title: Altered walking strategy and increased unsteadiness in participants with impaired glucose tolerance and Type 2 diabetes relates to small-fibre neuropathy but not vitamin D deficiency.
abstract: 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.
authors.affiliation: 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.
authors.forename: M M
authors.initials: MM
authors.lastname: Almurdhi
authors.affiliation: School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Brown
authors.affiliation: 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.
authors.forename: F L
authors.initials: FL
authors.lastname: Bowling
authors.affiliation: 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.
authors.forename: A J M
authors.initials: AJM
authors.lastname: Boulton
authors.affiliation: 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.
authors.forename: M
authors.initials: M
authors.lastname: Jeziorska
authors.affiliation: 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.|Weill-Cornell Medicine-Qatar, Doha, Qatar.
authors.forename: R A
authors.initials: RA
authors.lastname: Malik
authors.affiliation: School of Healthcare Science, Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.
authors.forename: N D
authors.initials: ND
authors.lastname: Reeves
mesh_terms: D000328:Adult; D000368:Aged; D000842:Ankle; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D005684:Gait / Q000502:physiology*; D018149:Glucose Intolerance / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D004856:Postural Balance / Q000502:physiology*; D014807:Vitamin D / Q000097:blood; D014808:Vitamin D Deficiency / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D016138:Walking / Q000502:physiology*
chemical_list: D014807:Vitamin D