Analysis And Correlation Of Neuroelectrophysiology,Plantar Tactile Sensation And Balance Function In Elderly Diabetic Peripheral Neuropathy

Research background and purpose:The incidence rate of Diabetic peripheral neuropathy(DPN)increases with the duration of diabetes mellitus,and is one of the common complications of diabetes.Long term DPN can cause autonomic nerve,sensory nerve and motor nerve injury,resulting in numbness,sensory loss and pain in the upper and lower limbs,and corresponding motor dysfunction in the lower limbs,such as muscle weakness and muscle atrophy.Studies have shown that the incidence of falls in DPN patients is 3 times that in patients without DPN diabetes,and the fall injury is 15 times that in patients without DPN diabetes.Reduced balance function is the main risk factor for falls in elderly DPN patients,and even fracture events occur in severe cases.It has been reported that the main reasons for the decline of balance function in elderly patients with diabetes are decreased eyesight,impaired vestibular function and muscle atrophy of lower limbs caused by diabetes,but the role of peripheral sensation of lower limbs(plantar tactile sensation)is mostly ignored,and the characteristics of plantar tactile sensation in elderly DPN patients are still unclear.In addition,the correlation between lower extremity plantar tactile sensation and balance function in elderly DPN is unclear.Therefore,the purpose of this study was to:1)to explore the characteristics of plantar tactile sensation in elderly DPN group,elderly non-DPN diabetes group and elderly healthy control group;2)to explore the balance function characteristics of elderly DPN group,elderly non-DPN diabetes group and elderly healthy control group;3)to explore the correlation between balance function and plantar tactile sensation in elderly DPN group.Methods:In this study,neuroelectrophysiological diagnostic techniques were used to divide type 2 diabetes patients into elderly DPN group(group A)(n=54)and elderly non-DPN diabetes group(group B)(n=78).Meanwhile,healthy elderly people with matched sex and age were recruited as healthy elderly control group(group C)(n=55).Collect general information on all participants;Neuroemg equipment(KOHDEN,MEB-9200K,JAPAN)was used to evaluate and collect nerve conduction data of bilateral tibial nerve,sural nerve,common peroneal nerve,superficial peroneal nerve,ulnar nerve,and median nerve in all patients with type 2 diabetes.The Semmes Weinstein monofilament examination(SWME)(Touch Test Complete Hand Kit,North Coast Medical Inc.,USA)was used to evaluate all participants bilateral tactile perception thresholds:great hallux finger(SWME-1),first metatarsal base(SWME-2),third metatarsal base(SWME-3),fifth metatarsal base(SWME-4),medial arch(SWME-5),lateral arch(SWME-6)and heel(SWME-7);Functional reach test(FRT)and Timed up and go(TUG)were used to evaluate the balance function of all participants.Independent sample T test was used to compare the differences of nerve conduction indexes between the elderly DPN group(group A)and the elderly non-DPN diabetes group(group B).Chi-square test was used to compare the abnormal rate of nerve conduction in upper and lower limbs of elderly DPN group(group A).Kruskal wails H test was used to compare the differences of plantar tactile sensation in elderly DPN group(group A),elderly non-DPN diabetes group(group B)and elderly healthy control group(group C).One way ANOVA was used to compare the differences of balance function among elderly DPN group(group A),elderly non-DPN diabetes group(group B)and elderly healthy control group(group C).Pearson correlation analysis was used to explore the correlation between DPN balance function and lower limb nerve conduction in the elderly.Spearman correlation analysis was used to explore the correlation between DPN balance function and plantar tactile sensation in the elderly.All the above statistical analysis were divided into dominant limbs and non-dominant limbs.Results:Chi-square test showed that the abnormal rate of lower limb motor nerve in elderly DPN group was higher than that in upper limb(x~2=51.297,p<0.001).Kruskal-wails H test showed that the SWME-1,the SWME-3,the SWME-4,the SWME-5,the SWME-6 and the SWME-7 in the elderly DPN group(group A)were worse than those in the other two groups in the dominant and non-dominant lower limbs,there was significant difference(p<0.05).The results of one-way ANOVA showed that in TUG test,there was no significant difference between elderly DPN group(group A)and elderly non-DPN diabetes group(group B)(p>0.05),the consumption time of TUG test in elderly DPN group(group A)and elderly non-DPN diabetes group(group B)were significantly longer than that in elderly healthy control group(group C)(p<0.05);In FRT test,there was no significant difference between elderly DPN group(group A)and elderly non-DPN diabetes group(group B)(p>0.05),the stretching distance of elderly DPN group(group A)and elderly non-DPN diabetes group(group B)in FRT test was significantly lower than that of elderly healthy control group(group C)(p<0.05).Pearson correlation analysis showed that FRT was positively and weakly correlated with P-CMAP and T-CMAP(r=0.329,p<0.05;r=0.373,p<0.05)in the dominant lower limbs.FRT was positively and weakly correlated with the T-CMAP(r=0.384,p<0.05)in the non-dominant lower limbs.Spearman correlation analysis showed that TUG test was positively correlated with the tactile sensation on the SWME-2 and the SWME-5(r=0.342,p<0.05;r=0.386,p<0.05),TUG test was positively correlated with the SWME-6(r=0.408,p<0.05),FRT test was negatively and weakly correlated with the SWME-5(r=-0.348,p<0.05)in the dominant lower limbs;In the non-dominant lower limbs,TUG test was positively correlated with the SWME-2 and the SWME-6(r=0.421,p<0.05;r=0.530,p<0.05),and TUG test was weakly correlated with the SWME-5(r=0.390,p<0.05).Conclusion:The decrease/loss of plantar tactile sensation in elderly DPN patients is more serious than that in elderly non-DPN diabetic patients and healthy elderly people in the dominant and non-dominant lower limbs.There was no significant difference in balance function between elderly DPN patients and elderly non-DPN diabetic patients,and both elderly DPN patients and elderly non-DPN diabetic patients showed balance dysfunction compared with elderly healthy people.FRT test was associated with lower limb nerve CMAP in elderly DPN patients,and TUG test was associated with plantar tactile sensation,suggesting that lower limb peripheral nerve damage and the reduction/loss of plantar tactile sensation may also be the cause of exacerbating balance dysfunction in elderly DPN patients.Therefore,we should pay close attention to the lower limb sensory function and balance function of elderly DPN patients,and consider improving the balance function of elderly DPN patients from the perspective of lower limb plantar tactile sensation.