title: Impact of Diabetic Complications on Balance and Falls: Contribution of the Vestibular System.
abstract: Diabetes causes many complications, including retinopathy and peripheral neuropathy, which are well understood as contributing to gait instability and falls. A less understood complication of diabetes is the effect on the vestibular system. The vestibular system contributes significantly to balance in static and dynamic conditions by providing spatially orienting information. It is noteworthy that diabetes has been reported to affect vestibular function in both animal and clinical studies. Pathophysiological changes in peripheral and central vestibular structures due to diabetes have been noted. Vestibular dysfunction is associated with impaired balance and a higher risk of falls. As the prevalence of diabetes increases, so does the potential for falls due to diabetic complications. The purpose of this perspective article is to present evidence on the pathophysiology of diabetes-related complications and their influence on balance and falls, with specific attention to emerging evidence of vestibular dysfunction due to diabetes. Understanding this relationship may be useful for screening (by physical therapists) for possible vestibular dysfunction in people with diabetes and for further developing and testing the efficacy of interventions to reduce falls in this population.
authors.affiliation: L.J. D'Silva, PT, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160 (USA). ldsilva@kumc.edu.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: D'Silva
authors.affiliation: J. Lin, MD, Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center.
authors.forename: James
authors.initials: J
authors.lastname: Lin
authors.affiliation: H. Staecker, MD, PhD, Department of Otolaryngology, Head and Neck Surgery, University of Kansas Medical Center.
authors.forename: Hinrich
authors.initials: H
authors.lastname: Staecker
authors.affiliation: S.L. Whitney, PT, DPT, PhD, NCS, ATC, FAPTA, Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, and Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Whitney
authors.affiliation: P.M. Kluding, PT, PhD, Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Kluding
mesh_terms: D000058:Accidental Falls; D048909:Diabetes Complications / Q000503:physiopathology*; D003929:Diabetic Neuropathies / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000503:physiopathology; D006801:Humans; D004856:Postural Balance / Q000502:physiology*; D015837:Vestibular Diseases / Q000503:physiopathology*