Improving Early Fall Risk Detection In Type 2 Diabetes

BACKGROUND: Single-leg stance (SLS) is utilized as a simple clinical assessment of falls risk, though it may be too simple to explain the underlying pathomechanics (Blodgett, 2022). The sensitivity of the SLS may be too low to serve as an early risk identifier. This may be problematic for healthy lifestyle management for persons with type 2 diabetes (T2D). Improved understanding may come by considering the sway excursion and impacts of altered base of support. PURPOSE: Evaluate the balance performance with T2D against healthy controls, utilizing multiple balance assessments. METHODS: 97 participants were recruited for this study. 39 reported being diagnosed with T2D and 60 reported to not have T2D. Participants completed timed SLS trials, one on each leg, where lower times relate to poorer balance. They also completed a Sway Task (ST) which quantified central excursion, where larger values indicate poorer balance and a value of 0.8 indicates clinical concern. A falls risk assessment (FR) included measure of sway velocity during each of four trials, feet shoulder width with eyes open and closed and feet together with eyes open and closed, where larger values indicate poorer balance. SLS and ST were analyzed using independent t-tests, FR was assessed using 2-way ANOVA to examine the effects by T2D and healthy group and stance condition. Alpha = 0.05 indicates significance. RESULTS: SLS times were significantly lower in the T2D group (right leg = 12.07 s ± 10.9, left leg = 11.49 s ± 10.7) than the healthy group (right leg = 18.49 s ± 11.8, left leg 16.36 s ± 11.6), both p < .05. ST was higher in the T2D group (0.946 ± 0.48) than the healthy group (0.717 ± 0.34), p < .05. FR results indicate a main effect of group and trial, as well as an interaction effect. T2D velocities were 6.02 ± 8.6, 7.66 ± 9.7, 14.04 ± 16.8, 20.04 ± 19.2, while healthy were 3.98 ± 2.2, 5.02 ± 2.8, 7.26 ± 3.7, 13.02 ± 8.3 m/s, for respective trials, all p < .05. CONCLUSION: Persons with T2D have impaired balance, likely due to excessive sway excursion manifesting particularly when the base of support is minimized. These findings support the need for advanced balance assessments in T2D populations, which could aid in proactive falls prevention. This work highlights opportunities for refined assessment and targeted interventions to control sway amplitude and velocity in persons with T2D.