Basic Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Mar 15, 2018; 9(3): 59-65
Published online Mar 15, 2018. doi: 10.4239/wjd.v9.i3.59
Patients with type 2 diabetes demonstrate proprioceptive deficit in the knee
Lucas Richard Ettinger, Ami Boucher, Elisabeth Simonovich
Lucas Richard Ettinger, Ami Boucher, Elisabeth Simonovich, Department of Exercise Science, Willamette University, Salem, OR 97302, United States
Author contributions: Boucher A and Simonovich E performed the majority of experiments and were also involved in editing the manuscript; all authors were involved with data analysis and interpretation; Ettinger LR designed the study and wrote the manuscript.
Supported by The Willamette University Mary Stuart Rogers Science Collaborative Research Program Endowment.
Institutional review board statement: This study was reviewed and approved by the Willamette University Institutional Review Board.
Informed consent statement: Written and verbal consent to enrollment in the study was obtained by all study participants prior to all other aspects of this study.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Lucas Richard Ettinger, PhD, Professor, Department of Exercise Science, Willamette University, 900 State Street, Salem, OR 97302, United States. lettinge@willamette.edu
Telephone: +1-503-3706240 Fax: +1-503-3706773
Received: January 25, 2018
Peer-review started: January 26, 2018
First decision: February 27, 2018
Revised: March 5, 2018
Accepted: March 14, 2018
Article in press: March 14, 2018
Published online: March 15, 2018
Processing time: 63 Days and 10.2 Hours
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: Proprioception; Diabetic neuropathy; Joint position sense; Knee position in space; Deafferentation in diabetic limb

Core tip: Diabetic peripheral neuropathy is often associated with small diameter afferent nerve damage. Here, we demonstrate participants with type-2 diabetes performing proprioceptive tasks as measured by a joint position sense activity of the lower extremity, result in greater errors with limb localization than matched controls. Findings from this study indicate that both large and small diameter afferent nerves are likely involved in diabetic neuropathy. These findings warrant future studies involving joint position sense as a measurement tool for disease progression and treatment.