Gastrocnemius and Tibialis Anterior Neuromuscular Activity Alterations in Adults with Control Type Two Diabetes Mellitus during Standing Postural Tasks
Authors: Rosario Martin G , Dunbar Donald C , Ortiz Alexis 
Published: November 2023

Objective

Diabetes with peripheral neuropathy (PN) has been linked to neuromuscular impairments and postural instability. However, there is very little information regarding neuromuscular activity and the impact on postural stability in people with the diagnosis of controlled (normal concentration of blood glucose and glucosylated hemoglobin) diabetes without PN. Thus, the purpose of this study was to determine if signs of neuromuscular alterations will emerge during the performance of different postural tasks in individuals with controlled diabetes prior the effects of PN.

Methods

The non‐neuropathic control typed two diabetes mellitus (non‐PN cDMII) group consisted of 15 adults (8 males, 7 females; 8.0±5.8 years with controlled DMII diagnosis). The control group (CG) consisted of 15 healthy adults (7 males, 8 females). Electromyographic (EMG) activity of Gastrocnemius (GA) and Tibialis anterior (TA) was investigated under eight different sensory conditions that selectively eliminated (visual) or altered (vestibular, somatosensory) different sensory inputs when standing on either hard or soft surfaces.

Results

TA activity in the non‐PN cDMII group differed in amplitude and/or duration from that in the CG during all tasks, with the exception of the eyes closed head movements (ECHUD) task on the hard surface. Amplitude reduction in this muscle occurred during the eyes open (EO) task on both the hard (CG: 0.34± 0.19, non‐PN cDMII: 0.15± 0.07; P <0.01) and soft (CG: 0.40±0.05, non‐PN cDMII: 0.20± 0.05; P <0.05) surfaces, during the eyes closed (EC) task on both the hard (CG: 0.10 ± 0.07, non‐PN cDMII: 0.59±0.22; P <0.001) and soft (CG: 0.81± 0.12, non‐PN cDMII: 0.42± 0.35;P <0.01) surfaces, and during the eyes open head movements (EOHUD) task on the hard surface (CG: 0.32± 0.10, non‐PN cDMII: 0.13± 0.08; P<0.05). In addition, duration of TA activity was longer during the EOHUD (CG: 0.32± 0.10, non‐PN cDMII: 0.13± 0.08; P<0.05) and ECHUD (CG: 0.30± 0.09, non‐PN cDMII: 0.48± 0.07; P<0.01) tasks on the soft surface, and shorter during the EC task on the soft surface (CG: 0.36± 0.09, non‐PN cDMII: 0.28± 0.07; P<0.05). GA showed altered activity during the EOHUD task on the hard surface (CG: 0.14± .07, non‐PN cDMII: 0.22± 0.10; P<0.05) and during the EO task on the soft surface (CG: 0.40± 0.25, non‐PN cDMII: 0.20± 0.05; P<0.05). Finally, amplitude in this muscle was reduced during the EC (CG: 0.73±0.16, non‐PN cDMII: 0.44± 0.24; P<0.05) and ECHUD (CG: 0.82±0.13, non‐PN cDMII: 0.55± 0.30; P<0.01) tasks on the soft surface.

Conclusion

People with controlled diabetes without peripheral neuropathy exhibit neuromuscular alterations in TA muscles and in a less extent in the GA muscles. The early detection of these neuromuscular variations is valuable clinically for establishing treatment interventions to reduce the risk and occurrence of falls and injury. The neuromuscular alterations might indicate that non‐PN cDMII patients have less stability during postural tasks than healthy individuals.

Support or Funding Information

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