Background: Patients with diabetes, particularly those with peripheral neuropathy, are known to be at increased risk for falls. The objective of this study was to determine if the presence of a positive Slipping Slipper Sign (SSS) - a clinical marker of severe diabetic peripheral neuropathy could be associated with an increase tendency towards falls, recurrent falls and fractures.

Subjects and Methods: Using a case control design, among 78 subjects selected from our diabetic clinic there were 26 subjects with the SSS and 52 controls without the SSS. Questionnaires were administered to obtain data related to the frequency of falls, recurrent falls and fractures which occurred within a one year time period (May 2015 to May 2016), in addition to demographic and medically relevant data.

Results: Overall 33 subjects had experienced a fall giving an incidence of 42% for the entire cohort whereas all 26 (100%) subjects with the SSS had experienced a fall within the one year-period. Only 7 (13·5%) subjects had fallen in the group with a negative SSS, p<0·001. Furthermore, 17 (65·4%) subjects with the SSS were found to have experienced recurrent falls as compared to only 4 (7·7%) non-SSS subjects, p<0.001. Similarly, 10 (38·5%) SSS subjects but only 3 (5·8%) subjects without the SSS were found to have sustained fractures, p = 0·001. Most falls occurred during the act of walking. Multivariate analysis showed the significant predictors of the SSS were: duration of diabetes (p = 0·001), female sex (p = 0·026) and the use of oral hypoglycemic agents (p = 0·047). The relative risks of falls, recurrent falls and fractures were 7·43 (95% CI: 3·73 - 14·79), 8·50 (95% CI: 3·18 - 22·69) and 6·67 (95% CI: 2·005 - 22·16) times greater for subjects with the SSS compared to those without.

Conclusion: A positive SSS among subjects with T2DM predicted the risk of falls, recurrent falls and fractures and has potential as a screening tool to reduce morbidity and mortality from falls among those with diabetic peripheral neuropathy.


M.M. Ramdath: None. R.R. Nandlal: None. L. Boppana: None. S. Teelucksingh: None.

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