Xiaorui Zhang, Shan Wang, Chiyu Sun, Shushu Li, Yushi Hu
The TUG-DT test is sensitive to detecting declines in functional mobility associated with T2DM. However, the history of falls in individuals with T2DM is primarily influenced by behavioral and psychological factors rather than isolated motor metrics. Poor sleep quality, indicated by a PSQI score greater than 9.5, emerges as a critical correlate of falls. Therefore, the risk of falls in individuals with T2DM is a multidimensional construct.
BACKGROUND: Emerging evidence indicates that individuals with type 2 diabetes mellitus (T2DM) have a higher incidence of falls compared to individuals without diabetes, likely due to impairments in both motor and cognitive function. To guide targeted prevention strategies, this study aims to investigate the association between TUG-DT performance, postural control, sleep quality, depression, and lifestyle habits and fall history in middle-aged and older adults with T2DM.
METHODS: A cross-sectional, observational study involved 60 participants aged over 50, comprising 30 patients with T2DM and 30 age- and gender-matched healthy controls. The T2DM cohort was further stratified into faller and non-faller subgroups. Assessments included: (1) mobility via TUG and TUG-DT; (2) balance and fear of falling via postural stability and the Falls Efficacy Scale International (FES-I); (3) Psychosocial and sleep status using Center for Epidemiologic Studies Depression Scale (CES-D), and Pittsburgh Sleep Quality Index (PSQI); (4) lifestyle factors, including smoking, alcohol, tea intake, and exercise status.
RESULTS: Significant differences were observed in TUG (p = 0.034) and TUG-DT (p < 0.001) time, postural stability (p < 0.05), visual preference (p = 0.045), CES-D (p = 0.015), and smoking (p = 0.01) and exercise (p < 0.001) behavior between T2DM and control groups. Notably, TUG-DT performance was significantly impaired in the T2DM group, with increased cognitive errors (p = 0.015), cognitive pauses (p < 0.001), and movement pauses (p = 0. 021). Within the T2DM group, PSQI emerged as the only variable significantly associated with fall status in logistic regression analysis [OR = 1.239, 95% CI: (1.033, 1.488)]. ROC analysis demonstrated that PSQI had acceptable discriminative ability (AUC = 0.785, p = 0.010), with an optimal cut-off value of 9.5, yielding a sensitivity of 72.7% and a specificity of 84.2%.
CONCLUSION: The TUG-DT test is sensitive to detecting declines in functional mobility associated with T2DM. However, the history of falls in individuals with T2DM is primarily influenced by behavioral and psychological factors rather than isolated motor metrics. Poor sleep quality, indicated by a PSQI score greater than 9.5, emerges as a critical correlate of falls. Therefore, the risk of falls in individuals with T2DM is a multidimensional construct.