Vestibular Function and Balance in People with Diabetes Mellitus

体力活动对糖尿病患者的血糖控制和疾病管理很重要 (DM)。平衡障碍是体力活动的障碍，并会增加糖尿病患者跌倒的风险， 在糖尿病和周围神经病变(DMPN)患者中尤其常见。此外，足够的前庭 功能对于保持足够的平衡很重要。不幸的是，糖尿病可导致外周前庭功能障碍和 也更有可能出现在DMPN患者身上。然而，前庭功能的进一步特征是 目前尚不清楚预期的前庭功能障碍是否与DMPN患者的失衡有关。 因此，本研究的目的是评估患有DMPN的退伍军人的前庭功能(目标1)，以及 确定前庭功能与平衡的关系程度(目标2)。DMPN患者(n=25)和 年龄、性别和体重指数匹配的非糖尿病对照组(n=25)将参与这项病例对照研究。 耳石功能将通过前庭诱发的颈部(球囊通路)和眼睛(椭圆囊通路)来测量 肌源性电位测试(VEMP)。波幅间期和潜伏期将是主要的VEMP测试结果。 用正弦谐加速度和阶跃速度测量水平半规管功能 转椅测试规程。前庭-眼反射(VOR)的增益、相位、时间常数和一种新的度量， GainTC，它组合了来自两个轮值主席协议的数据，以给出与剩余时间相关的单一指标 前庭功能，将是主要的转椅测试结果。动态平衡将通过以下方式评估 有效和反应灵敏的临床测试：计时起跑(TUG)和功能步态评估(FGA)。 次要结果包括全球健康、自我效能、体力活动和跌倒病史的测量。在- 前庭结果的组间比较将使用混合单因素方差和/或t检验(目标1)。GainTC 平衡测量(分别为TUG和FGA)的值将被回归，以确定是否存在前庭缺陷 与对照组相比，DMPN患者的失衡程度更大(目标2)。协变量，如 年龄、糖尿病持续时间和认知分数(蒙特利尔认知评估)将被考虑在内。评估 前庭功能和二次结局之间的关系也将被进行研究，以充分探索 预期前庭功能障碍的潜在后果。据怀疑，客观测量的前庭 在对照组中，DMPN患者的功能较差，且与功能失衡有关。如果这是真的， 研究结果将证实未来的工作，前瞻性地评估糖尿病、前庭功能障碍、 平衡，跌倒风险和体力活动，以及充实运动的发展，以检测到的目标 并评估这些练习对DMPN患者平衡的影响。

Physical activity is important for glycemic control and disease management in people with diabetes mellitus (DM). Balance impairment is a barrier to physical activity and elevates fall risk in people with DM, and is particularly frequent in those with DM and peripheral neuropathy (DMPN). Additionally, adequate vestibular function is important for adequate balance. Unfortunately, DM can result in peripheral vestibular dysfunction and is also more likely to be present in people with DMPN. However, further characterization of vestibular function is needed, and it is unknown if anticipated vestibular dysfunction is related to imbalance in people with DMPN. Therefore, the purpose of this study is to evaluate vestibular function in Veterans with DMPN (Aim 1), and determine the degree to which vestibular function is related to balance (Aim 2). People with DMPN (n=25) and age, gender, and body mass index matched controls without DM (n=25) will participate in this case-control study. Otolith function will be measured with cervical (saccule pathway) and ocular (utricle pathway) vestibular evoked myogenic potential testing (VEMP). Inter-amplitude and latency will be the primary VEMP testing outcomes. Horizontal semicircular canal function will be measured with sinusoidal harmonic acceleration and step velocity rotational chair testing protocols. Vestibulo-ocular reflex (VOR) gain, phase, time constant, and a novel metric, GainTC, which combines data from both rotational chair protocols to give a single metric related to remaining vestibular function, will be the primary rotational chair testing outcomes. Dynamic balance will be assessed with valid and responsive clinical tests: the Timed Up and Go (TUG) and the Functional Gait Assessment (FGA). Secondary outcomes include measures of global health, self-efficacy, physical activity, and fall history. Between- group comparisons in vestibular outcomes will be made with mixed ANOVAs and/or t-tests (Aim 1). GainTC values will be regressed on balance measures (TUG and FGA separately) to determine if vestibular deficits correlate with imbalance in people with DMPN to a greater degree than controls (Aim 2). Covariates such as age, duration of DM, and cognition scores (Montreal Cognitive Assessment) will be considered. Evaluation of relationships between vestibular function and secondary outcomes will also be conducted to fully explore the potential ramifications of anticipated vestibular dysfunction. It is suspected that objectively measured vestibular function is worse and related to imbalance in those with DMPN in comparison control participants. If this is true, study findings will substantiate future work to prospectively evaluate the interplay of DM, vestibular dysfunction, balance, fall risk and physical activity, as well as substantiate the development of exercises to target detected vestibular deficits and evaluate the effect of these exercises on balance in people with DMPN.