Photo Credit: Chinnapong

Postural sway velocity as a screening tool in diabetic peripheral neuropathy represents a potential early marker of balance impairment and fall risk.

The 2025 annual meeting of the Peripheral Nerve Society (PNS) took place in Edinburgh, Scotland, from May 17, 2025 to May 20, 2025. Several sessions included presentations on diabetic peripheral neuropathy (DPN), such as the Peter J. Dyck Lecture on mechanisms of diabetic neuropathic pain.

A look at recent research on DPN finds several papers on the topic of DPN. In one study that was not presented at the PNS annual meeting, the researchers aimed to assess whether evaluating balance and gait could serve as a viable screening tool of DPN. The findings were published in the Journal of NeuroEngineering and Rehabilitation.

Impact of DPN on Quality of Life

There are several types of DPN, diabetic sensorimotor polyneuropathy (DSPN) being the most common. Patients with this condition experience “symmetric distal degeneration of peripheral nerves and impaired nerve regeneration,” according to the study authors. This affects both small and large muscle fibers, rippling out into several common symptoms that impair:

• intrinsic foot muscles
• tactile sensitivity
• vibration perception
• plantar skin integrity
• proprioceptive feedback

Together, these deficits may alter gait patterns and impair a patient’s sense of balance. Over time, DPN causes progressive dysfunction of fibers that transmit proprioceptive and vibratory signals from the lower limbs, the researchers noted. This produces a significant sensory deficit that results in impaired balance response, prolonged double support phases, and increased fall risk.

Traditional DPN Screening Methods

 Diagnosing and treating DPN has traditionally been a multi-step process. Clinicians obtain a detailed medical history and conduct two screening tests, one assessing small fibers and another for large fibers.

However, the study authors suggest that assessing postural sway may be another route for early screening and diagnosis of DPN. They define postural sway as “a kinematic parameter that quantifies the displacement of the body’s center of pressure (COP) or center of mass over time during static or dynamic stance, reflecting the body’s ability to maintain balance.”

Assessing Postural Sway in DPN

 Prior research suggests that patients with diabetes experience increased postural sway even with their eyes open. This is because DPN degrades sensory feedback over time, making it more difficult for them to adjust their posture and maintain balance. As a result, they have an increased risk for falling compared to those without DPN, according to the study team.

The peripheral nervous system also regulates a patient’s gait. Sensory deficits from DPN make this more difficult, resulting in cautious walking strategies, including “slower walking speed, reduced cadence, and increased variability in step length and velocity,” the researchers wrote.

Generally, clinicians can assess postural sway using force-plate technology or wearable sensors. These tools measure sway area, length, velocity, and excursion in both anteroposterior (AP) and mediolateral (ML) directions.

Community-Based Study 

 Researchers recruited study participants from an adult daycare center to evaluate whether balance and gait are predictive for DPN. They separated 146 participants into three groups: healthy participants, patients with diabetes and DPN, and patients with diabetes without DPN. Patients were confirmed to have diabetes either through medical history or a random blood glucose reading of over 200 mg/dL. Researchers also assessed patients’ Toronto Clinical Neuropathy Score (TCNS), confirming participants with a score of 5 or higher as having DPN.

Researchers measured large nerve fiber function, small muscle fiber function, and balance and gait.

Use of Postural Sway in Patients With DPN

 Out of 146 study participants, 35 patients had diabetes, 22 of whom also had DPN. The other 111 participants were part of the healthy control group. Study results were presented as mean ± standard deviation.

Healthy participants had the lowest TCNS scores (1.78±0.86), followed by participants with diabetes but no DPN (1.92±1.75), then participants with diabetes and DPN (8.95±2.48).  These differences were statistically significant, and these trends persisted across the various assessments the researchers administered, including postural sway. Patients with DPN had “increased postural sway velocity, and longer postural sway trace length,” the researchers noted.

“Postural sway velocity emerged as the most reliable surrogate marker for balance and gait impairment in participants with DPN,” they continued.

“Balance and gait impairments are commonly observed in participants with DPN, indicating their potential utility as screening measures,” the study authors wrote. “Among these, postural sway velocity may serve as a promising early surrogate biomarker for DPN detection. This study supports its utility in early detection and emphasizes the importance of addressing balance deficits to guide targeted fall prevention interventions.”