Postural Control Deficits And Type 2 Diabetes: A Meta-analysis Of Observational Studies

Abstract

Type 2 diabetes patients often present diabetic peripheral neuropathy (DPN), and have an increased risk of falling. However, high fall incidence is also found in diabetic people without DPN. PURPOSE: To explore the association between postural control deficits and type2 diabetes beyond DPN. METHODS: We searched Pubmed, Embase, Medline, Web of Science, and Cochrane Library entries up to November 2021, using keywords including “diabetes” and “postural control” and their synonym. Cohort studies, case-control studies, and cross-sectional studies assessing the postural control of type 2 diabetes patients without DPN, and compared to non-diabetic controls were included. Center of pressure (COP)-based measures of postural sway were the primary outcome. Data were extracted by 2 independent reviewers and analyzed using STATA version 14.0. Random-effect models were applied to estimate the effect size with 95% confidence intervals (CIs), and I2 was used to evaluate the heterogeneity. RESULTS:Thirteen studies met the inclusion criteria, and 602 people (299 type 2diabetes patients and 303 healthy individuals) were included. Type 2 diabetes led to standing postural deficits on the floor with visual support (SMD = 1.25, 95% CI 0.70-1.1.79, P = 0.000, I2 = 88.4%), standing on floor without visual support (SMD = 1.18, 95%CI 0.63-1.84, P = 0.000, I2 = 89.7%), standing on foam with visual support (SMD = 1.03, 95%CI 0.21-1.84,P = 0.014, I2 = 87.0%), and standing on foam without visual support (SMD = 1.30, 95%CI 0.43-2.18,P = 0.004, I2 = 90.0%). Subgroup analysis demonstrated that postural sway increased significantly in patients with a diabetes duration of ≥5 years (SMD = 0.88, 95%CI 0.38-1.38, P = 0.001), BMI < 24.9 kg/m2 (SMD = 1.38, 95%CI 0.15-2.6, P = 0.028), and age < 50 years (SMD = 2.33, 95%CI 1.04-3.62, P = 0.000). CONCLUSIONS: Current literature indicates that postural control deficits are significantly associated with type 2 diabetes beyond DPN. Interestingly, this association is more evident in patients with a younger age or a normal BMI.