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Diabetes Mellitus and Gait Dysfunction: Possible Explanatory Factors

JS Brach, PT, PhD, GCS, is Assistant Professor, Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260 (USA).
JB Talkowski, PT, MPT, is Instructor, Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh.
ES Strotmeyer, PhD, MPH, is Assistant Professor, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh.
AB Newman, MD, MPH, is Professor, Department of Epidemiology, Graduate School of Public Health, and Division of Geriatric Medicine, Department of Medicine, University of Pittsburgh.

Address all correspondence to Dr Brach at: jbrach{at}pitt.edu

Background and Objective: Gait characteristics differ in individuals with diabetes compared with those without diabetes. Limited information regarding potential explanatory factors for this association exists. This study examined the association between diabetes and gait characteristics in older adults and explored potential explanatory factors.

Design: A cross-sectional, observational study design was used.

Methods: At the 1998–1999 clinic visit, 558 ambulatory older adults (mean age=79 years) from the Pittsburgh site of the Cardiovascular Health Study had an assessment of their gait characteristics, diabetes, health status, cognition, mood, lower-extremity circulation and sensation, vision, lower-extremity strength (force-producing capacity), physical activity, and body mass index (BMI). A series of linear regression models were developed to examine the association between diabetes and gait characteristics and to examine potential explanatory factors for the associations.

Results: Diabetes was related to gait speed (β=–.06 m/s); however, the association was partially explained by health status variables, cognition, mood, lower-extremity circulation and sensation, visual impairment, lower-extremity strength, physical activity, and BMI. Health status and lower-extremity strength each explained the greatest proportion of the association (β reduced 66% by each). Diabetes was related to step width (β=.02 m), and the association could not be explained by the examined factors.

Conclusions: Diabetes was associated with gait alterations in older adults. Slowed gait speed appears to be secondary to the peripheral effect of the disease on other body systems. The effect of diabetes on step width was not explained in the analyses and may be related to peripheral motor nerve function or central influences of the disease, which could not be assessed in this study.

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