Almurdhi M M, Brown S J, Bowling F L, Boulton A J M, Jeziorska M, Malik R A, Reeves N D
Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester and Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
Diabet Med. 2017 Jun;34(6):839-845. doi: 10.1111/dme.13316. Epub 2017 Feb 9.
To investigate alterations in walking strategy and dynamic sway (unsteadiness) in people with impaired glucose tolerance and people with Type 2 diabetes in relation to severity of neuropathy and vitamin D levels.
A total of 20 people with Type 2 diabetes, 20 people with impaired glucose tolerance and 20 people without either Type 2 diabetes or impaired glucose tolerance (control group) underwent gait analysis using a motion analysis system and force platforms, and detailed assessment of neuropathy and serum 25 hydroxy-vitamin D levels.
Ankle strength (P = 0.01) and power (P = 0.003) during walking and walking speed (P = 0.008) were preserved in participants with impaired glucose tolerance but significantly lower in participants with Type 2 diabetes compared with control participants; however, step width (P = 0.005) and dynamic medio-lateral sway (P = 0.007) were significantly higher and posterior maximal movement (P = 0.000) was lower in participants with impaired glucose tolerance, but preserved in those with Type 2 diabetes compared with the control group. Dynamic medio-lateral sway correlated with corneal nerve fibre length (P = 0.001) and corneal nerve branch density (P = 0.001), but not with vibration perception threshold (P = 0.19). Serum 25 hydroxy-vitamin D levels did not differ significantly among the groups (P = 0.10) and did not correlate with any walking variables or measures of dynamic sway.
Early abnormalities in walking strategy and dynamic sway were evident in participants with impaired glucose tolerance, whilst there was a reduction in ankle strength, power and walking speed in participants with Type 2 diabetes. Unsteadiness correlated with small-, but not large-fibre neuropathy and there was no relationship between vitamin D levels and walking variables.
研究糖耐量受损者和2型糖尿病患者的行走策略及动态摇摆（不稳定性）变化与神经病变严重程度和维生素D水平的关系。
共有20名2型糖尿病患者、20名糖耐量受损者和20名既无2型糖尿病也无糖耐量受损者（对照组）使用运动分析系统和测力平台进行步态分析，并对神经病变和血清25-羟基维生素D水平进行详细评估。
糖耐量受损参与者在行走过程中的踝关节力量（P = 0.01）、功率（P = 0.003）和步行速度（P = 0.008）得以保留，但与对照组参与者相比，2型糖尿病参与者的这些指标显著降低；然而，与对照组相比，糖耐量受损参与者的步幅（P = 0.005）和动态中外侧摇摆（P = 0.007）显著更高，而后方最大移动（P = 0.000）更低，但在2型糖尿病患者中得以保留。动态中外侧摇摆与角膜神经纤维长度（P = 0.001）和角膜神经分支密度（P = 0.001）相关，但与振动觉阈值无关（P = 0.19）。各组间血清25-羟基维生素D水平无显著差异（P = 0.10），且与任何行走变量或动态摇摆测量值均无相关性。
糖耐量受损参与者在行走策略和动态摇摆方面早期出现异常，而2型糖尿病参与者的踝关节力量、功率和步行速度降低。不稳定性与小纤维神经病变相关，与大纤维神经病变无关，且维生素D水平与行走变量之间无关联。
