Análise do equilíbrio estático em indivíduos diabéticos com e sem neuropatia periférica diabética

Abstract

Introduction: Diabetes mellitus (DM) is a public health problem that affects millions of people around the world, characterized by chronic hyperglycemia that affects the functioning of the body and culminates in numerous complications, including diabetic peripheral neuropathy (NPD), a very prevalent disorder in DM that increases the risk of diabetic foot ulcers, lower limb amputations and promotes nervous system dysfunction resulting in balance changes and increased risk of falls. Objective: To evaluate the static balance of individuals with type 2 DM, with and without NPD. Methods: This was an observational cross-sectional study, which included 36 individuals (mean age: 68.45 ± 1.04), allocated to three groups. The CG was composed of individuals without DM, the GD composed of individuals with DM without NPD and the GN group by individuals with DM and NPD. The volunteers underwent clinical evaluation through interview questionnaires (initial screening and MNSI for NPD diagnosis); physical examination of the feet (vascular assessment, tactile and vibratory sensitivity, ankle mobility and tendon reflexes), and stabilometric assessment, in which the volunteers performed two task blocks on the force platform: bipodal support with open eyes (BEO) and closed-eyed bipodal support (BEC) for 120 seconds and COP oscillations were verified in the time domain, frequency domain and spectral analysis (SEnt and CrossEnt). Results: The variables evaluated in the sample characterization showed no significant difference between the groups; the right talocrural range of motion (AM) showed a significant reduction in NG compared to CG, and the left talocrural movement decreased GC in relation to GD, GC in relation to GN and GD in relation to GN. Regarding the postural variables evaluated, the NG presented greater COP oscillation area in relation to the CG and GD in BEO and BEC; Anteroposterior range (AP) presented differences between GN and GC in BEO and BEC, in mediolateral (ML) presented difference between GN and GC and between GN and GD. In the frequency domain (F80) there was significant difference between GN and GC and GN and GD in BEC. Sample entropy (SEnt) showed differences between GN and GC and between GN and GD only in ML and cross entropy (CrossEnt) showed difference between GN and GC and between GN and GD in both BEO and BEC. Conclusion: NPD promotes somatosensory alterations, reduced articular mobility of the lower distal extremity, affecting the postural behavior of these individuals, and nonlinear analysis proved to be an effective tool to evaluate this behavior.