DIABETES

With diabetic nerve damage, walking can pose fall risk

Diabetics with nerve damage are more likely to have an uneven stride and struggle to maintain their balance even when walking on flat ground, a small study finds.

So-called peripheral neuropathy, or diabetic nerve damage, can lead to numbness and pain in the feet, legs and hands. It is the most common complication of diabetes, and though it has long been linked to an increased risk of falls, less is known about how specific body movements contribute to balance problems during daily activities such as walking or climbing stairs.

"By investigating the activities during which falls are more likely to occur, we can look to identify specific detriments of the underlying balance mechanisms, allowing a more targeted and educated approach to preventing falls within this population in the future," lead author Steven Brown, of Manchester Metropolitan University in the UK, said in an email interview.

About one in nine adults has diabetes, and the disease will be the seventh leading cause of death by 2030, according to the World Health Organization.

Most of these people have type 2 diabetes, which is linked to obesity and advanced age and happens when the body can't properly use or make enough of the hormone insulin to convert blood sugar into energy.

Roughly 70 percent of diabetics have some form of neuropathy, according to the National Institutes of Health. While the risk increases the longer people live with diabetes, nerve damage may be limited by keeping blood sugar as close to normal as possible.

To understand how nerve damage impacts gait and balance, Brown and colleagues analyzed the body mechanics of 22 diabetics with neuropathy while walking on flat ground and going up and down stairs. They compared the results to 39 diabetics without neuropathy and a control group of 28 people without diabetes.

The researchers did a gait analysis using a 10-camera motion capture system to collect data as participants moved on stairs and on flat ground. Everybody wore similar shoes, to ensure that footwear didn't influence results.

The diabetics with nerve pain moved at significantly slower speeds than the other study participants.

On stairs, front-to-back sway as well as side-to-side sway, which increase with poor balance, was significantly higher for the diabetics with neuropathy than for the people without diabetes. And front-to-back sway was also significantly greater for diabetics with nerve pain when they walked on level ground.

Standing still with open eyes, the diabetics with neuropathy had more front-to-back and side-to-side sway than the other study participants, and more than the control group when the test was repeated with eyes closed.

The diabetics with nerve pain also tended to stand with their feet spread further apart, a stance probably adopted to compensate for balance issues that can, in fact, increase the risk of falls, the researchers write in Diabetes Care.

There are some steps diabetics can take to stay on their feet even when they suffer from nerve pain, said Dr. James Richardson, a researcher at the University of Michigan Health System.

To decrease the chances of falling, diabetics need to have good vision or good control of ankle movements, strong hips, good reflexes, and avoid distractions while moving, said Richardson, who wasn't involved in the study.

Regular eye exams and good light can help with vision problems, and lightly touching a railing or wall can help with balance when it's hard to see, Richardson noted. And some exercises may be able to strengthen muscles around the hips.

At the end of the day, though, concentration is key.

"It doesn't matter if the muscles are strong if they are strong three seconds after you lose your balance," he said. "You only have about half a second before you hit the ground."