Datian Chen
Hui Gong- 1Department of Geriatrics, Affiliated Haimen Hospital of Xinglin College, Nantong University, Nantong, Jiangsu, China
- 2Department of Neurosurgery, Affiliated Haimen Hospital of Xinglin College, Nantong University, Nantong, Jiangsu, China
A Commentary on
Sensorimotor dysfunction and postural instability in older adults with type 2 diabetes mellitus: the role of proprioception and neuropathy
by Kardm, S. M., Kardm, A. S., Alanazi, Z. A., Alnakhli, H. H., Alkhamis, B. A., and Reddy, R. S. (2025). Front. Aging Neurosci. 17:1615399. doi: 10.3389/fnagi.2025.1615399
Introduction
Falls remain a leading cause of morbidity and mortality among older adults, especially those with Type 2 diabetes mellitus (T2DM). With over 68% of diabetic adults over 65 experiencing at least one injurious fall annually (Sun et al., 2022), there is a pressing need to identify modifiable neuromechanical contributors. Kardm et al. (2025) have made a timely and clinically meaningful contribution by highlighting proprioceptive impairments and their mechanistic ties to diabetic peripheral neuropathy (DPN). Their work builds on prior studies, such as those by Grewal et al. (2015) and Alissa et al. (2024), which identified proprioceptive deficits as critical risk factors for falls in diabetic populations, emphasizing the need for targeted sensorimotor interventions.
Key findings and mechanistic insights
This study employed dual-digital inclinometry (DDI) and computerized dynamic posturography (CDP) to quantify proprioceptive dysfunction and postural sway. The authors demonstrated several key findings:
• Proprioceptive error and glycemic control: each 1% increase in HbA1c was associated with a 0.54° rise in proprioceptive error (p < 0.001), and a 1° increase predicted a 17.3% greater fall risk.
• Stratification by neuropathy: diabetics with TCSS scores ≥6 had 2.1 times higher sway velocity compared to non-neuropathic counterparts (d = 1.82). Mediation analysis showed that DPN accounted for 58% of HbA1c's effect on postural control (Sobel test p = 0.003).
• Diagnostic thresholds: a sway area >55 cm2 optimized fall prediction (Youden Index = 0.71), and a proprioceptive error ≥2.3° yielded 83% sensitivity for DPN diagnosis.
These findings are closely aligned with the American Diabetes Association's (ADA) recent call for sensorimotor screening as part of comprehensive diabetic management (American Diabetes Association Professional Practice C. 3., 2025).
Limitations and methodological considerations
While innovative, the study has several limitations:
• Temporal ambiguity: longitudinal data are needed to clarify whether proprioceptive dysfunction precedes or follows microvascular complications.
• Uncontrolled confounders: medication effects (e.g., GLP-1 agonists, statins) and comorbid vestibular dysfunction (prevalence: ~41% in elderly diabetics) were not adjusted for (Kumar et al., 2022).
• Measurement precision: binary DPN classification may obscure risk gradation across TCSS 3–5. Additionally, CDP's ecological validity remains moderate (r = 0.32 with real-world gait variability) (Bril and Perkins, 2002).
Future research and translational directions
Phase 1: research priorities (0–2 years)
The 0–2-year timeframe prioritizes feasibility, focusing on interventions that leverage existing technologies and can be rapidly tested in controlled settings to establish efficacy (Table 1).
Table 1. Phase 1 interventions for proprioceptive dysfunction in diabetic neuropathy.
Phase 2: clinical implementation (2–5 years)
The 2–5-year timeframe allows for validation and scaling of interventions, aligning with the timeline for developing clinical guidelines and infrastructure for widespread adoption.
• Digital screening tools: smartphone-based DDI tools should be validated (AUC target ≥0.85), with < 3-min protocols developed for primary care use (Brognara, 2024)
• EMR integration: automated alerts based on combined criteria (HbA1c >7.5%, TCSS ≥3, fall history) may help stratify fall risk. Risk tiers:
• Low: < 40 cm2,
• Moderate: 40–55 cm2 → Physical therapy referral,
• High: >55 cm2 → Multidisciplinary intervention.
Conclusion
Kardm et al. provide robust, clinically actionable thresholds for proprioceptive screening in older adults with T2DM. These insights support the inclusion of quantitative postural assessment in diabetes care, particularly for patients with long disease duration, high HbA1c variability, or early neuropathic signs. Establishing Current Procedural Terminology (CPT) codes for proprioceptive testing and revising ADA guidelines to include routine stability evaluations could enhance both outcomes and healthcare efficiency (Zakeri et al., 2023).
Author contributions
DC: Writing – review & editing, Writing – original draft. HG: Formal analysis, Data curation, Writing – review & editing, Writing – original draft.
Funding
The author(s) declare that no financial support was received for the research and/or publication of this article.
Acknowledgments
The authors would like to thank the participating members.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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References
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American Diabetes Association Professional Practice C. 3. (2025). Prevention or delay of diabetes and associated comorbidities: standards of care in diabetes-2025. Diabetes Care 48, S50–S58. doi: 10.2337/dc25-S003
Bril, V., and Perkins, B. A. (2002). Validation of the Toronto clinical scoring system for diabetic polyneuropathy. Diabetes Care 25, 2048–2052. doi: 10.2337/diacare.25.11.2048
Brognara, L. (2024). Gait assessment using smartphone applications in older adults: a scoping review. Geriatrics. 9:95. doi: 10.3390/geriatrics9040095
Grewal, G. S., Schwenk, M., Lee-Eng, J., Parvaneh, S., Bharara, M., Menzies, R. A., et al. (2015). Sensor-based interactive balance training with visual joint movement feedback for improving postural stability in diabetics with peripheral neuropathy: a randomized controlled trial. Gerontology. 61, 567–74. doi: 10.1159/000371846
Kardm, S. M., Kardm, A. S., Alanazi, Z. A., Alnakhli, H. H., Alkhamis, B. A., Reddy, R. S., et al. (2025). Sensorimotor dysfunction and postural instability in older adults with type 2 diabetes mellitus: the role of proprioception and neuropathy. Front. Aging Neurosci. 17:1615399. doi: 10.3389/fnagi.2025.1615399
Kumar, P., Singh, N. K., Apeksha, K., Ghosh, V., Kumar, R. R., Kumar Muthaiah, B., et al. (2022). Auditory and vestibular functioning in individuals with type-2 diabetes mellitus: a systematic review. Int. Arch. Otorhinolaryngol. 26, e281–e288. doi: 10.1055/s-0041-1726041
Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., et al. (2022). Diabetes atlas: global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res. Clin. Pract. 183:109119. doi: 10.1016/j.diabres.2021.109119
Keywords: diabetic peripheral neuropathy, proprioception, sensorimotor dysfunction, postural instability, type 2 diabetes, falls in older adults
Citation: Chen D and Gong H (2025) Commentary: Sensorimotor dysfunction and postural instability in older adults with type 2 diabetes mellitus: the role of proprioception and neuropathy. Front. Aging Neurosci. 17:1658306. doi: 10.3389/fnagi.2025.1658306
Received: 25 July 2025; Accepted: 28 August 2025;
Published: 11 September 2025.
Edited by:
Yu-Min Kuo, National Cheng Kung University, TaiwanReviewed by:
Runnan Grace Li, University of Kentucky, United StatesCopyright © 2025 Chen and Gong. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Hui Gong, Z29uZ2h1aTkyN0BnbWFpbC5jb20=