Diabetic polyneuropathy has adverse effect on toe grip strength among elderly type 2 diabetes patients

Japan: A recent study published in the Journal of Diabetes & Metabolic Disorders has found that type 2 diabetes mellitus (T2DM), diabetic polyneuropathy (DPN), and age are related to toe grip strength (TGS). 

"The study findings could contribute to healthcare providers developing rehabilitation, fall prevention and foot care programs for diabetic patients," the researchers wrote in their study. 

Type 2 diabetes often brings along various complications, and among them, diabetic polyneuropathy can lead to muscle weakness. This weakness, particularly in the feet, can result in foot deformities and an increased risk of falls.

The cross-sectional study has delved into the factors influencing toe grip strength in individuals with T2DM, shedding light on potential strategies for foot care and rehabilitation in these patients.

The research involved 100 patients with T2DM who were undergoing hospital treatment for their condition, along with 50 healthy adults for comparison. The participants were categorised into three groups: healthy subjects, T2DM patients without DPN, and T2DM patients with DPN. To understand the factors influencing TGS, the researchers conducted hierarchical multiple regression analysis. They used TGS and the TGS-to-weight ratio (TGS/Wt%) as dependent variables, while considering age, T2DM presence, and DPN presence as independent variables, and adjusting for confounders like sex and body mass index (BMI).

Participants and Characteristics:

Initially, there were 150 participants in the study. Two T2DM patients without nerve conduction studies were excluded. A total of 148 patients were included in the analysis. No significant differences were observed in age or sex among the three groups: healthy subjects, patients without DPN, and patients with DPN. Weight and BMI were significantly higher in patients without DPN and patients with DPN compared to healthy subjects.

Physical Function and Falls:

● TGS and TGS/Wt% were significantly lower in both patients without DPN and patients with DPN compared to healthy subjects.

● TGS and TGS/Wt% were significantly lower in patients with DPN than in those without DPN.

● Among healthy subjects, no abnormalities were found in LOS (light touch sensation) or VPT (vibration perception threshold).

● Patients with DPN had a higher history of falls compared to the healthy group, while patients without DPN did not show a significant difference in falls history.

Hierarchical Multiple Regression Analysis:

● Hierarchical multiple regression analysis was employed to assess the association between age, T2DM, DPN, and TGS and TGS/Wt% after accounting for other factors.

● Model 2, controlling for TGS confounding factors, indicated associations for age (β = −0.339), T2DM (β = −0.162), and DPN (β = −0.396).

● In Model 4, controlling for TGS/Wt% confounders, associations were found for age (β = −0.293), T2DM (β = −0.273), and DPN (β = −0.491).

● Adjusted multiple correlation coefficient squared (R2) was 0.374 for Model 2 and 0.320 for Model 4, indicating that the factors explained 37% and 32% of the variance in TGS and TGS/Wt%, respectively.

● Variance inflation factor indicated no significant multicollinearity (1.084–1.567 for Model 2 and 1.054–1.392 for Model 4).

● The Durbin-Watson ratio was 1.972 for Model 2 and 1.871 for Model 4, signifying no autocorrelation in the samples.

This study highlights the relationship between TGS and various factors, including diabetic polyneuropathy, type 2 diabetes mellitus, and age. The findings offer valuable insights for healthcare providers, particularly in the development of effective foot care and rehabilitation programs for individuals living with diabetes. These insights could prove pivotal in enhancing the quality of life for patients by addressing muscle weakness and associated complications in the feet.

Reference:

Yoshida, K., Miura, Y., Nakanishi, S., Tanaka, S., Kuniyasu, K., Matsumoto, S., & Hanayama, K. (2023). The impact of diabetic polyneuropathy on toe grip strength in patients with type 2 diabetes mellitus: a cross-sectional study. Journal of Diabetes and Metabolic Disorders. https://doi.org/10.1007/s40200-023-01260-y