1.Dynamic postural stability in patients with diabetic peripheral neuropathy and relationship to presence of autonomic neuropathy
Jong Ha Baek ; Hosu Kim ; Kyong Young Kim ; Min-Kyun Oh ; Ki-Jong Park ; Yoon Young Cho ; oo Kyoung Kim ; Jung Hwa Jung ; Hyun-Jung Kim ; Jaehoon Jung ; Hee Suk Shin ; Dawon Kang ; Ryeal Hahm
Neurology Asia 2018;23(4):303-311
Diabetic neuropathy is a common complication that can negatively influence balance and is a major
cause of falls. We evaluated the association between postural sway and diabetic autonomic neuropathy
(DAN) among patients with diabetic peripheral neuropathy (DPN). Patients with DPN documented by
typical symptoms with abnormal results of nerve conduction study were included and postural stability
was assessed using dynamic posturography. Composite autonomic scoring scale (CASS) score was
calculated by evaluating sudomotor, cardiovagal, and adrenergic functions. CASS score ≥2 indicated
DAN and the severity of DAN was indicated by the CASS scores divided into three subscales of
10-point total CASS: none or mild autonomic failure (0-3), moderate failure (4-6), and severe failure
(7-10). A total of 34 patients comprised the DAN group (n=19) and non-DAN group (n=15). Patients
with DAN had higher prevalence of diabetic retinopathy(p=0.011), higher urine albumin-creatinine
ratio (p = 0.009), and lower HbA1c levels (p<0.001) than those with non-DAN. With regard to dynamic
postural instability, the presence (p=0.025) as well as the severity of DAN (p<0.05) was associated
with postural instability in the eyes-opencondition. Interestingly, the poorer dynamic postural instability
in moderate/severe DAN compared to mild DAN was observed only in medio-lateral direction and
this association remained significant after adjusting for age, sex, and glycemic control state (HbA1c).
In patients with DAN accompanied by DPN, the dynamic postural instability was affected by visual
feedback and medio-lateral directional instability was closely associated with the severity of DAN.
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