Multiple diabetic complications, as well as impaired physical and mental function, are associated with declining balance function in older persons with diabetes mellitus

OBJECTIVE To investigate whether there is a difference in balance function between older persons with and without diabetes mellitus (DM), and to identify whether mediating factors, such as diabetic complications, Instrumental Activities of Daily Living (IADL) score, Mini-Mental State Examination (MMSE) score, as well as hemoglobin A1c (HbA1c), fasting plasma glucose (FPG), serum total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL), are associated with balance function in older persons with DM. METHODS In this cross-sectional study, a total of 208 older persons were divided into a DM group (n=80) and a control group who did not have DM (n=128). Balance function was evaluated with the Tinetti performance-oriented mobility assessment (POMA), which includes balance and gait subscales. Activities of daily living (ADL), IADL, and the MMSE were also measured. Fall incidents in last 12 months, the use of walking aids, fear of falling, comorbidities, and polypharmacy were recorded. Diabetic complications were recorded, and HbA1c, FPG, TC, TG, and LDL were measured in the patients of the DM group. RESULTS Fall incidents in last 12 months were higher in the DM group than in the control group (P<0.01). POMA score as well as ADL and IADL scores were lower in the diabetic group than the control group (P<0.05). Within the diabetic group, the POMA score was positively related to the ADL score (odds ratio [OR], 11.7; 95% confidence interval [CI], 3.076-44.497; P<0.01), IADL score (OR, 16.286; 95% CI, 4.793-55.333; P<0.01), and MMSE score (OR, 10.524; 95% CI, 2.764-40.074; P<0.01), but was negatively related to age (OR, 7.707; 95% CI, 2.035-29.185; P<0.01) and diabetic complication (OR, 6.667; 95% CI, 2.279-19.504; P<0.01). Also, within the DM group, the decreased POMA score was associated with multiple diabetic complications (OR, 5.977; 95% CI, 1.378-25.926; P<0.05), decreased IADL score (OR, 10.288; 95% CI, 2.410-43.915; P<0.01), and MMSE score (OR, 13.757; 95% CI, 2.556-74.048; P<0.01). CONCLUSION Multiple diabetic complications, lower MMSE, ADL, and IADL scores were associated with declining balance function in the older persons with DM. These findings can alert physicians to detect and intervene earlier on declining balance in older persons with DM.