Background Type 2 diabetes (T2D) is a cause of multiple complications, including retinopathy and peripheral neuropathy. These complications are well understood and believed to contribute to gait instability. Poor balance control and increased falling risk have also been reported in people with diabetic peripheral neuropathy (DPN). Patients with DPN have increased risk of falling due to decreased proprioceptive feedback. Effective balance training should improve postural control in patients with DPN. For this purpose further evaluation was conducted and balance training was designed. Methods The goal of our study was to determine values of proprioception, balance, muscle coordination and strength in patients with T2D and analyze whether biofeedback balance training with use of the Biodex Balance System could improve these parameters. To assess the fall risk the general stability index (GSI), the index of frontal-posterior (FPI) and medial–lateral (MLI) stability were evaluated. 37 patients with diagnosed type 2 diabetes mellitus were recruited to this study. Their results were compared with control group consisting of 41 healthy participants who were homogenic to the study group in terms of age and body mass index (BMI). Results There were statistically significant differences between patients with diabetes compared to healthy subjects in GSI (2.79 vs 1.1), FPI (1.66 vs 0.7), MLI (0.88 vs 0.52) and risk of falling (5.18 vs 2.72) p < 0.05. There were also statistically significant changes before and after training in all stability indices (GSI: 2.79 vs 1.26, FPI: 1.66 vs 0.77, MLI: 0.88 vs 0.54 accordingly) p < 0.05 and risk of falling (5.18 vs 3.87) p < 0.05 in the study group who had undergone training with biofeedback. Conclusions This study found that there is a decreased balance and motor coordination and an increased risk of falling in patients with type 2 diabetes. These parameters improved in patients who have undergone training programme with biofeedback. Furthermore, an age-dependent deprivation of static balance was observed along with an increased risk of falling as a result of increasing BMI.

BackgroundDiabetes mellitus type II (DMII) causes many complications, including retinopathy and peripheral neuropathy. These complications are well understood and believed to contribute to gait instability and increase the risk of falls. Poor balance control and increased falling risk have also been reported in people with diabetic peripheral neuropathy (DPN). Patients with DPN are at an increased risk of falling due to the decreased proprioceptive feedbacks. Effective balance training should improve instabilities of postural control in patients with DPN. For this purpose, evaluations and balance training was designed. MethodsThe goal of our study was to establish values for proprioception, balance, muscle coordination and strength in patients with DMII and analyze whether biofeedback balance training using the Biodex Balance System can improve those parameters. To predict fall risk parameters such as overall stability index, the index of frontal-posterior and medial-lateral stability measurements were obtained. 37 patients with diagnosed type II diabetes mellitus were recruited to this study. Their results were compared with control group consisting of 41 healthy participants who were homogenic to the study group in terms of age and body mass index (BMI). ResultsStatistically significantly worse results for all three stability indexes in patients with diabetes compared to healthy subjects. For both the overall stability index and the index of frontal-posterior and medial-lateral stability (p < 0.05). There was statistically significant improvement in static balance with visual control in study group who received training with biological feedback. A statistically significant improvement was observed for all 3 stability indices (p <0.05). There was a statistically significant increase in the risk of falling in people with diabetes compared to healthy individuals. Statistically significant decrease in the risk of falling was observed in the study group who had undergone training with biofeedback (p <0.05). ConclusionsThis study found decreased balance and motor coordination and an increasing risk of falling in patient with type II diabetes that improved after training with biofeedback. Furthermore we established an age-dependent deprivation of static balance and an increased risk of falling as a result of increasing BMI. Trial registrationThis study was registered on ClinicalTrials.gov. Registration number: NCT04484480