Confidence crucial to combat falls in diabetic peripheral neuropathy

Rather than objective measures of functional performance, psychological factors appear to be more relevant risk factors for falls among patients with diabetic peripheral neuropathy (DPN), according to a recent Singapore study.

“[I]ncreased balance confidence is associated with reduction in fall risk among DPN patients, which suggests the importance of psychological factors in falls prevention,” the researchers said. “This highlights the potential role of interventions targeting improvements in balance confidence to reduce fall risk.”

A total of 146 DPN patients participated in the study, of whom 29 were at high risk of falls, as determined by the timed up-and-go test. Despite being comparable in age, these participants had significantly higher body mass index and blood pressure, and a longer diabetes duration than their 117 low-risk counterparts. [Front Endocrinol 2020;11:573804]

In terms of functional measurements, patients who were at low risk of falls walked for significantly more hours per week on average than high-risk participants (26.61±16.42 vs 19.45±14.62 hours; p=0.033).

Similarly, mean functional reach (25.23±6.63 vs 19.38±6.24 cm; p<0.001) and great toe extensor strength (7.03±1.79 vs 5.90±1.48 lbs; p=0.002) were significantly better in low-risk patients. No such between-group differences were observed in other objective functional measures, such as body sway velocity (p=0.169) and angle dorsiflexion strength (p=0.062).

The 16-item Activities Specific Balance Confidence (ABC) scale was then used to measure the participants’ self-confidence in performing daily routine activities without losing their balance.

DPN patients who were at low risk of falls earned a mean ABC score of 80.95±17.49, which was significantly greater than the 48.85±18.98 average of their high-risk counterparts (p<0.001).

Logistic regression analysis confirmed the impact of functional measures on fall risk. Crude interactions were reported for the health utility score (p<0.001), functional reach (p<0.001), great toe extensor strength (p=0.003), and total ABC score (p<0.001).

However, upon stepwise forward and backward adjustment for confounders, ABC score remained the only significant functional variable, showing a protective effect against fall risk (odds ratio [OR], 0.91, 95 percent confidence interval [CI], 0.88–0.95; p<0.001).

This result was in line with the larger literature and could be due to the physical deconditioning that stems from the physical inactivity due to poor self-confidence and fear of falling, the researchers explained.

Notably, a longer duration of diabetes also emerged as a significant and independent risk factor for falls (OR, 1.14, 95 percent, 1.05–1.23; p=0.001). This was also in line with previous studies, which showed that prolonged diabetes might contribute to muscle weakness. [J Diabetes Investig 2018;9:186-192]

“We observed that improvement in balance confidence, measured by total ABC, was associated with a reduction in fall risk, irrespective of other functional and health measures,” the researchers said.

“[B]alance confidence could be an important target for intervention in people with DPN as well for maintenance of physical activity levels and reducing fall risk in the long-term, and this should be formally examined in future studies,” they added.