699-P: Assessment and Management of Falling in Type 2 Diabetic Patients with Diabetic Kidney Disease

Background: Older type 2 diabetic patients are at an increased risk of falling. On the other hand, the risk of sarcopenia increases in patients with chronic renal disease. In the present study, we reported about the risk of falling in type 2 diabetic patients with diabetic kidney disease (DKD).

Methods: Participants were 111 outpatients with type 2 diabetes at our hospital (66.1±8.8 years old). We measured one-leg standing (OLS) time with eyes open and analyzed the date according to renal function. Participants were defined as patients with a high risk of falling, if their OLS time was less than 20s. In order to examine the cause of short OLS time, we measured the ten times sit to stand test (TTSTS) and toe grip strength test (TGST). Furthermore, we measured hand grip strength, the timed up and go test (TUG), skeletal muscle mass (Inbody S10, Biospace, Tokyo, Japan), and evaluated diabetic peripheral neuropathy (DPN) by DPN Check (HDN-1000, Omron, Tokyo, Japan). At last, we planned original physical therapy for patients.

Result: A total of 101 cases (60 males; 51 females) were included in this study. The prevalence of patients with a high risk of falling was 60.0%. In patients without renal failure (eGFR ≥ 60 ml/min/1.73 m²), with mild renal failure (30 ≤ eGFR < 60), and with sever renal failure (eGFR < 30), the prevalence of patients with a high risk of falling was 48.1%, 67.9%, and 81.8 % respectively. Patients with a short OLS time tended to perform the TTSTS more slowly than patients with a normal OLS time. Short OLS time is also associated with TGST. Patients with DPN did badly on the TGST. Based on this result, we provided patients with a physical therapy program and diet therapy.

Conclusion: These findings showed that the OLS time was significantly shorter in type 2 diabetic patients, especially those with advanced DKD. Therefore, exercise therapy, diet therapy including a good quality protein intake and management of complication including diabetic DPN are important for type 2 diabetic patients with DKD.