Postural balance in type 2 diabetics with vertigo, dizziness and/or unsteadiness

Fukunaga, Jackeline Yumi; Quitschal, Rafaela Maia; Dib, Sergio Atala; Ganança, Maurício Malavasi; Caovilla, Heloisa Helena

doi:10.1590/2317-1782/20202019070

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ORIGINAL ARTICLE • CoDAS 32 (06) • 2020 • https://doi.org/10.1590/2317-1782/20202019070 copy

Postural balance in type 2 diabetics with vertigo, dizziness and/or unsteadiness

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract:

Purpose:

To evaluate the postural balance of type 2 diabetics with vertigo, dizziness, and/or unsteadiness.

Methods:

limit of stability, pressure center displacement area, and sway velocity of 20 patients with type 2 diabetes were compared with 22 controls using the Balance Rehabilitation Unit (BRUTM, Medicaa) posturography.

Results:

Compared to the control group, patients with type 2 diabetes showed a significantly lower limit of stability and a significantly higher-pressure center displacement area on a firm surface with eyes open, eyes closed, and horizontal vestibular-visual interaction; and higher sway velocity on a firm surface with eyes open and with eyes closed.

Conclusion:

type 2 diabetics with vertigo, dizziness, and/or imbalance compromised postural balance related to visual stimuli and vestibular-visual interaction and moderate impairment in the quality of life.

Keywords:
Diabetes mellitus; Postural balance; Dizziness; Vertigo; Vestibular; Labyrinth

Authorship

Jackeline Yumi Fukunaga

Programa de Pós-graduação em Distúrbios da Comunicação Humana, Departamento de Fonoaudiologia, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM - São Paulo (SP), Brasil.Universidade Federal de São PauloBrazilSão Paulo, SP, Brazil Programa de Pós-graduação em Distúrbios da Comunicação Humana, Departamento de Fonoaudiologia, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM - São Paulo (SP), Brasil.

http://orcid.org/0000-0001-8472-8901

Rafaela Maia Quitschal

http://orcid.org/0000-0002-0615-7899

Sergio Atala Dib

Disciplina de Endocrinologia, Departamento de Medicina, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM - São Paulo (SP), Brasil.Universidade Federal de São PauloBrazilSão Paulo, SP, Brazil Disciplina de Endocrinologia, Departamento de Medicina, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM - São Paulo (SP), Brasil.

http://orcid.org/0000-0001-8653-8773

Maurício Malavasi Ganança

Disciplina de Otologia e Otoneurologia, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM - São Paulo (SP), Brasil.Universidade Federal de São PauloBrazilSão Paulo, SP, Brazil Disciplina de Otologia e Otoneurologia, Departamento de Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, Universidade Federal de São Paulo/Escola Paulista de Medicina - UNIFESP/EPM - São Paulo (SP), Brasil.

http://orcid.org/0000-0003-4483-8502

Heloisa Helena Caovilla

http://orcid.org/0000-0003-4157-8995

Correspondence address:
Jackeline Yumi Fukunaga. Rua Napoleão de Barros 590, Vila Clementino, São Paulo (SP),Brasil, CEP: 04024-002. E-mail: jackeline_fukunaga@yahoo.com.br

Authors’ contributions

JYF participated in the conception and design of the study, data collection, analysis and interpretation, writing and revising the article in an intellectually important way and final approval of the version to be published; RMQ participated in the study idealization, data collection and analysis, review of the article in an intellectually important way and final approval of the version to be published; SAD participated in the selection of the sample, analysis and interpretation of data, review of the article in an intellectually important way and final approval of the version to be published; MMG participated in the conception and design of the study, data analysis and interpretation, writing and revising the article in an intellectually important way and final approval of the version to be published; HHC participated as a supervisor, in the idealization and design of the study, analysis, data interpretation, writing and revision of the article in an intellectually important way and final approval of the version to be published.

Conflict of interest:

nothing to declare.

SCIMAGO INSTITUTIONS RANKINGS

Figures | Tables

Figures (1)
Tables (4)

Thumbnail

Figure 1
BRU^TM Posturography

Thumbnail

Table 1
Descriptive values of the Dizziness Handicap Inventory questionnaire, the visual analog scale of vertigo and dizziness, and the duration of illness of 20 type 2 diabetics with vertigo, dizziness, and/or instability

Thumbnail

Table 2
Descriptive values and comparative analysis of the stability limit of 20 type 2 diabetics with vertigo, dizziness, and/or instability and of 22 healthy individuals from the control group in the static posturography of the Balance Rehabilitation Unit (BRU ^TM )

Thumbnail

Table 3
Descriptive values and comparative analysis of the displacement of the pressure center (cm²) of 20 type 2 diabetics with vertigo, dizziness, and/or instability and 22 healthy individuals from the control group in the ten sensory conditions of the static posturography of the Balance Rehabilitation Unit (BRU ^TM )

Thumbnail

Table 4
Descriptive values and comparative analysis of the oscillation speed (cm/s) of 20 type 2 diabetic individuals with vertigo, dizziness, and/or imbalance and 22 healthy individuals in the control group in the ten sensory conditions of the static posturography of the Balance Rehabilitation Unit (BRU ^TM )

Figure 1 BRU^TM Posturography

Table 1 Descriptive values of the Dizziness Handicap Inventory questionnaire, the visual analog scale of vertigo and dizziness, and the duration of illness of 20 type 2 diabetics with vertigo, dizziness, and/or instability

Variable	Average	Standard deviation	Mean	Minimum value	Maximum value
DHI (points)	31.30	21.51	27.00	6.00	90.00
EVA (points)	6.45	2.82	7.00	1.00	10.00
Disease duration (months)	183.75	184.15	144	7.00	756.00

Captions: DHI: Dizziness Handicap Inventory; EVA: the visual analog scale of vertigo and dizziness

Table 2 Descriptive values and comparative analysis of the stability limit of 20 type 2 diabetics with vertigo, dizziness, and/or instability and of 22 healthy individuals from the control group in the static posturography of the Balance Rehabilitation Unit (BRU ^TM )

	Groups	Average	Standard deviation	Mean	Minimum value	Maximum value	p-value
SL	Control	160.00	52.93	156.50	83.00	274.00	0.045*
SL	Diabetes	126.00	53.38	120.00	19.00	228.00	0.045*

Captions: SL: stability limit; Student’s t-test for independent samples; * Statistically significant value at the 5% level (p <0.05)

Table 3 Descriptive values and comparative analysis of the displacement of the pressure center (cm²) of 20 type 2 diabetics with vertigo, dizziness, and/or instability and 22 healthy individuals from the control group in the ten sensory conditions of the static posturography of the Balance Rehabilitation Unit (BRU ^TM )

Area of pressure center displacement	Groups	Average	Standard deviation	Mean	Minimum value	Maximum value	p-value
FS/Open eyes
No stimuli	Control	1.96	1.56	1.62	0.34	7.20	0.023*^a
No stimuli	Diabetes	3.39	2.89	2.77	0.75	11.63	0.023*^a
FS/Closed eyes	Control	1.61	1.24	1.23	0.32	5.83	0.007*^a
FS/Closed eyes	Diabetes	4.65	6.59	2.51	0.66	29.87	0.007*^a
Foam/Closed eyes	Control	8.28	4.28	7.32	2.90	17.58	0.650^a
Foam/Closed eyes	Diabetes	9.98	7.11	7.88	2.87	30.73	0.650^a
FS/Saccadic	Control	2.31	2.21	1.70	0.70	11.19	0.074^a
FS/Saccadic	Diabetes	3.51	2.68	2.52	0.77	11.10	0.074^a
FS/Bars/Optokinetic to the right	Control	2.49	2.58	2.10	0.57	13.14	0.406^a
FS/Bars/Optokinetic to the right	Diabetes	3.64	4.37	1.88	0.88	20.51	0.406^a
FS/Bars/Optokinetic to the left	Control	2.58	2.18	2.37	0.30	10.54	0.734^a
FS/Bars/Optokinetic to the left	Diabetes	3.85	5.28	2.46	0.55	22.77	0.734^a
FS/Bars/Optokinetic downwards	Control	2.39	1.79	2.17	0.41	8.81	0.597^a
FS/Bars/Optokinetic downwards	Diabetes	3.80	4.48	2.09	0.64	19.55	0.597^a
FS/Bars/Upwards Optokinetic	Control	2.39	1.86	1.99	0.37	7.58	0.513^a
FS/Bars/Upwards Optokinetic	Diabetes	3.35	3.77	2.23	0.68	15.68	0.513^a
FS/visuovestibular interaction/Horizontal	Control	2.80	1.76	2.20	0.58	6.59	0.047*^a
FS/visuovestibular interaction/Horizontal	Diabetes	5.60	6.42	3.99	1.22	29.02	0.047*^a
FS/visuovestibular interaction/Vertical	Control	3.70	2.42	3.28	0.69	10.18	0.203^a
FS/visuovestibular interaction/Vertical	Diabetes	5.20	4.69	4.31	1.18	23.01	0.203^a

Captions: FS: hard surface; ^a: Mann-Whitney U test; * Statistically significant value at the 5% level (p <0.05)

Table 4 Descriptive values and comparative analysis of the oscillation speed (cm/s) of 20 type 2 diabetic individuals with vertigo, dizziness, and/or imbalance and 22 healthy individuals in the control group in the ten sensory conditions of the static posturography of the Balance Rehabilitation Unit (BRU ^TM )

Oscillation Speed (cm/s)	Groups	Average	Standard deviation	Mean	Minimum value	Maximum value	p-value
FS/Open eyes
No stimuli	Control	0.81	0.26	0.76	0.50	1.36	0.039*^a
No stimuli	Diabetes	0.95	0.28	0.88	0.54	1.64	0.039*^a
FS/Closed eyes	Control	0.96	0.35	0.87	0.60	2.00	0.020*^a
FS/Closed eyes	Diabetes	1.27	0.48	1.21	0.53	2.47	0.020*^a
Foam/Closed eyes	Control	2.53	0.62	2.37	1.56	3.82	0.513^a
Foam/Closed eyes	Diabetes	2.48	0.80	2.32	1.46	4.57	0.513^a
FS/Saccadic	Control	1.13	0.53	0.92	0.57	2.96	0.068^a
FS/Saccadic	Diabetes	1.29	0.36	1.26	0.67	2.12	0.068^a
FS/Bars/Optokinetic to the right	Control	1.15	0.53	0.95	0.58	2.77	0.247^a
FS/Bars/Optokinetic to the right	Diabetes	1.20	0.41	1.09	0.66	2.57	0.247^a
FS/Bars/Optokinetic to the left	Control	1.11	0.52	0.93	0.44	2.35	0.231^a
FS/Bars/Optokinetic to the left	Diabetes	1.21	0.51	1.09	0.60	2.71	0.231^a
FS/Bars/Optokinetic downwards	Control	1.07	0.46	0.93	0.44	2.02	0.066^a
FS/Bars/Optokinetic downwards	Diabetes	1.28	0.50	1.23	0.62	2.79	0.066^a
FS/Bars/Upwards Optokinetic	Control	1.06	0.43	0.92	0.48	2.23	0.158^a
FS/Bars/Upwards Optokinetic	Diabetes	1.19	0.51	1.06	0.58	2.76	0.158^a
FS/visuovestibular interaction/Horizontal	Control	1.47	0.68	1.28	0.58	3.41	0.406^a
FS/visuovestibular interaction/Horizontal	Diabetes	1.50	0.53	1.38	0.71	2.92	0.406^a
FS/visuovestibular interaction/Vertical	Control	1.63	0.66	1.52	0.66	3.38	0.118^b
FS/visuovestibular interaction/Vertical	Diabetes	1.52	0.43	1.48	0.74	2.42

Captions: SF: firm surface; ^a Mann-Whitney U test; ^b Student’s t-test for independent samples; * Statistically significant value at the 5% level (p <0.05)

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Postural balance in type 2 diabetics with vertigo, dizziness and/or unsteadiness

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[1] Correspondence address:
Jackeline Yumi Fukunaga. Rua Napoleão de Barros 590, Vila Clementino, São Paulo (SP),Brasil, CEP: 04024-002. E-mail: jackeline_fukunaga@yahoo.com.br