Associations Between Diabetic Neuropathy and Balance Impairments in Patients with Type 2 Diabetes: A Cross-Sectional Study

<b>Background:</b> Diabetic neuropathy (DN) may impair balance and gait, increasing the risk of falls in elderly patients with type 2 diabetes mellitus (T2DM). This study aimed to evaluate whether the presence and severity of DN are associated with balance and mobility impairment as well as with increased fear of falling in patients with T2DM. <b>Methods</b>: A total of 124 adults with T2DM underwent neuropathy assessment with the Michigan Neuropathy Screening Instrument (MNSI) and sudomotor testing (SUDOSCAN). Balance and fall risk were evaluated using the Berg Balance Scale (BBS), Timed Up and Go (TUG), Falls Efficacy Scale-International (FES-I), and Fear of Falling Questionnaire-Revised (FFQ-R). Comparison of parameters between patients with vs. without DN, correlations, and multivariable linear regressions (DN components as predictors) were performed. <b>Results</b>: Compared with those without DN, participants with DN had higher FES-I (31.0 vs. 21.0) and FFQ-R (56.0 vs. 42.0) scores and lower BBS (42.0 vs. 46.0). TUG did not differ significantly (11.8 vs. 11.25 s). In multivariable models, higher MNSI questionnaire and objective scores independently predicted lower BBS (<i>β</i> = -0.74 and -1.1, respectively) while only the MNSI questionnaire predicted higher TUG (<i>β</i> = 0.43). For fear of falling, the MNSI questionnaire predicted higher FES-I (<i>β</i> = 1.66) and both MNSI components predicted higher FFQ-R (<i>β</i> = 2.31 and 1.7, respectively). Leg SUDOSCAN values were not associated with BBS, TUG, FES-I, or FFQ-R. <b>Conclusions</b>: DN is associated with impaired balance and greater fear of falling. Neuropathy burden, particularly patient-reported symptoms, relates to worse performance and confidence, whereas sudomotor impairment alone does not.