Postural Instability and Fall Risk in Type 2 Diabetes: A Cross-sectional Study Using Posturography and Video Head Impulse Test.

OBJECTIVE

To investigate vestibular function, postural stability, and fall risk in individuals with type 2 diabetes mellitus (T2DM) with and without diabetic polyneuropathy (DPN), compared with healthy controls.

DESIGN

A cross-sectional study.

SETTING

University hospital outpatient clinic.

PARTICIPANTS

A total of 128 adults participated: 51 with T2DM and DPN, 38 with T2DM without DPN, and 39 healthy controls. Participants were consecutively recruited and classified based on clinical and electrophysiologic evaluation of DPN.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Vestibular function was assessed using the video head impulse test (vHIT). Postural stability was measured by computerized posturography (Fourier frequency band analysis [F2-F4 sway], Stability Index, Fall Risk Index). Fall concern was assessed by questionnaire, and fall history within the past year was self-reported.

RESULTS

Abnormal vHIT findings were rare (7%), and there were no group differences. Participants with T2DM and DPN demonstrated significantly higher F2-F4 sway compared with both T2DM without DPN and controls. A similar pattern was observed for the Stability Index, while the Fall Risk Index did not differ between groups. Participants with a heightened fall concern and participants reporting falls within the past year had greater F2-F4 sway. Logistic regression analysis confirmed an independent association between F2-F4 sway and fall history.

CONCLUSION

Computerized posturography, particularly F2-F4 sway, identified balance impairment and increased fall risk in individuals with T2DM, especially those with DPN. Abnormal vHIT findings were rare and unrelated to falls, suggesting a limited role of vHIT-detectable vestibular dysfunction in this population.