Assessing sensory complications of type 2 diabetes through concurrent balance testing

Abstract

Type 2 diabetes (T2D) is associated with microvascular complications that impair multiple sensory systems critical for maintaining balance, including proprioceptive, visual, and vestibular function. These impairments, commonly manifested as diabetic peripheral neuropathy (DPN), diabetic retinopathy (DR), and diabetic vestibulopathy (DV), contribute to increased postural instability and elevated fall risk. Current clinical approaches assess these complications independently using specialized diagnostic tools, limiting the feasibility of early, comprehensive screening. Therefore, there is a need for accessible, functional assessments capable of identifying sensorimotor impairments associated with T2D.The purpose of this dissertation was to evaluate the utility of balance-based assessments, specifically the Modified Clinical Test of Sensory Interaction in Balance (mCTSIB), as a screening tool for detecting T2D-related sensory complications. This work was conducted through a series of manuscripts that progressively examined the relationship between balance performance and sensory dysfunction. The first study established the theoretical and physiological basis linking T2D related microvascular complications to impairments in sensorimotor control of balance. The second study investigated the relationship between mCTSIB performance and self-reported sensory complications using multivariate linear regression, demonstrating that increased postural sway was associated with the presence of T2D related impairments. The third study expanded upon these findings using logistic regression analyses to evaluate the ability of mCTSIB performance to discriminate between individuals with and without specific sensory complications. Measures of diagnostic accuracy, including odds ratios, sensitivity, specificity, and receiver operating characteristic curve analyses. Collectively, the findings of this dissertation support the use of mCTSIB-derived measures of postural sway as a clinically feasible, non-invasive screening tool for identifying sensory complications in individuals with T2D. This work highlights the potential for functional balance assessments to provide an integrated evaluation of sensorimotor deficits, offering a practical approach for early detection and improved clinical management of T2D related impairments.