Diabetic peripheral neuropathy: impacts on balance, gait, and functional capacity in patients with Type 2 Diabetes Mellitus

Abstract

Introduction: Diabetic peripheral neuropathy is a condition associated with significant functional consequences for individuals with diabetes mellitus, potentially compromising postural balance, gait, mobility, and performance in activities of daily living. Alterations in postural stability and in the spatiotemporal and biomechanical parameters of gait can contribute to greater functional limitation and an increased risk of falls, making an integrated understanding of these impairments relevant. Objective: To analyze the impacts of diabetic peripheral neuropathy on balance, gait, and functional capacity in patients with type 2 diabetes mellitus, considering its repercussions on fall risk, mobility, and performance in activities of daily living, as well as the effects of the rehabilitation strategies investigated on these outcomes. Methods: This is an integrative literature review of a qualitative and descriptive nature. The search was conducted in the PubMed/MEDLINE, SciELO, and BVS databases using descriptors and terms related to type 2 diabetes mellitus, diabetic peripheral neuropathy, postural balance, gait, mobility, functional capacity, and fall risk, combined using the Boolean operators AND and OR. Initially, 110 records were identified; 40 were duplicates and were removed, leaving 70 for screening by title and abstract. At this stage, 30 records were excluded, resulting in 40 publications selected for full-text reading and eligibility assessment. After excluding 28 studies that did not meet the established criteria or did not present results relevant to the guiding question, 12 studies comprised the review's final sample. Results: The studies demonstrated that diabetic peripheral neuropathy is associated with impairments in static and dynamic balance, postural stability, and postural sway, as well as alterations in gait parameters—such as speed, step length, stance time, and lower-limb biomechanical components. Impacts on mobility, activities of daily living, functional performance, balance confidence, and fall risk were also identified. Various rehabilitation strategies were investigated—including balance training, physical exercise, functional rehabilitation, virtual reality, and feedback—aimed primarily at improving balance, gait, mobility, and functional performance. The studies also highlighted the importance of considering biomechanical aspects, such as lower-limb joint moments and plantar pressure, reinforcing the multidimensional nature of the functional changes associated with neuropathy. Conclusion: Diabetic peripheral neuropathy has significant repercussions on balance, gait, and functional capacity, potentially compromising mobility, independence, and safety during daily activities. These findings underscore the importance of comprehensive functional assessment; meanwhile, the rehabilitation strategies investigated yielded variable results across different outcomes, precluding the identification of a uniform benefit among the approaches. However, the heterogeneity of the studies highlights the need for further research using standardized methods and outcomes to enhance the understanding of functional impairments and the effects of interventions in this population.