Ann Rehabil Med.  2019 Aug;43(4):497-508. 10.5535/arm.2019.43.4.497.

Effect of Sensory Impairment on Balance Performance and Lower Limb Muscle Strength in Older Adults With Type 2 Diabetes

• Kraiwong R
• Vongsirinavarat M
• Hiengkaew
• von Heideken WÃ¥gert P

• KMID: 2457759
• DOI: http://doi.org/10.5535/arm.2019.43.4.497

Abstract

OBJECTIVE
To compare balance performance and lower limb muscle strength between older adults with type 2 diabetes mellitus (DM), with and without sensory impairments and non-DM groups. Influence of a number of sensory impairments, and muscle strength on balance performance were explored.
METHODS
Ninety-two older adults with and without type 2 DM, were examined relative to visual function with the Snellen chart, Melbourne Edge test, and Howard-Dolman test, vestibular function with the modified Romberg test, proprioception of the big toe, and diabetic peripheral neuropathy with the Michigan Neuropathy Screening Instrument. Balance performances were evaluated with the Romberg test, Functional Reach Test (FRT), and Timed Up and Go test (TUG). Strength of knee and ankle muscles was measured.
RESULTS
FRT of type 2 DM groups with at least two sensory impairments, was lower than the non-DM group (p<0.05). TUG of all DM groups, was worse than the non-DM group (p<0.01). Lower limb muscle strength of type 2 DM groups with two and three sensory impairments, was weaker than non-DM group (p<0.05). Regression analysis showed that type 2 DM with three sensory impairments, ankle dorsiflexors strength, and age were influential predictors of TUG.
CONCLUSION
There were significant differences, of muscle strength and balance performance among groups. Poorer balance and reduced lower limb strength were marked in older adults with type 2 DM, even ones without sensory impairment. Muscle weakness seemed to progress, from the distal part of lower limbs. A greater number of sensory impairments, weaker dorsiflexors, and advanced age influenced balance performance.

Keyword

Sensory; Balance; Muscle strength; Type 2 diabetes mellitus; Elderly

MeSH Terms

Adult*
Aged
Ankle
Diabetes Mellitus, Type 2
Hallux
Humans
Knee
Lower Extremity*
Mass Screening
Michigan
Muscle Strength*
Muscle Weakness
Muscles
Peripheral Nervous System Diseases
Proprioception
Vestibular Function Tests

Figure

• 

  Fig. 1. Flow diagram of enrollment the participants in this study, and divided into non-diabetes mellitus (non-DM) and type 2 DM groups. RT, Romberg test; FRT, Functional Reach Test; TUG, Timed Up and Go Test.

Reference

1. Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017; 128:40–50.

2. Kirkman MS, Briscoe VJ, Clark N, Florez H, Haas LB, Halter JB, et al. Diabetes in older adults. Diabetes Care. 2012; 35:2650–64.

3. Forbes JM, Cooper ME. Mechanisms of diabetic complications. Physiol Rev. 2013; 93:137–88.

4. Yang Y, Hu X, Zhang Q, Zou R. Diabetes mellitus and risk of falls in older adults: a systematic review and meta-analysis. Age Ageing. 2016; 45:761–7.

5. Herrera-Rangel AB, Aranda-Moreno C, Mantilla-Ochoa MT, Zainos-Saucedo AL, Jauregui-Renaud K. Awareness of sensory decline in patients with type 2 diabetes mellitus. Int J Diabetes Dev Ctries. 2015; 35:458–60.

6. Deshpande N, Hewston P, Aldred A. Sensory functions, balance, and mobility in older adults with type 2 diabetes without overt diabetic peripheral neuropathy: a brief report. J Appl Gerontol. 2017; 36:1032–44.

7. Horak FB. Postural orientation and equilibrium: what do we need to know about neural control of balance to prevent falls? Age Ageing. 2006; 35 Suppl 2:ii7–ii11.

8. Wilson SJ, Garner JC, Loprinzi PD. The influence of multiple sensory impairments on functional balance and difficulty with falls among U.S. adults. Prev Med. 2016; 87:41–6.

9. Nomura T, Kawae T, Kataoka H, Ikeda Y. Assessment of lower extremity muscle mass, muscle strength, and exercise therapy in elderly patients with diabetes mellitus. Environ Health Prev Med. 2018; 23:20.

10. Andersen H. Motor dysfunction in diabetes. Diabetes Metab Res Rev. 2012; 28 Suppl 1:89–92.

11. Hewston P, Deshpande N. Falls and balance impairments in older adults with type 2 diabetes: thinking beyond diabetic peripheral neuropathy. Can J Diabetes. 2016; 40:6–9.

12. Yagci N, Cavlak U, Aslan UB, Akdag B. Relationship between balance performance and musculoskeletal pain in lower body comparison healthy middle aged and older adults. Arch Gerontol Geriatr. 2007; 45:109–19.

13. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Diabetes, vestibular dysfunction, and falls: analyses from the National Health and Nutrition Examination Survey. Otol Neurotol. 2010; 31:1445–50.

14. Colenbrander A. Assessment of functional vision and its rehabilitation. Acta Ophthalmol. 2010; 88:163–73.

15. Eperjesi F, Wolffsohn J, Bowden J, Napper G, Rubinstein M. Normative contrast sensitivity values for the back-lit Melbourne Edge Test and the effect of visual impairment. Ophthalmic Physiol Opt. 2004; 24:600–6.

16. Lord SR, Dayhew J. Visual risk factors for falls in older people. J Am Geriatr Soc. 2001; 49:508–15.

17. Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994; 17:1281–9.

18. Nnodim JO, Yung RL. Balance and its clinical assessment in older adults: a review. J Geriatr Med Gerontol. 2015; 1(1):003.

19. Shumway-Cook A, Brauer S, Woollacott M. Predicting the probability for falls in community-dwelling older adults using the Timed Up & Go Test. Phys Ther. 2000; 80:896–903.

20. Mentiplay BF, Perraton LG, Bower KJ, Adair B, Pua YH, Williams GP, et al. Assessment of lower limb muscle strength and power using hand-held and fixed dynamometry: a reliability and validity study. PLoS One. 2015; 10:e0140822.

21. Lin SI, Chen YR, Liao CF, Chou CW. Association between sensorimotor function and forward reach in patients with diabetes. Gait Posture. 2010; 32:581–5.

22. Cimbiz A, Cakir O. Evaluation of balance and physical fitness in diabetic neuropathic patients. J Diabetes Complications. 2005; 19:160–4.

23. Vaz MM, Costa GC, Reis JG, Junior WM, Albuquerque de Paula FJ, Abreu DC. Postural control and functional strength in patients with type 2 diabetes mellitus with and without peripheral neuropathy. Arch Phys Med Rehabil. 2013; 94:2465–70.

24. Kukidome D, Nishikawa T, Sato M, Nishi Y, Shimamura R, Kawashima J, et al. Impaired balance is related to the progression of diabetic complications in both young and older adults. J Diabetes Complications. 2017; 31:1275–82.

25. Huxham FE, Goldie PA, Patla AE. Theoretical considerations in balance assessment. Aust J Physiother. 2001; 47:89–100.

26. Leenders M, Verdijk LB, van der Hoeven L, Adam JJ, van Kranenburg J, Nilwik R, et al. Patients with type 2 diabetes show a greater decline in muscle mass, muscle strength, and functional capacity with aging. J Am Med Dir Assoc. 2013; 14:585–92.

27. Menz HB, Lord SR, St George R, Fitzpatrick RC. Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy. Arch Phys Med Rehabil. 2004; 85:245–52.

28. Volpato S, Bianchi L, Lauretani F, Lauretani F, Bandinelli S, Guralnik JM, et al. Role of muscle mass and muscle quality in the association between diabetes and gait speed. Diabetes Care. 2012; 35:1672–9.

29. Park SW, Goodpaster BH, Strotmeyer ES, Kuller LH, Broudeau R, Kammerer C, et al. Accelerated loss of skeletal muscle strength in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes Care. 2007; 30:1507–12.

30. Andersen H, Nielsen S, Mogensen CE, Jakobsen J. Muscle strength in type 2 diabetes. Diabetes. 2004; 53:1543–8.

31. Park SW, Goodpaster BH, Strotmeyer ES, de Rekeneire N, Harris TB, Schwartz AV, et al. Decreased muscle strength and quality in older adults with type 2 diabetes: the health, aging, and body composition study. Diabetes. 2006; 55:1813–8.

32. Andreassen CS, Jakobsen J, Ringgaard S, Ejskjaer N, Andersen H. Accelerated atrophy of lower leg and foot muscles: a follow-up study of long-term diabetic polyneuropathy using magnetic resonance imaging (MRI). Diabetologia. 2009; 52:1182–91.

33. Benavent-Caballer V, Sendin-Magdalena A, Lison JF, Rosado-Calatayud P, Amer-Cuenca JJ, Salvador-Coloma P, et al. Physical factors underlying the Timed “Up and Go” test in older adults. Geriatr Nurs. 2016; 37:122–7.

34. D’Silva LJ, Lin J, Staecker H, Whitney SL, Kluding PM. Impact of diabetic complications on balance and falls: contribution of the vestibular system. Phys Ther. 2016; 96:400–9.

35. Fujimoto M, Hsu WL, Woollacott MH, Chou LS. Ankle dorsiflexor strength relates to the ability to restore balance during a backward support surface translation. Gait Posture. 2013; 38:812–7.

36. Daubney ME, Culham EG. Lower-extremity muscle force and balance performance in adults aged 65 years and older. Phys Ther. 1999; 79:1177–85.

37. Lanska DJ, Goetz CG. Romberg’s sign: development, adoption, and adaptation in the 19th century. Neurology. 2000; 55:1201–6.

38. Cordeiro RC, Jardim JR, Perracini MR, Ramos LR. Factors associated with functional balance and mobility among elderly diabetic outpatients. Arq Bras Endocrinol Metabol. 2009; 53:834–43.

39. Mold JW, Vesely SK, Keyl BA, Schenk JB, Roberts M. The prevalence, predictors, and consequences of peripheral sensory neuropathy in older patients. J Am Board Fam Pract. 2004; 17:309–18.