Balance disorders in the presence of diabetes mellitus

Authors: Igor Straka 1;  Alice Kušnírová 1;  Marián Šaling 1,2
Authors‘ workplace: II. neurologická klinika LF UK a UNB, Nemocnica akad. L. Dérera, Bratislava 1;  Ústav normálnej a patologickej fyziológie, Centrum experimentálnej medicíny SAV, Bratislava 2
Published in: Forum Diab 2018; 7(3): 161-166
Category: Review Article


Diabetes mellitus is a chronic metabolic disease with an ever-increasing prevalence. Inadequate compensation of diabetes mellitus leads to the development of complications which, among other complaints, include polyneuropathy, retinopa­thy, vestibular dysfunctions and encephalopathy. These may result in balance disorders. Instability of posture and gait leads to recurrent falls which significantly reduce patients’ quality of life and burden the health care system due to complications. Within the management of postural instability precise control of the disease itself is most important, as well as targeted rehabilitation of posture and gait.

Key words:

diabetes mellitus, dizziness, falls, polyneuropathy, postural instability


1.    Mokáň M, Galajda P, Prídavková D et al. Prevalencia diabetes mellitus a metabolického syndrómu na Slovensku. Diabetes a obezita 2006; 6(12): 10–16.
2.    Papanas N, Zeigler D. Risk factors and comorbidities in diabetic neuropathy: an update. Rev Diabetes Stud 2015; 12(1–2): 48–62. Dostupné z DOI: <>.
3.    Hajaš G. Diabetická polyneuropatia. Neurol Praxi 2018; 19(3): 161–171.
4.    Cibulčík F. Symptomatická liečba diabetickej neuropatie. Súč Klin Pr 2009; 1: 21–24.
5.    Kaňovský P. Poruchy chůze a pády ve stáří. Neurol Praxi 2003; 4(1): 21–25.
6.    Edwards JL, Vincent A, Cheng T et al. Diabetic neuropathy: mechanisms to managment. Pharmacol Ther 2008; 120(1): 1–34. Dostupné z DOI: <>.
7.    Tanenberg RJ, Donofrio PD. Neuropathic problems of lower limbs in diabetic patients. In: Bowker JH, Pfeifer MA (eds). The Diabetic Foot. 7th ed. Mosby Elsevier: Philadelphia 2008: 33–40. ISBN 9780323041454.
8.    Dixit S, Maiya A. Diabetic peripheral neuropathy and its evaluation in a clinical scenario: a review. J Postgrad Med 2014; 60(1): 33–40.
9.    Dewanjee S, Das S, Das AK et al. Molecular mechanism of diabetic neuropathy and its pharmacotherapeutic targers. Eur J Pharmacol 2018; 833: 472–523. Dostupné z DOI: <>.
10.    Jeřábek J. Pohled neurologa na problematiku závratí a poruch rovnováhy. Neurol Praxi 2007; 8(6): 338.
11.    Alam U, Riley DR, Jugdey RS et al. Diabetic Neuropathy and Gait: A Review. Diabetes Ther 2017; 8(6): 1253–1264. Dostupné z DOI: <–017–0295-y>.
12.    Kurča E. Nevestibulárne závraty. Neurol Praxi 2017; 18(3): 133–136.
13.    Brown SJ, Handsaker JC, Bowling FL et al. Diabetic peripheral neuropathy compromises balance during daily acitvities. Diabetes care 2015; 38(6): 1116–1122. Dostupné z DOI: <–1982>.
14.    Ferber R, Osternig LR, Woollacott MH et al. Reactive balance adjustments to unexpected pertubations during human walking. Gait Posture 2002; 16(3): 238–248.
15.    Schwartz AV, Hillier TA, Sellmeyer DE et al. Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care 2002; 25(10): 1749–1754.
16.    Menz HB, Lord SR, St George R et al. Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy. Arch Phys Med Rehabil 2004; 85(2): 245–252.
17.    Lalli P, Chan A, Garven A et al. Increased gait variability in diabetes mellitus patients with neuropathic pain. J Diabetes Complications 2013; 27(3): 248–254. Dostupné z DOI: <>.
18.    Vinik AI, Maser RE, Mitchell BD et al. Diabetic autonomic neuropathy. Diabetes Care 2003; 26(5): 1553–1579.
19.    Vučković-Rebrina S, Barada A, Smirčić-Duvnjak L. Diabetic Autonomic Neuropathy. Diabetologia Croatica 2013;42–43: 73–79. Dostupné z WWW: <–2.pdf>.
20.    Ricci F, De Caterina R, Fedorowski A. Orthostatic Hypotension: Epidemiology, Prognosis, and Treatment. J Am Coll Cardiol 2015; 66(7): 848–860. Dostupné z DOI: <>.
21.    Sosna T. Diabetikcá retinopatie. Med Praxi 2009; 6(5): 270–275.
22.    Ivers RQ, Cumming RG, Mitchell P et al. Diabetes and risk of fracture: the Blue Mountains Eye Study. Diabetes Care 2001; 24(7): 1198–1203.
23.    Agrawal Y, Carey JP, Della Santina CC et al. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001–2004. Arch Intern Med 2009; 169(10): 938–944. Dostupné z DOI: <>. Erratum in Arch Intern Med 2009; 169(15):1419.
24.    Walley M, Anderson E, Pippen MW et al. Dizziness and Loss of Balance in Individuals With Diabetes: Relative Contribution of Vestibular Versus Somatosensory Dysfunction. Clin Diabetes 2014; 32(2): 76–77. Dostupné z DOI: <>.
25.    Klagenberg KF, Zeigelboim BS, Jurkiewicz AL et al. Vestibulocochlear manifestations in patients with type I diabetes mellitus. Braz J Otorhinolaryngol 2007; 73(3): 353–358.
26.    D’Silva LJ, Lin J, Staecker H et al. Impact of Diabetic Complications on Balance and Falls: Contribution of the Vestibular System. Physical Therapy 2016; 96(3): 400–409. Dostupné z DOI: <>.
27.    McCaslin DL, Jacobson GP, Grantham SL et al. The influence of unilateral saccular impairment on functional balance performance and self-report dizziness. J Am Acad Audiol 2011; 22(8): 542–549; quiz 560–1. Dostupné z DOI: <>.
28.    Soares E, Nunes S, Reis F et al. Diabetic encephalopathy: the role of oxidative stress and inflammation in type 2 diabetes. Int J Interferon Cytokine Mediat Res 2012; 6(4): 75–85. Dostupné z DOI: <>.
29.    Mijnhout GS, Scheltens P, Diamant M et al. Diabetic encephalopathy: A concept in need of a definition. Diabetologia 2006; 49(6): 1447–1448. Dostupné z DOI: <–006–0221–8>.
30.    Vieira LL, de Lima Soares RG, da Silva Felipe SM et al. Physiological targets for the treatment of diabetic encephalopathy. Cent Nerv Syst Agents Med Chem 2016; 17(1): 78–86.
31.    Corriveau H, Prince F, Hebert R et al. Evaluation of postural stability in elderly with diabetic neuropathy. Diabetes Care 2000; 23(8): 1187–1191.
32.    Yau RK, Strotmeyer ES, Resnick HE et al. Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care 2013; 36(12): 3985–3991. Dostupné z DOI: <–0429>.
33.    Strotmeyer ES, Cauley JA, Schwartz AV et al. Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging, and body composition study. Arch Intern Med 2005; 165(14): 1612–1617. Dostupné z DOI: <>.
34.    Reid RD, Tulloch HE, Sigal RJ et al. Effects of aerobic exercise, resistance exercise or both, on patient-reported health status and well-being in type 2 diabetes mellitus: a randomised trial. Diabetologia 2010; 53(4): 632–640. Dostupné z DOI: <–009–1631–1>.
35.    Tilling LM, Darawil K, Britton M. Falls as a complication of diabetes mellitus in older people. J Diabetes Complications 2006; 20(3): 158–162. Dostupné z DOI: <http://dx.doi.rg/10.1016/j.jdiacomp.2005.06.004>.
36.    Nicholson M, King J, Smith PF et al. Vestibulo-ocular, optokinetic and postural function in diabetes mellitus. Neuroreport 2002; 13(1): 153–157.

Diabetology Endocrinology Internal medicine
Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.


Don‘t have an account?  Create new account