Abdul Razzak Rima, Hussein Wiam
Dept. of Physiology, Arabian Gulf University, Complex 329, Salmaniyah Road, Manama, Kingdom of Bahrain.
Dr Wiam Diabetes and Endocrine Clinic, P O Box 16165, Bahrain.
J Diabetes Complications. 2016 Apr;30(3):501-6. doi: 10.1016/j.jdiacomp.2015.12.016. Epub 2015 Dec 18.
Increasing evidence indicates that diabetes may negatively affect vestibular function, and postural control more so under postural challenging conditions. Healthy and diabetic subjects were compared on visual control of posture during a postural challenging task.
Forty-eight asymptomatic patients with type 2 diabetes free of peripheral neuropathy and 29 age-matched normal subjects were compared on postural stability on a high-density foam block with computerized posturography. Sway parameters were measured and Romberg ratios calculated and compared between the two groups.
For subjects who succeeded in maintaining balance, all sway parameters were larger in the diabetics with vision available. With eye closure, only the sway area was almost significantly larger and of greater variability in diabetics, but with a smaller and less variable Romberg ratio. Among the two groups and visual conditions, the tightest anterioposterior-mediolateral (AP-ML) coupling was found in diabetics during eye closure. Differences in anthropometric factors did not influence postural sway.
Despite the smaller Romberg ratios in diabetics than controls, findings still suggest greater but masked postural visual dependence in diabetics faced with postural challenging situations due to subclinical vestibular deficits. They also indicate that diabetics may be vulnerable before any clinical signs of peripheral neuropathy arise to falls on unstable surfaces especially in poorly lit areas, and may require to employ other complex postural tactics such as stiffening to maintain their balance.
越来越多的证据表明，糖尿病可能会对前庭功能产生负面影响，在姿势具有挑战性的情况下，对姿势控制的影响更大。在一项姿势挑战性任务中，对健康受试者和糖尿病受试者在姿势的视觉控制方面进行了比较。
将48例无周围神经病变的无症状2型糖尿病患者和29例年龄匹配的正常受试者在高密度泡沫块上进行姿势稳定性比较，并采用计算机化姿势描记法。测量摆动参数，计算并比较两组的罗姆伯格比率。
对于成功保持平衡的受试者，在有视觉的情况下，糖尿病患者的所有摆动参数都更大。闭眼时，只有糖尿病患者的摆动面积几乎显著更大且变异性更大，但罗姆伯格比率更小且变异性更小。在两组和不同视觉条件下，闭眼时糖尿病患者的前后-内外侧（AP-ML）耦合最紧密。人体测量因素的差异不影响姿势摆动。
尽管糖尿病患者的罗姆伯格比率比对照组小，但研究结果仍表明，由于亚临床前庭功能缺陷，糖尿病患者在面对姿势挑战性情况时对姿势视觉的依赖性更大但被掩盖。研究结果还表明，糖尿病患者在出现周围神经病变的任何临床症状之前，可能容易在不稳定表面尤其是光线昏暗的区域跌倒，可能需要采用其他复杂的姿势策略（如僵硬）来维持平衡。
