ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy.
Otolaryngology Department, Marche Polytechnic University, Ospedali Riuniti of Ancona, Via Conca 71, 60020, Torrette, AN, Italy.
Acta Diabetol. 2018 Dec;55(12):1201-1207. doi: 10.1007/s00592-018-1183-2. Epub 2018 Jun 23.
Diabetes mellitus is an independent risk factor for falling, particularly in the elderly. Due to chronic hyperglycemia and hyperinsulinemia patients with diabetes mellitus may have neurological deficits as peripheral neuropathy that is a debilitating micro-vascular complication affecting the proximal and distal peripheral sensory and motor nerves. Sensory neuropathy is prominent and represents the chief contributor to postural instability in diabetic subjects. Diabetic retinopathy is another complication consequent to a breakdown of the inner blood-retinal barrier with accumulation of extracellular fluids in the macula and growth of new vessels causing retinal detachment. Together peripheral neuropathy and retinopathy contribute to increase the risk of falls in diabetic patients, but a certain vestibular organs impairment should not be underestimated. Nevertheless, the exact mechanism and localization of peripheral vestibular damage consequent to chronic hyperglycemia and hyperinsulinemia are currently not still understood. Moreover it is not defined the possible role of these two blood conditions in worsening the prognosis of typical vestibular pathologies like "benign paroxysmal positional vertigo" and "Meniere disease". The aim of this review was to retrieve all studies investigating about the balance system alterations in patients suffering of diabetes. A search thorough Ovid MEDLINE was performed to enroll all eligible articles. Fourteen studies comprising a total of 1364 patients were included and analyzed in detail. On the basis of data reported in our review it appears plausible to hypothesize a direct connection among chronic hyperglycemic/hyperinsulinemic damage and peripheral vestibular organ dysfunction.
糖尿病是跌倒的独立危险因素，尤其是在老年人中。由于慢性高血糖和高胰岛素血症，糖尿病患者可能有神经功能缺陷，如周围神经病变，这是一种使人衰弱的微血管并发症，影响近端和远端周围感觉和运动神经。感觉神经病变很突出，是糖尿病患者姿势不稳定的主要原因。糖尿病视网膜病变是另一种并发症，由于内血视网膜屏障破裂，细胞外液在黄斑区积聚，新血管生长，导致视网膜脱离。周围神经病变和视网膜病变共同增加了糖尿病患者跌倒的风险，但一定不能低估某些前庭器官的损伤。然而，目前还不完全清楚慢性高血糖和高胰岛素血症导致外周前庭损伤的确切机制和定位。此外，这两种血液状况在加重典型前庭疾病（如“良性阵发性位置性眩晕”和“梅尼埃病”）的预后方面可能起什么作用也还没有明确。本综述的目的是检索所有关于糖尿病患者平衡系统改变的研究。通过 Ovid MEDLINE 进行了全面搜索，以纳入所有合格的文章。共纳入并详细分析了 14 项研究，共涉及 1364 例患者。根据我们综述中报告的数据，似乎可以假设慢性高血糖/高胰岛素血症损伤与外周前庭器官功能障碍之间存在直接联系。
