Balance and motion coordination parameters can be improved in patients with type 2 diabetes with physical balance training: non-randomized controlled trial

Artur Stolarczyk, Igor Jarzemski, Bartosz M Maciąg, Kuba Radzimowski, Maciej Świercz, Magda Stolarczyk, Artur Stolarczyk, Igor Jarzemski, Bartosz M Maciąg, Kuba Radzimowski, Maciej Świercz, Magda Stolarczyk

Abstract

Background: Type 2 diabetes (T2D) is a cause of multiple complications, including retinopathy and peripheral neuropathy. These complications are well understood and believed to contribute to gait instability. Poor balance control and increased falling risk have also been reported in people with diabetic peripheral neuropathy (DPN). Patients with DPN have increased risk of falling due to decreased proprioceptive feedback. Effective balance training should improve postural control in patients with DPN. For this purpose further evaluation was conducted and balance training was designed.

Methods: The goal of our study was to determine values of proprioception, balance, muscle coordination and strength in patients with T2D and analyze whether biofeedback balance training with use of the Biodex Balance System could improve these parameters. To assess the fall risk the general stability index (GSI), the index of frontal-posterior (FPI) and medial-lateral (MLI) stability were evaluated. 37 patients with diagnosed type 2 diabetes mellitus were recruited to this study. Their results were compared with control group consisting of 41 healthy participants who were homogenic to the study group in terms of age and body mass index (BMI).

Results: There were statistically significant differences between patients with diabetes compared to healthy subjects in GSI (2.79 vs 1.1), FPI (1.66 vs 0.7), MLI (0.88 vs 0.52) and risk of falling (5.18 vs 2.72) p < 0.05. There were also statistically significant changes before and after training in all stability indices (GSI: 2.79 vs 1.26, FPI: 1.66 vs 0.77, MLI: 0.88 vs 0.54 accordingly) p < 0.05 and risk of falling (5.18 vs 3.87) p < 0.05 in the study group who had undergone training with biofeedback.

Conclusions: This study found that there is a decreased balance and motor coordination and an increased risk of falling in patients with type 2 diabetes. These parameters improved in patients who have undergone training programme with biofeedback. Furthermore, an age-dependent deprivation of static balance was observed along with an increased risk of falling as a result of increasing BMI.

Trial registration: ClinicalTrials.gov NCT04484480.

Keywords: Balance; Coordination; Diabetes mellitus; Fall risk; Physical training.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Box and whiskers graphs of results for the biofeedback posture test. C—control group; A1, A2—study group, before and after intervention. Square—median, box—25–75%, whiskers—min–max
Fig. 2
Fig. 2
Box and whiskers graphs of results for the biofeedback posture test with closed eyes. C—control group; A1, A2—study group, before and after intervention. Square—median, box—25–75%, whiskers—min–max
Fig. 3
Fig. 3
Box and whiskers graphs of results for the risk of falling test. C—control group; A1, A2—study group, before and after intervention. Square—median, box—25–75%, whiskers—min–max

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