Risk Factors For Poor Balance In Elderly Patients With Type2Diabetes And Treatment For Improving Balance Degree

Objective To evaluate the degree of balance in type2diabetic patients with longduration and investigate the association of body mass index, duration, diabeticcomplications, level of vitamin D3, bone mineral density, etc with balance, aiming atproviding theoretical basis for screening high risk group of falls and preventing falls inelderly patients with diabetes. To evaluate the influence of various vitamin Dsupplement on reducing risks of fall and explore proper treatment for improving balancedegree and reducing incidence of fall.Methods First part: This study was conducted among97diabetic patients aged over65years with duration over10years (including32diabetic nephropathy), and59elderlypeople without diabetes were taken as controls. The exclusion criteria included patientswith disease affecting balance, such as malformation, new bone fracture, craniocerebraldisease (excluding mild lacunar infarction), rheumatic diseases, aural vertigo,hypokalemia, Guillain-Barre syndrome, etc.①The balance degree of all subjects wereevaluated by Berg balance scale.②Perception of vibration, pressure and temperature,and ankle brachial index of all subjects were measured by specific tools.③Waist-Hipratio, percent body fat, lean balance and muscle strength of all subjects were measuredby human body composition analyzer.④Serum25(OH)D3and1.25(OH)2D3of allsubjects were measured by Elisa.⑤Blood glucose, HbA1C, blood lipid and bloodpressure were measured. The cases and number of falls of all subjects in last12monthsand the relationship between falls and hypoglycaemia were recorded. Second part: Wesearched for randomized controlled trials in the following electronic databases: MEDLINE and the Cochrane Library, and collected all randomized controlled trialsbased on the inclusion criteria. All data were analyzed using Stata11.0.Results First part:1) The cases and number of falls were significant higher in diabeticpatients than in controls in last12months (P<0.05).2) Berg balance scale scores weresignificant lower in diabetic patients than in controls (P<0.01). Perception of vibration,pressure and temperature, and ankle brachial index significantly declined in diabeticpatients than in controls (P<0.05). There was no significant difference between patientswith diabetic nephropathy and without diabetic nephropathy in berg balance scalescores by covariance analysis (P>0.05). There was no significant difference betweenpatients with diabetic neuropathy and without diabetic neuropathy in berg balance scalescores by covariance analysis (P>0.05).3) The level of serum25(OH)D3and1.25(OH)2D3were significant lower in diabetic patients than in controls (P<0.05). Thelevel of serum25(OH)D3and1.25(OH)2D3were significant lower in patients withdiabetic nephropathy than in patients without diabetic nephropathy(P<0.05).4) Bergbalance scale scores were negatively correlated with vibration perception(r=-0.786,P<0.001), positively correlated with pressure sense(r=0.552, P<0.001) and anklebrachial index(r=0.475, P<0.001). By multiple linear regression analysis, vibrationperception and pressure sense were identified as independent factors influencing Bergbalance scale scores. Regression equation was Berg=-0.265×vibration perception+0.940×pressure sense.Second part:1) The number of falls were significant lower in high dose vitamin Dsupplemental group than in controls [RR=0.84,95%CI (0.73,0.98), P<0.05]. There wasno significant difference in the number of falls between low dose vitamin Dsupplemental group and controls [RR=1.00,95%CI (0.86,1.17), P>0.05].2) There was no significant difference in the number of falls between high dose vitamin Dsupplemental group with a treatment duration of more than12months and controls[RR=0.89,95%CI (0.75,1.04), P>0.05]. However, sensitivity analysis showedsignificant difference [RR=0.85,95%CI (0.78,0.93), P<0.05]. The number of falls weresignificant lower in high dose vitamin D supplemental group with a treatment durationof less than12months than in controls [RR=0.73,95%CI (0.57,0.93),P<0.05].3) Thenumber of falls were significant lower in high dose vitamin D2supplemental group thanin controls[RR=0.87,95%CI(0.78,0.97),P<0.05].There was no significant difference in the number of falls between high dose vitaminD3supplemental group and controls [RR=0.83,95%CI (0.67,1.04), P>0.05]. However,sensitivity analysis showed significant difference [RR=0.79,95%CI (0.69,0.90),P<0.05].Conclusion1.The balance degree in elderly patients with type2diabetes declinedobviously.2. The level of serum25(OH)D3and1.25(OH)2D3in elderly patients withtype2diabetes decreased significantly. The level of serum25(OH)D3and1.25(OH)2D3in patients with diabetic nephropathy were significant lower than inpatients without diabetic nephropathy.3. Vibration perception and pressure sense wereidentified as independent factors influencing balance degree in elderly patients withtype2diabetes.4. High dose supplemental vitamin D may reduce fall risk in elderlypeople, but the range of effective dose should be further identified.