Abstract
The purpose of this study was to look at the determinants of the unsteady walking (UW) symptom in patients with type 2 diabetes mellitus (T2DM) by defining if UW and/or the Diabetic Neuropathy Symptoms Score (DNSS) are associated with positive scores in Beck's Depression Inventory (BDI) and with a positive Michigan Neuropathy Screening Instrument score (MNSI). We evaluated 203 T2DM patients without visible gait disturbances. They were divided into UW (+) and UW (−) or DNSS (+) and DNSS (−) according to symptoms. We found a prevalence of 48.3% for UW (+) and of 63% for DNSS (+) in our sample. In univariate analysis, the presence of UW was significantly associated with waist circumference (P=0.024), number of comorbidities (P=0.012), not practicing physical exercise (P=0.011), positive BDI score (P=0.003), presence of neuropathic symptoms by the MNSI questionnaire (P<0.001), and positive diabetic neuropathy screening by MNSI (P=0.021). In multivariate analysis, UW (used as a dependent variable) was independently associated with a positive BDI score (P<0.001; 95%CI=1.01-1.03), T2DM duration (P=0.023; 95%CI=1.00–1.03), number of co-morbidities (P=0.032; 95%CI=1.01–1.37), and a sedentary lifestyle (P=0.025; 95%CI=1.06–2.5). The UW symptom and a positive DNSS are more closely related to a positive score for depression than to presence of neuropathy in T2DM.
Highlights
Since a direct relationship between neuropathic and depressive symptoms has been demonstrated in different studies [1,2,3] the use of scales for screening neuropathy and depression in diabetic patients should be cautiously interpreted
Vileikyte et al suggest that the symptom of unsteadiness in walking (UW) has a biological basis that could provide a possible explanation for this finding, since it is common to both depression in type 2 diabetes mellitus (T2DM) and peripheral polyneuropathy (PPN) [3]
Diabetic Neuropathy Symptoms Score (DNSS) is a simple questionnaire that was created as a method for measuring symptoms of neuropathy [9,10]
Summary
Since a direct relationship between neuropathic and depressive symptoms has been demonstrated in different studies [1,2,3] the use of scales for screening neuropathy and depression in diabetic patients should be cautiously interpreted. Vileikyte et al suggest that the symptom of unsteadiness in walking (UW) has a biological basis that could provide a possible explanation for this finding, since it is common to both depression in type 2 diabetes mellitus (T2DM) and peripheral polyneuropathy (PPN) [3]. Some authors have shown that walking impairment occurs as a late complication of diabetes, primarily in people with established neuropathy [4,5]. All of them provide a good identification of people with large fiber disease. The instruments do not have questions or measurements related to UW [8]
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