Vestibular dysfunction in people with diabetes is predicted by clinical measures of peripheral neuropathy and associated with imbalance and low physical activity.

AIMS To characterize and predict otolith dysfunction of the peripheral vestibular system and its effect on balance in people with diabetes mellitus (DM).

METHODS This cross-sectional study included people with DM and peripheral neuropathy (PN), DM without PN, and controls (N = 68). Participant characteristics (e.g., age, HbA1c) including clinical measures of PN were procured. Cervical (saccule pathway) and ocular (utricle pathway) vestibular evoked myogenic potential (VEMP) testing outcomes included interamplitude and absent response counts. The Functional Gait Assessment and activity watch step counts characterized participant function. VEMP outcomes were compared between groups. In all DM participants, logistic regression was used to predict VEMP responses from participant characteristics, and functional outcomes were compared between those with and without VEMP responses.

RESULTS Worse PN predicted abnormal utricle and saccule function (1.1 ≤ odds ratio ≤ 1.7, p ≤ 0.05). Utricle function was the worst (p ≤ 0.04) and more frequently absent in those with DMPN. Balance and physical activity were worse in those with absent utricle (p ≤ 0.03), but not saccule, responses.

CONCLUSIONS Clinical measures of PN can provide rationale for vestibular testing as those with DM and abnormal utricle function have imbalance and low physical activity.