The impact of lower extremity neuropathy and artery disease on gait characteristics in type 2 diabetic individuals

Background It is generally believed that gait characteristics of diabetic neuropathic patients differ from non-diabetic ones. However, it is still unclear whether these changes during walking could also be extended for different conditions of type 2 diabetes mellitus (T2DM), especially diabetic individuals with lower extremity complications. Methods In this investigation, gait was examined among 1861 participants with or without T2DM from three study centers. Subjects with NGT(normal glucose tolerance) and IGT (impaired glucose tolerance) were taken as control groups, patients with T2DM were divided into 4 groups: DM (no chronic complications), DPN (DM complicated with diabetic peripheral neuropathy), LEAD (DM complicated with lower extremity artery disease) and DPN + LEAD. Analyses of variance were employed to verify possible differences of gait parameters between these groups. Results Results showed lowered cadence, increased step time and decreased walking speed in diabetes with lower extremity neural and/or vascular complications (all p < 0.05). Increased duty factor_double stance was displayed in participants with LEAD alone (32.51%, p < 0.05). And the results displayed lower SDA (1.32 vs. 1.57, p < 0.01) and SDB (0.38 vs. 0.51, p < 0.01) of subjects with both DPN and LEAD. All these indicated the subjects with diabetic lower extremity complications showed much more conservative gait pattern. Stepwise multivariate regression models showed that independent variables were sex, age and leg length (p < 0.01). While, VPT was listed as significant independent predictor of cadence, step time, SDA and SDB (p < 0.05). And ABI was documented as significant independent predictor of stride length, duty-factor_Double stance, SDA and SDB (p < 0.05). Binary logistic regression analysis revealed a significant positive association between decreased stride length and the lowest ABI group (OR = 112.19, 95% CI: 3.11- 4040.13, p = 0.01). ROC analysis showed a significant discriminatory power of step time for occurrence of DPN. The AUC value was 0.752 (95% CI: 0.721–0.782, p < 0.01) . Conclusions In total, the cut-off point was 526.13 ms for predicting DPN. Maybe, this non-invasive and non-irritating gait examination could be an alternative measurement that could help distinguish diabetic neuropathy conveniently.