Balance Impairment in Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) is associated with impaired balance, but it is unclear whether adults with DPN have greater balance difficulty than adults with diabetes without DPN, particularly when sensory information is limited or altered. This cross-sectional study examined the association between DPN and standing balance under different sensory conditions. Data were obtained from 2,152 adults aged 40 years or older in the 2003–2004 National Health and Nutrition Examination Survey. Peripheral neuropathy was defined using monofilament testing, and balance was assessed using the Modified Romberg test. Survey-weighted logistic regression compared four groups: DPN, diabetes without DPN, prediabetes without peripheral neuropathy, and healthy controls. Models were adjusted for demographic factors and body mass index. Stata version 18.0 was used for the analyses. Few participants failed the eyes-open test on a firm surface, and failure rates did not differ significantly across groups. With healthy controls as the reference, the DPN group had higher adjusted odds of failure in the other conditions: eyes closed on a firm surface (aOR 4.43; 95% CI 2.12–9.25), eyes open on a compliant surface (aOR 10.49; 95% CI 3.18–34.57), and eyes closed on a compliant surface (aOR 2.25; 95% CI 1.47–3.45). No significant difference was found between diabetes without DPN and healthy controls. Poorer balance in DPN was thus associated with conditions that challenged vision or sensory information from the support surface. Testing these conditions may reveal deficits that are less apparent with the eyes open on a firm surface.