title: Lower-limb risk factors for falls in people with diabetes mellitus.
abstract: BACKGROUND
  Older people with diabetes mellitus (DM) may be at high risk of falling because of general risk factors for falls as well as disease-specific factors.
  
  
  OBJECTIVE
  To determine the prevalence of falls and to investigate lower-limb factors for falls in older people with DM. Methods Sixty patients with DM over 55 years of age were recruited. 'Fallers' were those who self-reported at least one fall in the previous year. In addition to diabetes status and demographic information, the following were assessed: neuropathy symptom score (NSS), neuropathy disability score (NDS), foot deformity score (FDS), Tinetti performance-oriented assessment of mobility (POMA), ankle muscle strength and gait parameters. Data from 'fallers' and 'non-fallers' were compared and logistic regression analysis performed to identify variables predictive of falls.
  
  
  RESULTS
  Thirty-five per cent (n = 21) of participants had fallen in the preceding year. Compared with 'non-fallers', there was a greater incidence of peripheral neuropathy among 'fallers' (86% of 'fallers' and 56% of 'non-fallers'), higher vibration perception threshold (P = 0.04), slower gait velocity (P < 0.001), lower muscle strength for dorsiflexion, plantarflexion, inversion and eversion (all P < 0.001) and higher incidence of bony prominences and prominent metatarsal heads (both P < 0.001). There was a strong and significant correlation between dorsiflexion muscle strength and gait velocity. Logistic regression analysis determined that walking velocity, strength of ankle dorsiflexors and NSS accurately predicted 75% of 'fallers'.
  
  
  CONCLUSIONS
  Simple clinical measures of gait velocity and ankle muscle strength may be used to identify people with DM at risk of falling, allowing preventative strategies to be implemented.
authors.affiliation: School of Health, Glasgow Caledonian University, Glasgow, UK. cmacgi13@gcal.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Macgilchrist
authors.forename: L
authors.initials: L
authors.lastname: Paul
authors.forename: B M
authors.initials: BM
authors.lastname: Ellis
authors.forename: T E
authors.initials: TE
authors.lastname: Howe
authors.forename: B
authors.initials: B
authors.lastname: Kennon
authors.forename: J
authors.initials: J
authors.lastname: Godwin
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D000843:Ankle Joint / Q000502:physiology; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000175:diagnosis; D004185:Disability Evaluation; D005260:Female; D005530:Foot Deformities / Q000175:diagnosis; D005684:Gait; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D053580:Muscle Strength; D012307:Risk Factors