Risk of Falls in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

PLoS One. 2016 Apr 27;11(4):e0154654. doi: 10.1371/journal.pone.0154654. eCollection 2016.


Introduction: Diabetic neuropathy (DN) is a prevalent complication of Type 2 Diabetes Mellitus (T2DM) with a major impact on the health of the affected patient. We hypothesized that mediated by the dysfunctionalities associated with DN's three major components: sensitive (lack of motion associated sensory), motor (impairments in movement coordination) and autonomic (the presence of postural hypotension), the presence of DN may impair the balance in the affected patients. Our study's main aim is to evaluate the possible association between the presence and severity of DN and both the balance impairment and the risk of falls in patients with T2DM.

Material and method: In this cross-sectional study we enrolled, according to a consecutive-case population-based setting 198 patients with T2DM. The presence and severity of DN was evaluated using the Michigan Neuropathy Screening Instrument, a tool which allows both diagnosing and severity staging of DN. The balance impairment and the risk of falls were evaluated using four validated and standardized tools: Berg Balance Scale (BBS), Timed-up and Go test (TUG), Single Leg Stand test (SLS) and Fall Efficacy Scale (FES-I).

Results: The presence of DN was associated with significant decreases in the BBS score (40.5 vs. 43.7 points; p<0.001) and SLS time (9.3 vs. 10.3 seconds; p = 0.003) respectively increases in TUG time (8.9 vs. 7.6 seconds; p = 0.002) and FES-I score (38 vs. 33 points; p = 0.034). The MNSI score was reverse and significantly correlated with both BBS score (Spearman's r = -0.479; p<0.001) and SLS time (Spearman's r = -0.169; p = 0.017). In the multivariate regression model, we observed that patient's age, DN severity and depression's symptoms acted as independent, significant predictors for the risk of falls in patients with T2DM.

Conclusions: The presence of DN in patients with DM is associated with impaired balance and with a consecutively increase in the risk of falls.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls*
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Neuropathies / physiopathology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Postural Balance / physiology*
  • Risk

Grants and funding

This research was supported by an internal grant, funded by “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania (PLURINEURODIAB. PII-C4-TC-2016-16441-01). The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.