Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Mar 15;9(3):59-65.
doi: 10.4239/wjd.v9.i3.59.

Patients with type 2 diabetes demonstrate proprioceptive deficit in the knee

Lucas Richard Ettinger  1 , Ami Boucher  2 , Elisabeth Simonovich  2
Affiliations

Patients with type 2 diabetes demonstrate proprioceptive deficit in the knee

Lucas Richard Ettinger et al. World J Diabetes. .

Abstract

Aim: To investigate proprioceptive discrepancies in the lower extremity in persons with type 2 diabetes mellitus (T2DM).

Methods: In this cross-sectional study, a total of 46 older persons were divided into a T2DM group (n = 23) and a control group who did not have T2DM (n = 23). Participants were given a brief warm up with stretching exercises. Diabetic neuropathy scores were collected prior to proprioceptive testing. For proprioceptive testing, participants performed leg extensions to randomized target positions of 15°, 30°, 45, 60° degrees of elevation in the sagittal plane, each target was repeated a total of four times. Subjects were guided to target positions in the absence of visual feedback via auditory cues from a custom JPS application. When the participant entered the target position, they memorized the location of their limb in space and subsequently attempted to re-locate this position in space. Proprioceptive errors were measured from the target positioned, target remembered, target repositioned protocol.

Results: Proprioceptive accuracy was lower in the diabetic group at all levels of target angle than the control group (P < 0.05). The diabetic group had 46% greater inaccuracy than the control group at all levels of target position. Diabetics also reported greater neuropathy scores than controls in the past 12 mo P < 0.01.

Conclusion: Deficits in lower limb localization and greater diabetic neuropathy scores were identified in this study. Our findings may be associated with deafferentation as peripheral neuropathy is a common complication with the disease. These findings may help to explain the declining balance function in the older persons with T2DM which is also commonly reported.

Keywords: Deafferentation in diabetic limb; Diabetic neuropathy; Joint position sense; Knee position in space; Proprioception.

PubMed Disclaimer

Conflict of interest statement

Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.

Figures

Figure 1
Figure 1
Ipod orientation and experimental setup. Target angles A: 15°; B: 30°; C: 45°; D: 60° of leg elevation in the sagittal plane.
Figure 2
Figure 2
Joint sense constant errors for diabetic (blue) and control (red) participants by target angle of elevation at 15, 30, 45 and 60 degrees of elevation. bDenote significant differences.
Figure 3
Figure 3
Joint sense variable errors for diabetic (blue) and control (red) participants by target angle of elevation at 15, 30, 45 and 60 degrees of elevation.
See this image and copyright information in PMC

References

    1. Centers for Disease Control and Prevention. Crude and Age-Adjusted Percentage of Civilian, Noninstitutionalized Adults with Diagnosed Diabetes, United States, 1980-2011 [updated April 12, 2013; cited 2013 November 1] Available from: http://www.cdc.gov/diabetes/statistics/prev/national/figageadult.htm.
    1. Ogurtsova K, Fernandes JD, Huang Y. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pr. 2017;128:40–50. - PubMed
    1. Sugimoto K, Murakawa Y, Sima AA. Diabetic neuropathy--a continuing enigma. Diabetes Metab Res Rev. 2000;16:408–433. - PubMed
    1. Chantelau EA. Nociception at the diabetic foot, an uncharted territory. World J Diabetes. 2015;6:391–402. - PMC - PubMed
    1. Stewart WF, Ricci JA, Chee E, Hirsch AG, Brandenburg NA. Lost productive time and costs due to diabetes and diabetic neuropathic pain in the US workforce. J Occup Environ Med. 2007;49:672–679. - PubMed