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Review of the Impact of Type 2 Diabetes Mellitus on Balance System Performance and Fear of Falling in the Elderly

Background and Aims Approximately 463 million people worldwide were diagnosed with diabetes in 2019, most of whom had type 2 diabetes. The prevalence of type 2 diabetes increases with age; on average, 27.8% of the elderly (≥65 years of age) have this disease. Since diabetes and its complications such as peripheral diabetic neuropathy and diabetic retinopathy can cause balance impairments and also falling is a relatively common problem in the elderly that often causes fear of falling and reduces the elderly’s quality of life; considering the effect of type 2 diabetes on the balance system performance, falling and fear of falling in the elderly who themselves are prone to fall, is very important that we will discuss in this review study. Methods Literature was searched for the studies investigating the impact of type 2 diabetes on balance disorders and fear of falling in the elderly in PubMed, Research Gate, Scopus, Science Direct, and Google Scholar databases from among the papers published between 1986-2020 using the keywords including “Type 2 diabetes Mellitus”, “Fear of Falling”, “Fall”, “Balance,” and “aging”. Results of 54 papers, 41 articles were selected based on inclusion criteria. Among those articles, 25 were explicitly related to the research subject and thus were further examined. The results reported in most studies indicated that the prevalence of fear of falling and balance disorders in the elderly with type 2 diabetes is significantly higher than in the elderly without diabetes. Conclusion Many factors associated with type 2 diabetes play a role in increasing the prevalence of balance disorders and fear of falling in the diabetic elderly, including peripheral diabetic neuropathy, diabetic retinopathy, obesity, hyperglycemia, and inactivity. Although many pieces of evidence and studies confirm the effect of type 2 diabetes mellitus on increasing balance disorders and fear of falling, the mechanism and extent of this effect are not yet fully understood. Therefore, further studies in this area are needed to determine how type 2 diabetes mellitus affects balance system performance and fear of falling not only in the elderly but also in younger adults.