Quantitative assessment of posture stability using computerised dynamic posturography in type 2 diabetic patients with neuropathy and its relation to glycaemic control

Emam AA, Gad AM, Ahmed MM, Assal HS, Mousa SG
Correspondence: Dr Ahmed Alsayed Emam, ahmedemam6@hotmail.com

ABSTRACT
Introduction Patients with diabetic neuropathy have an imbalance, which comes with a higher risk of falls. The aim of this study was to assess posture stability using computerised dynamic posturography in type 2 diabetics mellitus patients with neuropathy as well as its relation to glycaemic control.
Methods 54 type 2 diabetics mellitus patients with peripheral neuropathy were recruited, together with 18 type 2 diabetics mellitus patients without peripheral neuropathy acting as the control group. The first group was divided into two subgroups according to glycaemic control assessed by HbA1c (A1c), the first subgroup comprising 24 patients had good glycaemic control with A1c less than or equal to seven percent and the second subgroup with 30 patients had poor glycaemic control with A1c more than 7 percent. The postural stability was evaluated using dynamic posturography.
Results The composite equilibrium score, sensory organisation test 1, 2 and 3 conditions were significantly lower in the neuropathic group as compared to the non-neuropathic group (p-value is less than 0.001). A1c was significantly correlated with the composite equilibrium score in the neuropathic group with poor glycaemic control (r-value equal to -0.395) but not correlated in the neuropathic group with good glycaemic control ( r-value equal to 0.151).
Conclusion Posture instability in type 2 diabetic patients with peripheral neuropathy reflects an impairment of the somatosensory system; also, poor glycaemic control resulted in more posture instability. The early detection of imbalance using dynamic posturography and achieving good glycaemic control may be of great help in the prevention of falls in such patients.

Keywords: glycaemic control, computerised dynamic posturography, diabetes mellitus, glycaemic control, peripheral neuropathy, type 2 diabetes mellitus
Singapore Med J 2009; 50(6): 614-618