The co-existence of peripheral and vestibular neuropathy in diabetes: a cross-sectional study

Abstract

Purpose Diabetic neuropathy can lead to decreased peripheral sensation and motor neuron dysfunction associated with impaired postural control and risk of falling. However, the relationship between decreased peripheral sensation and impaired vestibular function in diabetes mellitus is poorly investigated. Therefore, the aim of this study was to investigate the relationship between peripheral and autonomic measurements of diabetic neuropathy and measurements of vestibular function. Methods A total of 114 participants with type 1 diabetes (n = 52), type 2 diabetes (n = 51) and controls (n = 11) were included. Vestibular function was evaluated by video head impulse testing. Peripheral neuropathy was assessed by quantitative sensory testing and nerve conduction. Autonomic neuropathy using the COMPASS 31 questionnaire. Data were analyzed according to data type and distribution. Results Measurements of vestibular function did not differ between participants with type 1 diabetes, type 2 diabetes or controls (all p-values above 0.05). Subgrouping of participants according to the involvement of large-, small- or autonomic nerves did not change this outcome. Correlation analyses showed a significant difference between COMPASS 31 and right lateral gain value (ρ = 0.23, p = 0.02,), while no other significant correlations were found. Conclusion Diabetic neuropathy does not appear to impair vestibular function in diabetes, by means of the VOR. Clinical trials NCT05389566, May 25th, 2022.

When, where, and why should we look for vestibular dysfunction in people with diabetes mellitus?

“…While otolith function in people with DMPN was worse than controls in 3/4 studies, discrimination of DMPN and DM without PN was only detected in 1/4 studies ( 43 , 44 , 50 , 57 ). Two studies did not detect differences in high frequency SCC function as measured by VOR gain (vHIT) between healthy controls and people with DM, regardless of PN status ( 50 , 56 ). Lastly, while Ward et al ( 48 ) acknowledged the potential for insufficient statistical power, significant correlations between clinical scores of PN (Michigan Neuropathy Screening Instrument) and otolith and SCC function in people with DM were not observed.…”

“…To this point, 8/9 of these studies detected either otolith or SCC abnormalities in people with DM. Surprisingly, one study including people with Type 1 DM with 8.2% HbA1c, and the longest reported duration of reviewed studies (28 years), did not detect horizontal SCC dysfunction compared to people with Type 2 DM and a small subset of healthy controls ( 56 ). However, this study may not necessarily be an outlier, as a similar frequency of abnormal findings were observed in those across disease duration.…”

“…Given this chronological distribution and more recent clinical implementation of cervical and ocular vestibular evoked myogenic potential (VEMP) and multi-canal head thrust tests, the horizontal semicircular canal (SCC) was the most frequently assessed vestibular end-organ in people with Type 1 DM. In these studies, some degree of abnormal caloric responses (low frequency) were consistently reported (5/5 studies), 1/3 reported vestibulo-ocular reflex (VOR) abnormalities with higher frequency SCC tests ( 35 , 36 , 39 – 42 , 55 , 56 ), and 2/2 reported abnormal saccule and/or utricle function ( 44 , 55 ). In contrast, the otolith received more attention than the SCCs, and SCC assessments were across a range of frequencies (low, middle, high; Table 2 ) ( 17 ) in people with Type 2 DM.…”

“…In contrast, the otolith received more attention than the SCCs, and SCC assessments were across a range of frequencies (low, middle, high; Table 2 ) ( 17 ) in people with Type 2 DM. Specifically, 10/11 studies detected some form of otolith dysfunction ( 43 , 45 – 53 , 57 ), and 4/7 studies identified SCC dysfunction ( 40 , 48 , 49 , 52 – 54 , 56 ). While one study did not report DM type and another did not differentiate between types ( 37 , 38 ), two studies compared classes of DM; demonstrating similarity in high frequency SCC testing (passive/active head thrust, video head impulse testing: vHIT) between people with Type 1 and 2 ( 40 , 56 ).…”

“…Female representation ranged from 8%–88%, but more often ranged between 30% and 60%. BMI was only reported in 6/23 reviewed studies ( 46 , 49 , 54 , 56 , 57 ). While the importance of age is implicitly recognized by authors who matched or controlled for age within designs, we are unaware of studies directly considering the possible interaction of age and DM with vestibular function.…”