Testing for imbalance in the diabetics to presage inner ear lesions and stroke: Using Timed Up and Go test as a screening test

Abstract

Background: Imbalance and impaired hearing are less known complications of diabetics. Very few studies have been conducted in this regard. A common reason for imbalance is insufficiency of cerebral vascular perfusion. This is dreaded because imbalance may presage stroke. Hence in every diabetic, clinicians must always ask for the presence of imbalance. Such self-report by the patient may be highly subjective and may lead several investigations, which are expensive and time-consuming. Hence, an objective screening test for the presence of imbalance is the need of the hour. One such test is the Timed Up and Go (TUG) test. Objectives: The objectives of the study were (i) to ascertain ‘whether self-reporting the absence of imbalance alone is robust enough to presume the absence of imbalance and (ii) to ascertain whether TUG test is feasible to use as a screening test. Method: The subjects of this study were 98 subjects in the age group of 41 to 50 years attending a large diabetic clinic, with confirmed diagnosis of Type 2 Diabetes Mellitus. Each subject was asked a simple question about whether they had ever felt any imbalance. Subsequently, all the subjects underwent the TUG test. The scores of the TUG test were analysed for association with the self-report of imbalance. Results: Among the 98 subjects, only 42 persons self-reported imbalance. The rest denied any imbalance. Among the 56 subjects (group A) who denied experiencing any imbalance, only 40 subjects had normal TUG scores i.e. 12 seconds or less. The remaining 16 subjects had prolonged scores i.e. 13 s or more. On the other hand, among the 42 subjects who admitted to having imbalance (group B), only 24 subjects had scores of 13 s or higher. The other 18 subjects had normal TUG scores. It is noteworthy that the self-reporting by 16 subjects of group A and 18 subjects group B were wrong, when we checked with the TUG test. With regard to the feasibility of the TUG test, we found it was inexpensive and required only two or three minutes. Even clinical assistants could learn and do it right. Conclusion: Because of the above reasons, TUG test is recommended for every diabetic patient. However, we should always keep in mind that TUG test is only a screening test and is not specific to any individual organ system.