| BackgroundDiabetes is a chronic disease and a worldwide public health problem,which poses a serious threat to human health.Over the past 30 years,the prevalence of diabetes in China has shown a rapid increase.Statistics in 2015 showed that the number of adult diabetes patients in China ranked first in the world.With the prolonged course of diabetes and poor blood sugar control,a variety of complications may occur.Diabetic peripheral neuropathy(DPN)is one of the most common chronic complications,which will affect the sensory nerve,motor nerve and autonomic nerve,and thus lead to the decrease or disappearance of protective sense.Studies have shown that diabetes,especially patients with DPN,has a decreased balance ability,an increased risk of falls,and can lead to fracture,disability and even death.Therefore,it is of great significance to evaluate the balance ability of diabetic patients.For the assessment of balance ability in diabetes patients,there is still a lack of simple,effective and accurate detection methods.ObjectiveThis study is under the condition of open and close eyes,the subjects on descending sloped surface,-5°;horizontal sloped surface,0°;rising sloped surface 5°.Pressure plate is used to inspect a foot position of center of pressure(COP),through calculation of the full-body,the left leg,right leg COP area and velocity,aims to study the balance ability of patients with type 2 diabetes,and to explore the effective detection method of evaluation of patients with balance.By comparing the nerve conduction velocity between the two groups,the correlation analysis between nerve conduction velocity and COP area and the velocity of COP,and the correlation analysis between MNSI and NTSS-6 questionnaire and COP indicator,the relationship between lower extremity neuropathy and the change of balance ability was discussed.MethodsA total of 62 subjects were included in this study,including 32 patients with type 2 diabetes(diabetes group)and 30 healthy subjects(healthy control group).General information was collected for all subjects,including age,height,weight,body mass index(BMI),waist-to-hip ratio(WHR),heart rate,blood pressure,history of smoking,history of alcohol consumption,and family history of diabetes.Fasting blood was drawn and analyzed for fasting blood glucose(FBG),glycosylated hemoglobin(HbA 1 c),triglyceride(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C).Physical signs such as tactile sensation,temperature sensation,vibration sensation and ankle reflex were examined.The Michigan neuropathy screening table(MNSI)and neuropathy symptom score questionnaire(NTSS-6)were performed.The nerve conduction velocity of tibial motor nerve,peroneal motor nerve,superficial peroneal sensory nerve and sural sensory nerve were examined.Pressure plate was used to detect the position of pressure center(COP)on the soles of all subjects under the conditions of open and closed eyes,respectively.The COP area and the mean velocity of COP in anterior-Posterior(AP)and medial-lateral(ML)of different support surfaces were compared between the diabetes group and the control group.The correlation between nerve conduction velocity and plantar pressure area and velocity was analyzed.The correlation between MNSI and NTSS-6 scale and plantar pressure area and velocity was analyzed.ResultsThere were no significant differences in age,height,weight,BMI,WHR,heart rate,blood pressure,smoking history and drinking history between the diabetes group and the control group(p＞0.05).There were significant differences in FBG and HbAlc between the diabetes group and the control group(p＜0.05);There was no significant difference in TG,TC,HDL-C and LDL-C(p＞0.05).Comparison of COP area between the diabetes group and the control group:under the condition of open eyes,the COP area of both leg in the diabetes group was higher than that in the control group on the descending and ascending surfaces(p＜0.05);The left leg COP area in the diabetes group was higher than that in the control group at all supporting surfaces(p＜0.05);The right leg COP area in the diabetes group was higher than that in the control group at the descending and ascending surfaces(p＜0.05).Under the condition of eye closure,the total COP area of the diabetic group was higher than that of the control group at the descending and ascending surfaces(p＜0.05).The COP area of right leg in the diabetes group was higher than that in the control group(p＜0.05).However,there was no significant difference between the two groups in the ascending surface and descending surface of the left leg and the ascending surface of the right leg(p＞0.05).Comparison of the velocity of COP in anterior-Posterior(AP)direction between the diabetes group and the control group:under the conditions of open and closed eyes,the full-body,the left leg and the right leg of the diabetes group were all higher than those of the control group on all supporting surfaces,but the difference was not statistically significant(p＞0.05).The mean velocity of COP in medial-lateral(ML)direction of the diabetic group was higher than that of the control group on the descending and ascending surfaces when the eyes were open(p＜0.05);There was no significant difference in the left and right leg when the eyes were open,nor in the whole body,left leg and right leg when the eyes were closed(p＞0.05).The nerve conduction velocity of bilateral tibial motor nerve,peroneal motor nerve,superficial peroneal sensory nerve and sural sensory nerve in the diabetes group was lower than that of the control group(p＜0.05).There was no significant difference in the conduction velocity of left superficial peroneal sensory nerve between the two groups(p＞0.05).Under the descending surface condition,the COP area,the mean velocity of COP in AP and ML directions in the diabetes group were negatively correlated with the nerve conduction velocity of the left leg(p＜0.05).On the descending and ascending planes,there was a significant negative correlation with nerve conduction velocity of the right leg(p＜0.05).There was a significant positive correlation between NTSS-6 scale score and COP area in the diabetes group under the descending and ascending surfaces(p＜0.05),MNSI scale score was positively correlated with COP area of the whole body only at the horizontal level(p<0.05)ConclusionBy comparing the COP area,the mean velocity of COP between the two groups,it was found in this study that the COP area and the mean velocity of COP of patients with type 2 diabetes mellitus were larger than those of healthy people,which reflected the decreased body balance ability of patients with type 2 diabetes mellitus.The COP area and the mean velocity of COP were positively correlated with the nerve conduction velocity,indicating that lower extremity neuropathy was one of the reasons for the decreased balance ability in diabetic patients.The COP area and the mean velocity of COP were different between the two groups when standing on inclined support surface than horizontal support surface,which could detect the abnormal balance ability of patients with type 2 diabetes in the early stage.Besides,the pressure plate examination was non-invasive and easy to operate,which had potential clinical detection value. |
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