Functional Limitations in Patients with Diabetic Neuropathy: Prevalence, Optimal Cut-off Points, and Impact on Physical and Mental Health
Main Article Content
Abstract
Background: This study aimed to examine the prevalence of functional limitations, compare physical ability and mental health between diabetic participants with diabetic peripheral neuropathy (DPN) who had and did not have functional limitations, and determine the correlations, cut-off points, area under the curve (AUC), sensitivity, and specificity of various physical performance tests for identifying individuals with these limitations.
Methods: The participants’ baseline characteristics and neuropathy severity were assessed. Functional limitations and mental health were evaluated using the 9-Question Depression Screening tool (9Q) questionnaire, while physical abilities were measured by handgrip strength (HG), the Five Times Sit To Stand Test (FTSTS), Timed Up and Go (TUG), the 10-m walk test (10MWT), and the 2-min step test (2MST).
Results: Among the participants with DPN, 58% had at least one functional limitation, most commonly walking up 10 steps (86.8%), performing leisure activities (63.2%), and stooping or rising from a chair (27.9%). Those with limitations had significantly lower mental health, muscle strength, balance, and endurance (P < 0.05). Functional limitations correlated moderately with HG, FTSTS, TUG, 2MST, and 10MWT (P < 0.001) and mildly with 9Q score. 10MWT showed the strongest predictive ability (AUC = 0.927), while other tests demonstrated moderate to high accuracy (AUC = 0.692–0.899).
Conclusion: Over half of the individuals with DPN experienced at least one functional limitation, most commonly affecting mobility and daily activities. Those with limitations exhibited poorer dynamic balance, muscle strength, and endurance. Among the physical performance tests, 10MWT demonstrated the strongest predictive ability (cut-off = 0.75 m/s, AUC = 0.927), underscoring its reliability and efficiency in identifying functional limitations in this population.
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References
American Diabetes Association. Classification and diagnosis of diabetes: standards of medical care in diabetes 2018. Diabetes Care. 2018;41(Suppl 1):S13–27. https://doi.org/10.2337/dc18 S002
Bandyopadhyay P. Cardiovascular disease and diabetes mellitus: highlights from the Annual Professional Conference of Diabetes UK. Drug News Perspect. 2006;19(6):369–375.
Skidmore S, Bareford E, Williams A. Type 2 diabetes from the perspective of those at lower risk of developing foot health problems: impact, understanding, and foot self-care behaviour. J Diabetes Nurs. 2021;25(3):1–8.
Javed S, Hayat T, Menon L, Alam U, Malik RA. Diabetic peripheral neuropathy in people with type 2 diabetes: too little too late. Diabet Med. 2020;37(4):573–579. https://doi.org/10.1111/dme.14194
Baum P, Toyka KV, Blüher M, Kosacka J, Nowicki M. Inflammatory mechanisms in the pathophysiology of diabetic peripheral neuropathy (DN)—new aspects. Int J Mol Sci. 2021;22(19):10835. https://doi.org/10.3390/ijms221910835
Li J, Guan R, Pan L. Mechanism of Schwann cells in diabetic peripheral neuropathy: a review. Medicine (Baltimore). 2023;102(1):e32653. https://doi.org/10.1097/MD.0000000000032653
American Diabetes Association. Standards of medical care in diabetes 2017. Diabetes Care. 2017;40(Suppl 1):S1–S135. https://doi.org/10.2337/dci17-0007
Candra W, Harini GA, Lestari AS, Gama K, Ketut Gama I, Gede Sastra D, et al. The effect of assertive behavior on depression in diabetes mellitus patients. Eduvest J Univ Stud. 2022;2(9):1776–1784. https://doi.org/10.36418/eduvest.v2i9.581
Anderson RJ, Freedland KE, Clouse RE, Lustman PJ. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care. 2001;24(6):1069–1078. https://doi.org/10.2337/diacare.24.6.1069
Jindai K, Nielson CM, Vorderstrasse BA, Quiñones AR. Multimorbidity and functional limitations among adults 65 or older, NHANES 2005–2012. Prev Chronic Dis. 2016;13:E151. https://doi.org/10.5888/pcd13.160174
Techo P, Amatachaya S, Donpunha W, Thaweewannakij T. Differences in the level of functional ability between diabetic peripheral neuropathy patients both with and without functional limitations. Arch Allied Health Sci. 2020;32(2):58–69. https://doi.org/10.14456/arch-ahs.2020.7
Lim KB, Kim DJ, Noh JH, Yoo J, Moon JW. Comparison of balance ability between patients with type 2 diabetes and with and without peripheral neuropathy. PM R. 2014;6(3):209–214. https://doi.org/10.1016/j.pmrj.2013.11.007
Mete T, Aydin Y. Comparison of efficiencies of Michigan neuropathy screening instrument, neurothesiometer, and electromyography for diagnosis of diabetic neuropathy. Arch Med Sci. 2013;9(3):438–443. https://doi.org/10.1155/2013/821745
Huang WW, Perera S, VanSwearingen J, Studenski S. Performance measures predict onset of activity of daily living difficulty in community-dwelling older adults. J Am Geriatr Soc. 2010;58(5):844–852. https://doi.org/10.1111/j.1532-5415.2010.02820.x
Ortega-Bastidas P, Gómez B, Aqueveque P, Luarte-Martínez S, Cano-de-la-Cuerda R. Instrumented Timed Up and Go Test (iTUG)—more than assessing time to predict falls: a systematic review. Sensors (Basel). 2023;23(7):3426. https://doi.org/10.3390/s23073426
Khamnon N, Amatachaya S, Wattanapan P, Musika N, Jitmongkolsri P, Kongngoen N, et al. Reliability and concurrent validity of the Spinal Cord Independence Measure III among rehabilitation professionals. Spinal Cord. 2022;60(10):875–881. https://doi.org/10.1038/s41393-022-00807-9
Prasertsri B, Chatchawan U, Sukkasem N, Saengkaew P, Boonla O, Sirthawong A. The optimal cutoff score of the 2-minute step test and its association with physical fitness in type 2 diabetes mellitus. J Exerc Rehabil. 2022;18(3):195–201. https://doi.org/10.12965/jer.2244232.116
Atasever B. Receiver operating characteristic curve analysis in diagnostic accuracy studies: a guide to interpreting the area under the curve value. Turk J Emerg Med. 2023;23(4):175–181. https://doi.org/10.4103/tjem.tjem_182_23
Al-Mahmoud T, Al-Hadidy A, Al-Hadidy AI. Diabetic neuropathy and gait: a review. J Diabetes Metab Disord. 2017;16:35.
Ploegmakers MJ, Reijnierse EM, van der Horst N, van den Berg C, van der Schaaf M. Sensory-motor mechanisms increasing falls risk in diabetic peripheral neuropathy. Diagnostics (Basel). 2021;11(5):457. https://doi.org/10.3390/medicina57050457
Ali S, Stone MA, Peters DH, Davies MJ. The prevalence of depression in adults with type 2 diabetes: a systematic review and meta-analysis. Diabet Med. 2006;23(11):1127–1138. https://doi.org/10.1111/j.1464-5491.2006.01943.x
Mangoulia P, Milionis C, Vlachou E, Ilias I. The interrelationship between diabetes mellitus and emotional well‑being: current concepts and future prospects. Healthcare. 2024;12(14):1457. https://doi.org/10.3390/healthcare12141457
Miller ME, Rejeski WJ, Reboussin BA, Ten Have TR, Ettinger WH. Physical activity, functional limitations, and disability in older adults. J Am Geriatr Soc. 2000;48(10):1264–1272. https://doi.org/10.1111/j.1532-5415.2000.tb02600.x
Tyson S, Connell L. The psychometric properties and clinical utility of measures of walking and mobility in neurological conditions: a systematic review. Clin Rehabil. 2009;23(11):1018–1036. https://doi.org/10.1177/0269215509339004
Li S, Wang Q, Zhang C, Chen Y. Effectiveness of gait speed as a predictor of fall risk in older adults with knee osteoarthritis: a longitudinal study. J Geriatr Phys Ther. 2025;48(1):15–22.
Amatachaya A, Thaipisuttikul P, Thepkhunthod A, Siritaratiwat S, Theansunthon T, Theppiban P. The 10-meter walk test and the 6-minute walk test in patients with spinal cord injury. Spinal Cord. 2014;52(9):686–689. https://doi.org/10.1038/sc.2013.171