title: Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension.
abstract: OBJECTIVE
  Benign Paroxysmal Positional Vertigo (BPPV) has been linked to comorbidities like diabetes and hypertension. However, the relationship between type 2 diabetes (DM) and BPPV is unclear. The purpose of this retrospective study was to examine the relationship between DM and BPPV in the presence of known contributors like age, gender and hypertension.
  
  
  METHODS
  A retrospective review of the records of 3933 individuals was categorized by the specific vestibular diagnosis and for the presence of type 2 DM and hypertension. As the prevalence of BPPV was higher in people with type 2 DM compared to those without DM, multivariable logistic regressions were used to identify variables predictive of BPPV. The relationship between type 2 DM, hypertension and BPPV was analyzed using mediation analysis.
  
  
  RESULTS
  BPPV was seen in 46% of individuals with type 2 DM, compared to 37% of individuals without DM (p< 0.001). Forty two percent of the association between type 2 DM and BPPV was mediated by hypertension, and supported hypertension as a complete mediator in the relationship between type 2 DM and BPPV.
  
  
  CONCLUSIONS
  Hypertension may provide the mediating pathway by which diabetes affects the vestibular system. Individuals with complaints of dizziness, with comorbidities including hypertension and diabetes, may benefit from a screening for BPPV.
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Linda J
authors.initials: LJ
authors.lastname: D'Silva
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Hinrich
authors.initials: H
authors.lastname: Staecker
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: James
authors.initials: J
authors.lastname: Lin
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Sykes
authors.affiliation: Department of Biostatistics, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Milind A
authors.initials: MA
authors.lastname: Phadnis
authors.affiliation: Division of Medical Informatics, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Tamara M
authors.initials: TM
authors.lastname: McMahon
authors.affiliation: Division of Medical Informatics, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Connolly
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Carla H
authors.initials: CH
authors.lastname: Sabus
authors.affiliation: University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburg, PA, USA.|Department of Rehabilitation Sciences, King Saud University, Riyadh, Saudi Arabia.
authors.forename: Susan L
authors.initials: SL
authors.lastname: Whitney
authors.affiliation: Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, KS, USA.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Kluding
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D065635:Benign Paroxysmal Positional Vertigo / Q000453:epidemiology / Q000503:physiopathology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology*; D004244:Dizziness; D005260:Female; D006801:Humans; D006973:Hypertension / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012737:Sex Factors; D014724:Vestibular Function Tests; D055815:Young Adult
keywords: Type 2 Diabetes; benign paroxysmal positional vertigo; hypertension