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Impact of diabetic peripheral neuropathy on gait abnormalities in patients with type 2 diabetes mellitus

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Abstract

Background

Many patients with type 2 diabetes (T2DM) suffer from diabetic peripheral neuropathy (DPN) and impaired muscle coordination. These changes may lead to walking instability, and gait abnormalities resulting in increased fall risk and lower limb amputations. The aim of this study was to assess the impact of DPN and patient footwear on the gait in patients with diabetes, in addition to Comparing the peak plantar pressure (PPP) in patients with and without DPN and assessing its association with gait abnormalities.

Methodology

This is an observational case–control study. Forty Subjects with T2DM were divided into two age and sex-matched groups, 20 subjects each. Group A: subjects with DPN. Group B: subjects without DPN. All study participants were subjected to a thorough history taking, clinical examinations focusing on detailed foot examination, PPP assessment, and functional gait evaluation.

Results

The results obtained in this study showed a median gait assessment score of 21 (17.0–22.5) for group A and 26 (23.5–26.0) for group B which was statistically significant (p < 0.001). There was no statistically significant difference between both groups (p > 0.05) regarding the assessment of footwear appropriateness. Comparing the PPP measurement among both studied groups, the prevalence of an elevated PPP was 80% in group A compared to 65% in group B, which was statistically non-significant, p = 0.288.

Conclusions

Gait abnormalities are common among patients with T2DM even in the absence of DPN. However, the presence of DPN was the strongest independent risk factor for gait abnormalities among the studied factors.

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Data availability

Data is available through the corresponding author upon justified request.

Abbreviations

ACAD:

Atherosclerotic coronary artery disease

BMI:

Body mass index

DNS:

Diabetic neuropathy symptom score

DPN:

Diabetic peripheral neuropathy

DSPN:

Distal symmetric polyneuropathy

FGA:

Functional gait assessment

HbA1c:

Glycosylated hemoglobin

PPP:

Peak plantar pressure

T2DM:

Type 2 diabetes

VPT:

Vibration perception threshold

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Funding

The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grants, or other support was received.

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Authors and Affiliations

  1. Department of Internal Medicine, Unit of Diabetes, Lipidology and Metabolism, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Samir H. Assaad Khalil, Martin Otwang Dak Ajang & Noha Gaber Amin

  2. Department of Neuropsychiatry, Faculty of Medicine, Alexandria University, Alexandria, Egypt

    Hany Mohammed Ali El Deeb

  3. Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt

    Nermin A. Osman

  4. Department of Internal Medicine, Faculty of Medicine, Upper-Nile University, Juba, South Sudan

    Martin Otwang Dak Ajang

Authors
  1. Samir H. Assaad Khalil
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Contributions

All authors have made substantial contributions to all the following: (1) the conception and design of the study, or acquisition of data, or analysis and interpretation of data, (2) drafting the article or revising it critically for important intellectual content, (3) final approval of the version to be submitted.

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Correspondence to Noha Gaber Amin.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no competing interests to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethical approval

The study design was approved by the ethics committee of Alexandria University. The study followed the criteria set by the declaration of Helsinki. Confidentiality and personal privacy were respected at all levels of the study. IRB approval number is 0106242 dated 16/JAN/2020.

Informed consent

The participating study population signed an informed consent before any study-related procedure took place. Patients felt free to withdraw from the study at any time without any consequences. Participants also signed an additional consent for publication.

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Khalil, S.H.A., Deeb, H.M.A.E., Ajang, M.O.D. et al. Impact of diabetic peripheral neuropathy on gait abnormalities in patients with type 2 diabetes mellitus. Diabetol Int 15, 58–66 (2024). https://doi.org/10.1007/s13340-023-00652-y

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